Karen Worm

Citalopram concentrations in samples from autopsies and living persons.

Abstract Concentrations of citalopram in medicolegal samples from 92 autopsies and 27 living persons are described. In autopsy cases in which citalopram alone was the cause of death, concentrations ranged from 2.0 to 6.2 mg/kg whole blood. In autopsy cases in which citalopram together with other substances was considered to be the cause of death, the concentrations of citalopram ranged from 0.6 to 5.2 mg/kg whole blood. In autopsy cases toxic concentrations ranged from 0.4 to 0.9 mg/kg whole blood and therapeutic concentrations from 0.03 to 0.6 mg/kg whole blood. In samples from living persons the concentrations of citalopram in whole blood were 0.02 to 0.3 mg/kg.

Methadone and drug addicts

SummaryDrug addicts who had died in Copenhagen City and County in 1981 and 1989 were analysed for methadone. In 1981, 94 cases were analysed of which 16% were found positive for methadone, and in 1989, 70 cases were analysed of which 37% were positive. Methadone alone was found to be the cause of death in 50% more cases in 1989 than in 1981. Only half of the drug addicts who were found positive for methadone had been under methadone treatment. Morphine and benzodiazepines were the most frequently occurring other substances in both 1981 and 1989. Alcohol was found in only about 30% of the methadone-positive cases. The median whole blood concentrations of methadone found in addicts where methadone was the cause of death was 0.3 mg/kg where no alcohol was present and 0.2 mg/kg where alcohol was present. In living persons using methadone, the median was 0.1 mg methadone/kg whole blood with or without alcohol present.ZusammenfassungEs wurden Drogenabhängige, die im Bereich der Stadt und des Kreises Kopenhagen in den Jahren 1981 and 1989 verstarben, hinsichtlich einer Methadoneinnahme untersucht. 1981 wurden 94 derartige Fälle untersucht, von denen 16% einen positiven Methadonbefund erbrachten. 1989 wurden 70 Fälle untersucht, von denen 37 positiv waren. Eine Methadonintoxikation als alleinige Todesursache wurde 1989 50% häufiger diagnostiziert als 1981. Nur die Hälfte der Drogenabhängigen, die Methadonpositiv waren, befanden sich in einer therapeutischen Methadonbehandlung. Morphin und Benzodiazepine waren sowohl 1981 als auch 1989 die am häufigsten nachzuweisenden weiteren Substanzen. Alkohol konnte nur in 30% der Methadon-positiven Fälle detektiert werden. Der Median der Vollblutkonzentration von Methadon betrug in jenen Fällen, in denen eine Methadonintoxikation die Todesursache war und keine zusätzliche Alkoholbeeinflußung vorlag, 0,3 mg/kg, hingegen bei einer zusätzlichen Alkoholbeeinflußung nur 0,2 mg/kg. Bei lebenden Personen, welche Methadon einnahmen, betrug der Median jeweils 0,1 mg Methadon/kg Vollblut unabhängig von der Alkoholbeeinflussung.

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.

DRUGS IN BLOOD SAMPLES FROM UNCONSCIOUS DRUG ADDICTS AFTER THE INTAKE OF AN OVERDOSE

This investigation includes whole blood samples from 53 drug addicts found unconscious in the Copenhagen area with evidence of a heroin overdose. Heroin/morphine was detected in 85% of the patients and other opioids in 11%. One or more benzodiazepines, most often diazepam, were detected in 75% of the patients. A blood alcohol concentration higher than 1.00 mg/g was detected in 57% of the patients. Methadone was detected in seven patients, ketobemidone in four, amphetamine in five and cocaine in one. This investigation showed widespread multi-drug abuse and heroin/morphine alone was detected in only one patient. As indicators of heroin intake, 6-monoacetylmorphine (MAM) and morphine were detected in this investigation.

