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Heroin Addiction and Related Clinical Problems: 2018, 20, N2 (pages: 23 - 29)

Heroin Deaths in Norway in 2000 and 2009: A Comparative Study of Polydrug Use

Karinen R., Konstantinova-Larsen S., Normann P.T., Mørland J., Christophersen A.S., and Arnestad M.

Summary: Background: Norway has a high number of deaths following heroin use, often involving the use of additional drugs. In 2000, most of the overdose deaths reported with heroin present turned out to be cases of polydrug use. Aims: In this study we have looked for changes in the polydrug use pattern among the deceased in 2000 and 2009, a period during which heroin-related deaths declined markedly. Methods: Blood samples from autopsy cases were analysed for the possible presence of heroin metabolites: 6-monoacethylmorphine (6-MAM) and morphine; as well as codeine, amphetamines, cocaine and cannabis (THC), methadone, benzodiazepines, a selection of antidepressants, antipsychotics and miscellaneous drugs, and ethanol. 6-MAM was analysed separately in urine samples. Results: Cases with detection of heroin declined from 264 (15%) to 125 (9%) out of 1,794 and 1,435 forensic autopsy cases analysed in our laboratory in 2000 and 2009, respectively. A large number of these cases were also positive for alcohol, illicit drugs or medicinal drugs. The number of additional drug findings rose from 2000 to 2009, and a change in drug use pattern was seen. In comparing all the results for 2000 and 2009, findings of CNS stimulants, cannabis, benzodiazepines, and methadone became more common, whereas findings of ethanol fell, and the prevalence of additional drug findings rose in general. Similar changes in drug use patterns were found in the two gender groups. Conclusions: The results demonstrated that the significant reduction of heroin-related deaths in Norway between 2000 and 2009 was accompanied by a sharp increase in the number of other drugs discovered in those who had died.