Deaths caused by medication in persons not using illicit narcotic drugs: An autopsy study from Western Denmark

Abstract

Information regarding deaths caused by poisoning or adverse effects of medication in Danish persons not using illicit narcotic drugs (PNUIDs) is sparse. To characterize aetiology, demographics, and death scene, we reviewed all legal autopsies performed at Aarhus University from 2017 to 2019 and isolated 96 deaths caused by medications in PNUIDs. Suicides caused by medication overdose accounted for 38%. Opioids and psychotropic medications were the main cause of death in 48% and 35% of the 96 cases, respectively. Morphine, tramadol, and quetiapine were the most commonly involved individual medications. A single medication caused death in 50% of cases, and multiple substances were involved in 50%. The median total number [interquartile range] of detected medications was 5 [4-6], with a higher number in females (5 [4-7]) than males (4 [2-5]), p = 0.009. Median age was 51 [42.5-61.5] years, and 57% were female. Scene of death most frequently involved a body on a bed or couch in the decedent's own home (72%). In conclusion, opioids and psychotropic medications dominated by morphine, tramadol and quetiapine most frequently caused medication-related deaths in PNUIDs. Monitoring this type of death may yield important knowledge to direct prophylactic initiatives regarding medication use and prescription.

Keywords: clinical toxicology; forensic toxicology; medication; opioids; psychiatry; psychopharmacology.

FIGURE 1

Flowchart showing identification of cases with medication‐related deaths among persons not using illicit narcotic drugs, and sub‐grouping of cases according to manner of death and the number of involved medications. Abbreviations: miQTP, medication induced QT prolongation

FIGURE 2

Aetiology. (A) Number of deaths mainly caused by opioids, psychotropic and other medications in suicides and non‐suicides in males and females, respectively. (B) Number of cases in which different groups of medication was considered to cause death in suicides and non‐suicide deaths according to single or multiple contributing medications, respectively. Groups with ≤3 cases are omitted. (C) Number of cases in which the depicted medication was considered to cause death. Only substances considered to cause death in more than five cases are shown. More than one medication could cause death in one case.

FIGURE 3

Location of body at death scene. Proportion of fatal opioid and psychotropic medication‐induced poisonings, respectively, found on a bed or couch, on the floor, or found or died under other circumstances, respectively. A significant higher proportion of cases with fatal poisoning with psychotropic medication was found on the floor compared with cases dying from opioid poisoning (p = 0.02).