Elisabet Kaa

Impurities, adulterants and diluents of illicit heroin. Changes during a 12-year period

Changes in the content of impurities, adulterants and diluents are described for 383 samples of illicit heroin seized in the western part of Denmark during the 12-year period 1981 through 1992. A wide range in purity was found within each year, whereas the average purity did not vary much from one year to another. The average purity of wholesale samples (45%) was only slightly higher than the purity of retail samples (36%). The SW Asian type of heroin, containing high concentrations of noscapine, predominated from the mid-eighties. Heroin base and heroin hydrochloride each accounted for approximately half of the samples during the eighties. However, in recent years the base form has become predominant. During the early eighties caffeine and procaine were the most frequent additives next to sugars. During the middle and late eighties an increasing number of heroin samples were cut with phenobarbital and methaqualone. During the early nineties the occurrence of phenobarbital and methaqualone has decreased, whereas paracetamol in combination with caffeine has become predominant. Re-analyses of samples which had been kept in storage for several years showed that most samples had not changed after being stored in the dark for a couple of years at room temperature. However, storage for more than 5 years often resulted in decomposition, particularly in samples consisting of the SW Asian type of heroin.

Deaths among drug addicts in Denmark in 1987-1991.

In the period 1987-1991 a total of 739 fatalities among drug addicts was investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 130-140 in the first 4 years to 192 in 1991, and 80% were males. The mean and median age for both males and females increased by 1 year in the period. The main drug of abuse was heroin, in most cases supplemented by various other drugs, and in almost all cases taken intravenously. In about one-third of the cases each year there was information of abuse of alcohol in addition. In the poisoning cases, the main drug of poisoning was morphine/heroin, constituting 35-55% of the cases each year. As regards methadone-poisoning cases, the number increased significantly in 1991 compared to the first 4 years. Furthermore, the number and proportion of addicts dying while in methadone treatment increased during the 5-year period. In about half of the methadone poisoning cases, there was information of methadone treatment at the time of death. The other half obviously obtained the methadone completely illegally. Ketobemidone was the third most frequent drug of poisoning, while propoxyphene and barbituric acid only were found in a very few cases each. The results are compared to those from an earlier investigation concerning drug deaths in Denmark in 1968-1986. The importance of registering drug deaths is emphasized.

Narcotics at street level in Denmark a prospective investigation from 1995 to 2000

This article describes an investigation of illicit drugs at street level in six selected police districts in different regions of Denmark. The investigation was carried out during a 6-year period from 1995 to 2000. During the period, a total of 1244 samples were examined, as about 200 samples were seized each year. A total of 94% of the seized samples were familiar drugs: heroin base, heroin hydrochloride, cocaine hydrochloride and amphetamine sulphate. Only 2% of the samples contained designer drugs. From having constituted 53% of the samples in 1995, the frequency of heroin base fell during the period to 27% of the samples in 2000. The frequency of heroin hydrochloride was unchanged. In the same period, the frequency of cocaine hydrochloride increased from 10% of the samples in 1995 to about 25% of the samples in 2000. Apart from a few exceptions, cocaine had the same extension in all regions of Denmark after 1996. Amphetamine was more frequent in the west of Denmark, while heroin hydrochloride was more frequent in central Denmark. The purity of heroin base was lower in the period 1997-1999 than in the other years. During the entire period, the purity of cocaine hydrochloride and amphetamine sulphate fell, while the purity of heroin hydrochloride was unchanged. No significant differences between the various regions of Denmark were detected during the period in the purity of heroin hydrochloride, heroin base, cocaine hydrochloride or amphetamine sulphate. MDMA was the most frequent designer drug, but other types of designer drugs such as MDA and MDE and the less common PMA, PMMA and MBDB were also found.

Drug-related deaths during the 1980s. A comparative study of drug addict deaths examined at the institutes of forensic medicine in Aarhus, Denmark and Oslo, Norway

