Walter J. Schulz-Schaeffer

Drug abuse emergencies in Hamburg 1990/91

During a 30-month investigation of the prevalence and structure of drug emergencies in Hamburg, data from all ambulances were analysed. From January 1991 to June 1992 there were 1565 drug-related emergency patients suffering a life-threatening event in Hamburg (1097 male, 350 female, 118 without information concerning the sex) to whom medical care was given by an emergency team. The number of cases grew strongly from 538 in 1990 to 720 in 1991. The place where the patients were found was very often in the region around the main railway station and near to the Reeperbahn, but we could also observe a scene south of the river Elbe.

Comparison of drug abuse fatalities and emergencies

During a 9-month period, drug abuse emergencies were investigated prospectively and compared with drug-related fatalities of the same period. The emergency patients were of younger age, the proportion of women and the prevalence of infections with HIV, HBV and HCV was higher than in drug-related deaths. Additional alcohol consumption was similar in both groups but more frequent in drug-addict emergencies where the patients were 20-30 years of age. It is suggested that the emergency patients might characterise a special risk group of drug addicts and might be a target for interventional help to prevent fatalities.

Undetected drug addict fatalities.

A urine screening in fatalities with an unnatural or unknown cause of death (13-40 years of age) was carried out to evaluate the proportion of undetected drug-related cases. Ten out of 160 fatalities without a hint of drug consumption were classified as drug-related according to the definition of the Bundeskriminalamt; 5 of them committed suicide. Moreover, we found a relevant amount of AIDS deaths from the risk group of intravenous drug addicts not registered as drug-related deaths.

Typology of drug abuse deaths in Hamburg.

Based on a multidisciplinary approach (social-scientific questionnaire and forensic-pathological investigations), a typology of the drug-related fatalities in Hamburg during the period from July 1991 to June 1992 was achieved. A distinction between 3 types of addicts is proposed. Each group represents a different consumption pattern: (1) the opioid type, (2) polyvalent-drug users, and (3) primary alcoholics. With respect to these 3 types of abuse, some medical (concentration of alcohol and opioids in the blood) and social-scientific data (age at the beginning of the drug career, consumption of different drugs, distribution of age and sex, the quality and frequency of contact to facilities of the drug aid in Hamburg) are discussed.

Harm Reduction: Aspects of Prevention and Handling of Drug Addict Emergencies

This paper reviews potentially harmful aspects of illicit drug addiction, points out ways in which these may be prevented or ameliorated and suggests consequences for the medical care system. In most cases, emergency situations are accidental and unexpected by the patients and result from injecting heroin too quickly, from underestimation of additional consumption or from changes of the intraindividual tolerance after absolute or relative drug abstinence. The authors suggest to use the emergency situation for interventional care, achieving a change in the behavior of patients either for harm reduction or for therapy aspects.