Analysis of cases of fatal poisoning by narcotic and psychotropic substances in Ukraine based on the results of the epidemic, clinical, forensic, and laboratory research (2015–2019)
Keywords:acute poisoning, drugs, psychotropic substances, mortality
Background. Today in Ukraine, acute poisoning by narcotic drugs and psychotropic substances is an extremely urgent medical and social problem, which is far out of being solved, that’s why there is a need for in-depth study of the causes of deaths from poisoning to prevent them. The purpose of this study is to analyze the cases of fatal poisonings by narcotic and psychotropic substances with the involvement of epidemic, clinical, forensic, and laboratory research methods, aimed at finding measures to improve the health care system for acute domestic poisoning. Materials and methods. There were studied the medical data of patients treated with the diagnosis: “Acute drug poisoning” (ICD-10: T40.0–T40.3) in the Kyiv Toxicological Center, the statistical data of the State Statistics Service of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine, the data from reports of the Bureau of Forensic Medical Examinations. The laboratory studies of narcotic and psychotropic substances in the biological environment were performed using immunochromatographic analysis and chromatography-mass spectrometry (device — Aligent 6850/5973N, column — HP-5MS). The statistical analysis was performed using the program Statistica 12.6 (Windows 10/7): the reliability of the difference in indicators in the study groups was assessed using Student’s t-test with a significance level of p < 0.05. Results. In the last 5 years, the most common narcotic and psychotropic substances are synthetic and semi-synthetic opioids, psychostimulants, smoking mixtures, sedatives, or hypnotics. At the same time, the number of poiso-nings associated with the combined use of drugs and psychotropic substances, pharmaceuticals, and ethanol is increasing. During the period 2015–2019, more than 40 groups of substances that led to acute poisoning were found in the laboratory of the Kyiv Toxicological Center. The number of positive tests increased 2.3 times during the study period. The leaders in the structure of opioid drugs are methadone, heroin, and morphine. According to the State Statistics Service of Ukraine, in 2014–2018, 1365 deaths were registered as a result of poisoning by narcotic and psychotropic substances. In 2018, a total of 399 cases of deaths related to narcotic and psychotropic substances use and poisoning were recorded in Ukraine. Of these, 64 (16.04 %) cases were related to mental and behavioral disorders due to drug and psychotropic substance abuse and 335 (98.82 %) cases were related to external causes of death related to poisoning or overdose. Among those who died in 2018, there were 90.5 % men (361 cases) and 9.5 % women (38 cases). The largest number of deaths, 340 cases (85.2 %), occurred in the age group from 25 to 44 years, 13 ca-ses — in the age group from 15 to 24 years, and 46 cases — from 45 years and older. Three hundred and fifty-five cases of death from poisoning by psychotropic substances were investigated, it was established that opioid poisoning occurred in 153 cases (codeine and morphine — 54 cases (43.1 %), methadone — 76 cases (21.4 %), opium — 15 cases (4.2 %), synthetic opioids — 8 cases (2.3 %)). One hundred and forty-four cases of death from other drug poisonings were studied, including 31 (21.5 %) cases of psychodysleptic poisoning (hallucinogens), 2 (1.4 %) cases of cocaine poisoning, and 5 (3.5 %) cases of psychostimulant poisoning. According to state statistics, the number of deaths from poisoning in 2018 compared to 2017 increased by half and much. In particular, methadone poisoning increased 2.5 times, and unidentified drug poisoning was three-fold increased. According to the intent, the deaths were distributed as follows: 268 deaths — accidental poisoning; 66 deaths — poisoning by indefinite intent; one case — self-poisoning. The opioid poisoning accounted for 28 % of all cases of the psychotropic substances revealed in biological material, 24.4 % cases were drugs containing narcotic and psychotropic substances or precursors, 15 % — of unidentified substances, the rest consisted of other psychoactive substan-ces. The age characteristics of the group of deaths resulted from narcotic and psychotropic substances revealed in the biological material, and in the group of deaths from overdose are the same (p ≤ 0.05). It means that in the samples of both groups, the age group of 25–44 years presented over 75 % of cases. In Ukraine in 2018, the frequency of deaths related to drug and psychotropic substance abuse and poisoning among the population aged 15 to 64 was 10 people per 1,000,000. Conclusions. The results of the epidemic, clinical, forensic, and laboratory studies conducted by various government agencies in the period 2014–2019, demonstrate a threatening dynamic of increasing both the number of cases of narcotic and psychotropic poisoning and their diversity, resulting in a progressive increase in lethality and mortality, mainly among the male population aged 25–44 years. The main way of the use of narcotic and psychotropic substances in Ukraine continues to be the injection of opioids (methadone, heroin, buprenorphine, etc.) and amphetamine-type stimulants. There has been an increase in the number of deaths associated with the simultaneous use of several narcotic and psychotropic substances (methadone, amphetamine, marijuana, benzodiazepines, ethanol, etc.) in various combinations.