SummaryCases of fatal poisoning among drug addicts examined at the institutes of forensic medicine in Aarhus, Denmark (n = 238) and Oslo, Norway (n = 263) are compared and discussed on the basis of the availability of illicit and medical drugs during the 1980s. The annual number of deaths among drug addicts in age groups over 30 years increased, but there was no increase in the number of deaths among younger drug addicts in either country. More than 80% of the drug addicts in both samples were men. Heroin-/morphine-related deaths comprised three-quarters of the Norwegian material compared with one-third of the Danish material. The registered medical drugs propoxyphene, methadone and ketobemidone accounted for half of the Danish cases but only a small number of the Norwegian cases. Amphetamine caused few deaths in either country. Alcohol and benzodiazepines were present in more than one-third of the cases in both countries, indicating frequent use of these substances.ZusammenfassungTödliche Vergiftungen Drogenabhängiger, untersucht in den Instituten für Forensische Medizin in Aarhus, Dänemark (n = 238) und Oslo, Norwegen (n = 263) werden verglichen und vor dem Hintergrund der Verfügbarkeit illegaler Drogen und mißbräuchlich verwendeter Arzneistoffe während der 80er Jahre diskutiert. Die jährliche Zahl von Todesfällen unter jungen Drogenabhängigen in den Altersklassen über 30 Jahren nahm zu, aber es gab in keinem der beiden Länder eine Zunahme der Zahl der Todesfälle unter jungen Drogenabhängigen. Mehr als 80% der Drogenabhängigen in beiden Kollektiven waren Männer. Heroin- und morphinbezogene Todesfälle machen Dreiviertel des norwegischen Materials aus, verglichen mit einem Drittel des dänischen Materials. Die dort rezeptpflichtigen Medikamente Dextropropoxyphen, Methadon und Ketobemidon standen für die Hälfte der dänischen Fälle, aber nur für eine kleine Zahl der norwegischen Fälle. Amphetamin verursachte wenige Todesfälle in jedem der beiden Länder. Alkohol und Benzodiazepine waren in mehr als einem Drittel der Fälle in beiden Ländern vorhanden. Dies weist auf einen häufigen Gebrauch dieser Substanzen hin.

Street Drugs in Denmark

Street samples of heroin (n = 102) and amphetamine (n = 120) seized in different areas of Denmark during a one-year period were analyzed for purity and additive content. The mean concentrations of the heroin and the amphetamine samples were 34 and 35%, respectively, but the purity of both drugs varied greatly. Sugars and caffeine were the most frequently encountered cutting agents in both drugs. The additives phenobarbital, methaqualone, and procaine were seen only in heroin, especially in heroin base. Half of the heroin samples were heroin base, the other half heroin chloride. Brownish samples of heroin base containing large amounts of opium alkaloids dominated in the seizures in the provincial towns, whereas white/beige samples containing heroin chloride with little or no papaverine or noscapine were frequently seen among the seizures in the capital. The result may indicate different import routes for heroin to the eastern and western parts of Denmark.

Fatal intoxications in Denmark following intake of morphine from opium poppies

SummaryIn Denmark it is legal to grow opium poppies for the production of poppy seeds and until 1986 for decoration purposes, too. Danish poppy capsules contain 0.3–5 mg morphine per capsule and the content of morphine in opium exuded from the capsules may amount to 24%. This has resulted in misuse as both fresh and dried poppy capsules have been used for the production of “opium tea”. During the period 1982–1985, seven casualties occurred among drug addicts in Denmark which were solely or partly caused by these opium poppies.ZusammenfassungDer Anbau von Mohn zur Produktion von Mohnsamen (für Brötchen) ist in Dänemark erlaubt; bis 1986 war er auch zu dekorativen Zwecken zugelassen. Dänische Mohnkapseln enthalten 0,3–5 mg Morphin per Kapsel. Der Inhalt von Morphin im Opium, das aus den Kapseln gewonne wird, kann bis zu 24% ausmachen. Dieses hat zum Mißbrauch von sowohl frischen als auch getrockneten Mohnkapseln zur Produktion von „Opiumtee“ geführt. In der Zeit von 1982–1985 erfolgten sieben Todesfälle von Drogensüchtigen in Dänemark, verursacht ausschließlich oder teilweise durch diese Mohnkapseln.

Fatal poisonings in Jutland (Denmark) during the 1980s

SummaryDuring the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.ZusammenfassungWährend des Zeitraums 1980 bis 1989 wurden insgesamt 1029 Fälle tödlicher Vergiftungen (638 Männer und 391 Frauen) in der Abteilung für Forensische Medizin der Universität Aarhus, Dänemark, untersucht. In 68% der Fälle war der Tod durch Medikamente verursacht, während Alkoholvergiftung und Kohlenmonoxid für 15% bzw. 14% der Fälle standen. Alkohol wurde in mehr als der Hälfte aller 1029 tödlichen Vergiftungsfällen gefunden und in 42% aller Fälle war die Blutalkoholkonzentration höher als 0.8 g/kg. In 57% der Fälle war der Tod als Unfalltod kategorisiert, in nur 31% der Fälle als Suizid. Unfalltodesfälle waren besonders herausragend bei Personen mit Drogen und/oder Alkoholmißbrauch. Propoxyphen war die Droge, welche die meisten tödlichen Vergiftungen während des Jahrzehnts verursacht hatte (30% der medikamentenbezogenen Todesfälle). Die meisten der Propoxyphen-bezogenen Todesfälle ereigneten sich in den frühen und mittleren 80er Jahren. Barbiturat-Vergiftungen waren ziemlich häufig während der ersten Hälfte der 80er Jahre. Jedoch nahm die Zahl der Todesfälle durch Barbiturate signifikant nach 1986 ab, als die meisten Barbiturate vom Markt genommen wurden. Die Zahl der Todesfälle durch Narkotika und Analgetika nahm während des Übersichtszeitraums zu, während mit Antidepressive keine spezifische Tendenz beobachtet wurde.

