New issues regarding drug-related deaths: combined suicide

Background

Drug-related deaths in Slovenia have been monitored in accordance to EMCDDA recommendations since 2003. Data about direct drug-related deaths are obtained from the General Mortality Register

Although prevalence of opioid deaths, especially heroin, prevailed during this period, new trends have been observed in recent years. In Slovenia, cocaine deaths have been raising steadily since 2016, there are many deaths with a combination of various illicit drugs and medicinal drugs. In the last two years we have also seen more and more combined suicides; with combination of illicit drugs taken in toxic or lethal concentrations and an external cause of death that is not poisoning. The purpose of this paper is to present some examples of combined suicides.

Methods

In the case study we studied 4 cases of combined suicides in 2018, with combination of illicit drugs taken and an external cause of death that is not poisoning. Those deaths occurred among drug users shortly after the consumption of the substances, when drug(s) had reached toxic or lethal concentrations in their body in combination with external cause of death that is not poisoning.

We examined forensic reports and toxicology analyses, involvement in treatment of drug addiction and hospital treatments.

Results

We will present 4 case reports of combined suicides, according to basic demographic characteristics, illicit drugs profile, external cause of death, history of treatment of drug addiction and hospital treatments.

Conclusions

Drug-related deaths are becoming increasingly complex and require consideration about the extension of the methodology to determine the cause of death. For example, cases of combined suicides pose a question or dilemma of the primary cause of death. Similar issues are to discuss regarding drug-related deaths due to a combination of different drugs, as majority of direct deaths are caused by poly-drug use but due to ICD-10 instructions can not be coded as poly-drug deaths.