Ma J., Bao Y.P., Wang R.J., Su M.F., Liu M.X., Li J.Q., Degenhardt L., Farrell M., Blow F.C., Ilgen M., Shi J., Lu L. Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol Psychiatry. 2019 Dec; 24(12):1868-1883. doi: 10.1038/s41380-018-0094-5.
Kelty E., Hulse G., Joyce D., Preen D.B. Impact of Pharmacological Treatments for Opioid Use Disorder on Mortality. CNS Drugs. 2020 Jun; 34(6):629-642. doi: 10.1007/s40263-020-00719-3.
Wilson N., Kariisa M., Seth P., Smith H. 4th, Davis N.L.Drug and Opioid-Involved Overdose Deaths - United States, 2017-2018. MMWR Morb Mortal Wkly Rep. 2020 Mar 20; 69(11):290-297. doi: 10.15585/mmwr.mm6911a4.
Babakhanian M., Zarghami M., Alipour A., Khosravi A., Hashemi-Nazari S.S., Saberi M., Ghadirzadeh M.R. An Estimation of Drug-Related Deaths in Iran, Using the Capture-Recapture Method (2014-2016).Addict Health. 2020 Apr; 12(2):87-97. doi: 10.22122/ahj.v12i2.266.
Fountain J.S., Reith D.M., Tomlin A.M., Smith A.J., Tilyard M.W. Deaths by poisoning in New Zealand, 2008-2013. Clin Toxicol (Phila). 2019 Nov; 57(11):1087-1094. doi: 10.1080/15563650.2019.1582777.
Andryushchenko V.V., Kurdilʹ N.V., Kalysh M.M., Struk V.F., Padalka V.M. Obgruntuvannya zakhodiv intensyvnoyi terapiyi ta ekstrakorporalʹnoyi detoksykatsiyi pry kombinovanykh otruyennyakh metadonom. Medytsyna nevidkladnykh staniv. Tom 16. №6. 2020. S. 60 - 68. doi: https://doi.org/10.22141/2224-05188.8.131.520.216510.
Kurdilʹ N.V. Osoblyvosti kombinovanykh otruyenʹ «vulychnym» metadonom /V.V. Andryushchenko, M.M. Kalysh, N.V. Kurdilʹ // Medytsyna neotlozhnykh sostoyanyy. – 2018. – 1(88). S. 136-141. doi: http://dx.doi.org/10.22141/2224-05184.108.40.2068.124981.
Derzhavna sluzhba statystyky Ukrayiny. Ofitsiynyy sayt. URL: http://www.ukrstat.gov.ua/
Tsentr medychnoyi statystyky MOZ Ukrayiny. Ofitsiynyy sayt. URL: https://moz.gov.ua/article/statistic/centr-medichnoi-statistiki-moz-ukraini.
Yevropeysʹkoho monitorynhovoho tsentru z narkotykiv ta narkotychnoyi zalezhnosti (European Monitoring Centre for Drugs and Drug Addiction). Ofitsiynyy sayt. URL: https://www.emcdda.europa.eu/
Nakaz MOZ Ukrayiny «Pro vnesennya zminy do Poryadku vidpusku likarsʹkykh zasobiv i vyrobiv medychnoho pryznachennya z aptek ta yikh strukturnykh pidrozdiliv» vid 15.01.2018 №65. Electronic resource. URL: https://zakon.rada.gov.ua/laws/show/z0150-18#Text
Nakaz MOZ Ukrayiny «Pro vnesennya zmin do nakazu Ministerstva okhorony zdorovʺya Ukrayiny vid 16 chervnya 2014 roku № 398» vid 08.10.2018 №1833. Electronic resource. URL: https://zakon.rada.gov.ua/laws/show/z1500-18#Text.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.