Morphine concentrations in autopsy material from fatal cases after intake of morphine and/or heroin

Abstract This paper presents 245 fatal cases due to morphine and/or heroin over an 8-year period from East Denmark. All but 13 of the cases were from narcotics addicts. In 40% of the cases, only morphine was detected; in 32%, morphine and ethanol; in 19%, morphine and other drugs; and in 9%, morphine, ethanol and other drugs. Morphine concentrations in blood and liver for these four groups, and the age and sex distribution are shown. Morphine levels in blood and liver were also compared for: cases with a short survival time after the injection of morphine and/or heroin; cases from non-addicts; and cases where the drug used was obviously not the cause of death. The blood values in these groups were compared with blood concentrations found in living persons. Concentrations of morphine in stomach contents after intravenous injection of morphine and/or heroin are shown to be of the same level as in blood and liver. Ten fatal morphine cases are presented in which no morphine was detected in the urine after hydrolysis of the urine.

Muscle as an Autopsy Material for Evaluation of Fatal Cases of Drug Overdose

Abstract Striated muscle constitutes a large portion of the body weight and is nearly always available even in burned, putrefied, mummified or exhumed bodies. Drug concentrations have been estimated in extremity muscle, blood and liver in 142 fatal cases where drug overdose was implicated. The results suggest that muscle should be included as a standard autopsy material in examinations for drug poisoning.

Clozapine cases with fatal, toxic or therapeutic concentrations

SummaryThe neuroleptic drug clozapine is used in the treatment of schizophrenia and is characterized by not having the extrapyrimidal side-effects usually shown by neuroleptics. Unfortunately clozapine has other side-effects, which limit its use. This study presents methods for the analysis of clozapine and desmethylclozapine in whole blood and tissue. Case histories and pathology findings are described for 3 autopsy cases with fatal concentrations of clozapine, 5 with toxic concentrations and 2 with therapeutic concentrations together with the concentrations found in a living person.ZusammenfassungDas Neuroleptikum Clozapin, welches für die Behandlung der Schizophrenie benutzt wird, ist dadurch charakterisiert, daß es nicht die extrapyrimidal-motorischen Nebenwirkungen hat, welche Neuroleptika gewöhnlich aufweisen. Die Anwendung von Clozapin ist hingegen durch andere Nebenwirkungen stark begrenzt. Die vorliegende Untersuchung stellt Methoden zur Analyse von Clozapin und seinem Metaboliten Desmethylclozapin in Vollblut und Gewebe vor. Vorgeschichte und pathologische Befunde bei 3 Autopsiefällen mit tödlichen Konzentrationen von Clozapin sowie Ergebnisse von 5 Fällen mit toxischen Konzentrationen und 2 Fällen mit therapeutischen Konzentrationen werden zusammen mit den Medikamentspiegeln bei einer lebenden Person vorgestellt.

Cases of fatal triazolam poisoning

Benzodiazepines have been regarded as relatively safe drugs but since triazolam was introduced into Denmark in 1978, six fatal cases of poisoning by triazolam alone or in combination with ethanol, have occurred in East Denmark. In one case where no ethanol was detected, a blood triazolam concentration of 0.11 mg/l was found. In another case in which blood was unavailable because of putrefaction, muscle was analyzed. In the four cases in which the ethanol concentration was in the range 110-202 mg/100 ml, the triazolam concentration range was 0.04-0.22 mg/l. Blood concentrations from these five cases were compared to those from living persons who had also ingested the drug, and these were in the range 0.002-0.03 mg/l (n = 28), with an average concentration of 0.01 mg/l.

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.

Diazepam in Blood of Danish Drivers: Occurrence as shown by Gas–Liquid Chromatographic Assay following Radioreceptor Screening

Abstract A rapid radioreceptor screening technique for benzodiazepines was found to correlate well with results from a specific, quantitative GLC technique. Analysis of a sample of the 26000 bloods taken from Danish drivers for ethanol determination in one year (1978–79) showed that 5.5% out of 1382 contained diazepam or desmethyldiazepam. In only 15% of these positive cases had a request for benzodiazepine analysis been made by the police.