Fatal dextropropoxyphene poisonings in Jutland, Denmark.

SummaryFor many years dextropropoxyphene (dxp) has been the medicament most frequently occurring in drug poisoning cases examined at the Institute of Forensic Medicine, University of Aarhus.This study includes 85 cases of acute fatal poisoning examined in the period 1985–1987 in which dxp alone (40 cases) or in combination with alcohol (29 cases) and/or other drugs (16 cases) contributed significantly to death. Two-thirds of the deceased were men and one-third women. The average age was 37 years for both sexes. More than half of the deceased were drug and/or alcohol misusers. Eighteen were drug addicts. Half of the deaths resulted from accidents, while 40% were suicides. Accidental deaths prevailed among younger men. In a majority of the cases the drug had been taken orally. In these cases the median total blood concentration of dxp and the metabolite nordextropropoxyphene (ndxp) was 17 mg/kg in the suicide cases and 7.1 mg/kg in the accident cases. The corresponding figures for dxp without metabolite were 9.4 mg/kg and 2.2 mg/kg, respectively. The median value of the quotient dxp/ndxp was 1.9 in the suicide cases and 0.5 in the accident cases. The quotient, together with the concentrations of the drug, may therefore indicate the manner of death in many cases.ZusammenfassungFür viele Jahre war Dextropropoxyphen (dxp) im Institut für Rechtsmedizin der Stadt Aarhus das am häufigsten vorkommende Arzneimittel bei Arzneistoffintoxikationen. In der vorliegenden Studie werden 85 tödliche Intoxikationen der Jahre 1985–1987 ausgewertet, in denen dxp allein (40 Fälle) oder in Kombination mit Alkohol (29 Fälle) und/oder anderen Arzneistoffen ursächlich war. Zwei Drittel der Fälle betraf Männer, ein Drittel Frauen. Das Durchschnittsalter lag für beide Geschlechter bei 37 Jahren. Über die Hälfte betrieben Alkohol- und/oder Arzneimittelabusus. Achtzehnmal lag eine Abhängigkeit vor. Bei 40% handelte es sich um einen Suizid, bei 50% um eine akzidentelle Intoxikation, überwiegend bei jungen Menschen. Bei peroraler Einnahme lag der Medianwert der Blutkonzentration von dxp und nordxp (ndxp) bei 17 mg/kg (Suizid) oder 7,1 mg/kg bei akzidenteller Vergiftung. Entsprechend betrugen die Konzentrationen an dxp allein bei 9,4 bzw. 2,2 mg/kg und die Quotienten dxp/ndxp betrugen 1,9 bzw. 0,5. In Verbindung mit der Gesamtkonzentration kann der Quotient in vielen Fällen Aufschluß über die Art und Weise des Todes geben.

A comparison of drug-related deaths in Oslo, Norway and Aarhus, Denmark

Abstract A comparative survey was carried out of cases of acute fatal poisoning examined at the Institutes of Forensic Medicine in Oslo, Norway and in Aarhus, Denmark from 1981 to 1985. In both populations, two-thirds of the deaths were caused by drugs, and ethanol was detected in approximately half of these cases. Antidepressive and neuroleptic drugs predominated in the cases from Oslo, while poisoning with dextropropoxyphene was the most common cause of death in the cases from Aarhus. Barbiturates overdose was seen more frequently in cases investigated in Aarhus than in Oslo, but in both countries intoxication with these drugs declined during the period surveyed. The number of cases in which the deceased had been a drug addict was similar in the two countries. The cause of death among Norwegian addicts was mainly heroin/morphine, while most of the Danish drug addicts died from an overdose of a legally approved drug.

Drug abuse in Western Denmark during the eighties. II. Fatl poisonings among drug abusers

Cases of fatal poisoning among drug addicts (n = 246) and abusers of medical drugs (n = 138) are discussed on the basis of the availability of illicit and medical drugs during the eighties. Propoxyphene was frequently the cause of death among both drug addicts and abusers of medical drugs. Deaths caused by analgesics and psychoactive drugs, mainly barbiturates and antidepressants, predominated among abusers of medical drugs. During the late eighties the number of deaths caused by barbiturates and propoxyphene declined as a result of changes in the distribution regulations for both drugs. Heroin/morphine accounted for only one-third of the poisonings in drug addicts. No trends concerning the prevalence of deaths caused by these drugs were observed throughout the decade. The number of deaths caused by the synthetic opiates methadone and ketobemidone, however, increased during the late eighties, probably due to an increased availability of these drugs in the illicit drug market. Alcohol was detected in half of all the poisoning cases and benzodiazepines in one-third.