Herbert Käferstein

Methadone and its role in drug-related fatalities in Cologne 1989–2000

All drug-associated deaths from 1989 to 2000 were analysed at the Institute of Forensic Medicine in Cologne. Information concerning sex, gender, drug consumption, time, place and circumstances of death were analysed. A number of 605 cases were recorded; in 518 cases a toxicological analysis was possible and in 171 an autopsy was performed. When it was possible to determine the cause of death form the information available, acute drug intoxication was recorded in 65%. Heroin head the list of identified substances. Sixty-three percent of the specimens showed a combination of several substances, especially a combination of morphine, benzodiazepines, other medications and alcohol. In comparison with other studies the percentage of methadone-positive specimens is low, even though the proportion of specimens positive for methadone increased from 1989 to 2000. This analysis is discussed using background information concerning the management of substitution therapy and the available literature.

Combination of fatal digoxin poisoning with endocardial fibroelastosis

This is the first report in the forensic literature of a combination of fatal digoxin poisoning with endocardial fibroelastosis (EFE). Typical morphological features of EFE as the cause of clinically diagnosed cardiomyopathy were present in the autopsy of a 3-year-old girl, including cardiac hypertrophy and marked thickening of the left-sided endocardium, consisting of numerous elastic and collagenic fibres. After exclusion of cardiac and cerebral causes of death, accidental digoxin intoxication was proved. Postmortem toxicological analyses by fluorescence polarization immunoassay (FPIA) disclosed digoxin levels of 71 micrograms/kg (femoral vein blood), 77 micrograms/kg (cardiac blood), 255 and 221 micrograms/kg (cardiac muscle of the right and left chamber), 163 micrograms/kg (psoas muscle), 91 micrograms/kg (lung), 222 micrograms/kg (liver) and 520 micrograms/kg (kidney). The results are compared with the antemortem digoxin concentration of 39 ng/ml serum. The case is discussed from its unusual morphological and toxicological aspects, with special consideration of possible medical malpractice.

Konsum von Amphetamin, Methylendioxyamphetaminen und Beigebrauch anderer Drogen (Köln 1991–1996)

Abstract The amount of analyses positive for amphetamine or amphetamine derivatives carried out in Köln showed an increase in the years 1991–1996. Among the users there were more male than female individuals and the age was about 25 years. In addition to an increase in the total amount of these drugs, the additional consumption of other drugs also increases (> 90%) of predominantly cannabinoids and cannabinoids combined with alcohol or cocaine were detected in the samples. Since 1994 the total amount of samples positive for methylenedioxyamphetamines has shown a clear increase. A comparison of the drugs additionally used by consumers of amphetamine or methylenedioxyamphetamines showed – in addition of the abuse of opioides or medicaments such as benzodiazepines – no significant differences.Zusammenfassung Die Anzahl der chemisch-toxikologischen Analysen mit positivem Nachweis von Amphetaminderivaten und/oder Amphetamin im Kölner Untersuchungsgut der Jahre 1991–1996 zeigt eine deutliche Zunahme. Das Verhältnis von Männern zu Frauen weist eine Überrepräsentanz des männlichen Geschlechts auf, das Alter der untersuchten Personen ist mit um 25 Jahren im Vergleich zu anderen Drogenkonsumenten ohne Auffälligkeiten. Der Anteil von zusätzlich konsumierten Drogen stieg in den letzten Jahren auf über 90%, wobei die Kombinationen mit Cannabis, Cannabis und Alkohol sowie Cannabis und Kokain überwiegen. Der Anteil an Methylendioxyamphetaminderivaten steigt deutlich ab 1994. Die Amphetaminderivatkonsumenten wiesen – mit Ausnahme des Opiat- und Medikamentenkosums – kein wesentlich abweichendes Beikonsumverhalten im Vergleich zum reinen Amphetaminkonsum auf. Eine Verknüpfung der „harten Drogenszene“ mit der „Amphetaminszene“ im Sinne eines zunehmenden Amphetaminkonsums als Ersatzstoff anderer Drogen kann aus den Auswertungen nicht abgeleitet werden. Der Anteil an Opiaten ist im Vergleich zu Cannabis und Alkohol von geringer Bedeutung, der Anteil an Kokain als zusätzlich konsumiertem Suchtstoff war in den letzten Jahren schwankend.