Forensic Science

Forensic Science International 62 (1993) 111-116

International

Drug emergencies in Bremen in 1991 and 1992

Peter Lang*, Christel Zenker

Bremen Institute for Prevention, Research and Social Medicine (BIPSj Griinenstr. 120, 28199 Bremen, Germany

(Accepted 1 September 1992)

Abstract

About one-fifth of all drug addicts in Bremen are involved in intoxications in a I-year period; a relatively high percentage of drug intoxication emergencies are caused by a small group of addicts, but in this group no higher proportion of drug-related deaths could be found.

Key words: Drug emergencies; Drug-related deaths; Sex differences in drug intoxications

1. Introduction

The following results are part of the ‘Drug Mortality and Drug Emergencies Study’ which was carried out in Bremen, Berlin, and Hamburg between July 1991 and June 1992. The aim of the study was to discover causes and implications of deaths and intoxications in i.v. drug users, in order to develop prevention strategies for the reduction of emergency and mortality rates. In this context, the question of drug emergencies as a potential predictor of future drug mortality has gained increasing interest.

Based on the number of drug emergencies between July 1991 and June 1992 in Bremen the following questions will be analysed:

(i) How many drug addicts suffer from drug emergencies? (ii) Do some addicts have more drug emergencies than others? (iii) Is an increased number of drug emergencies an indicator for a future drug death?

* Corresponding author.

0379-0738/93/$06.00 0 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. SSDI 0379-0738(93)01344-Q

112 P. Lang, C. Zenker / Forensic Sri. ht. 62 (1993) 111-116

It has to be considered that the definition of a drug emergency has problems:

(1) Toxicological analyses for classification exist only for few cases. (2) The usual prima vista diagnosis for differentiation (alcohol addiction vs. il- legal drug addiction) sometimes is not precisely enough. (3) A definition which is exclusively oriented at the abuse of opiates is not helpful, considering emergencies caused by additional drug intake such as benzodia- zepines.

All drug emergencies diagnosed by physicians as heroin or drug intoxications were counted, based on 2 kinds of records:

(a) Admission records of those hospitals in Bremen to which drug emergency patients had been transferred. (b) Records of emergency transports, accompanied by a physician.

Percentage of Intoxicated Patients

100%

80%

60%

40%

20%

0% 1 2 3 4 >=5

Number of Drug Emergencies

??FEMALES (N=151) ??MALES (N=372)

Fig. I. Number of drug emergencies per patient (total number of drug emergencies n = 881). July 1991-June 1992.

P. Lung, C. Zenker/Forensic Sci. ht. 62 (1993) 111-116 113

By the applied coding system, double counting of single cases as a result of transport by ambulance and admission or transfers to hospitals could be avoided in the follow- ing analyses.

2. Results and discussion

From 1 July 1991 to 30 June 1992, 945 drug emergencies were registered. These include 45 cases (4.8%) with no further information. The remaining 900 emergencies were caused by 523 persons: 29% (n = 15 1) women and 71% (n = 372) men. The estimated number of heroin addicts in Bremen is 2000. Therefore almost one-tifth of all heroin users are involved in drug emergencies each year.

Nearly 75% of the drug emergency victims have had only 1 emergency during the

FEMALES Number of Victims (N=304) Percentage

i-

I -

1 -

I -

/ :il I

I /

/

, -

/

- -

30%

10%

20%

0% 1 1 ,,I,1 3 2 3 3 21 112

Number of Drug Emergencies (N=l51)

Fig. 2. Cumulative graph of drug emergencies (n = 304) by number of events and victims (n = 151). July 91-June 92.

I14 P. Lang, C. Zenker / Forensic Sci. ht. 62 (1993) 1 I I-I 16

study period. Only a relatively small portion of women (7%) and men (3%) have had at least 5 drug emergencies (Fig. 1).

A cumulative graph of the reported emergencies, however, indicates the extent to which this relatively small group of addicts dominates the occurrence of drug emergencies. The graph illustrates how many persons have had emergencies express- ed as a percentage of the total number of drug emergencies: 10 women for example have caused 40% of all drug intoxications of females and 20% of all emergencies have been caused by 3 women (Fig. 2).

The results for men are not quite as striking. Twenty percent of the emergencies in male drug addicts have been caused by 12 persons (Fig. 3).

MALES Number of Drug Emergencies (N=596) Percentage

1

: 7

180 15 24

1 1 2 1 2

Number of Victims (N=372)

00%

iO%

Fig. 3. Cumulative graph of drug emergencies (n = 596) by number of events and victims (n = 372), July 91-June 92.

P. Lang, C. Zenker / Forensic Sci. Int. 62 (1993) II I-116 115

Table 1 Percentage of females and males in drug emergencies and drug mortalities, July 1991-June 1992 in Bremen, Germany

Females Males

n o/u n o/o

Drug emergency 151 28.9 372 71.1 Drug mortality 6 1.5 14 92.5

x2 = 14.86, P 5 0.001.

It can be stated that the portion of male and female i.v. drug users in drug related deaths and emergencies is not balanced: 28% of the emergency victims are female but only 8% of drug-related deaths are caused by women (Table 1).

Related to the total number of emergency occurrences there is an even higher pro- portion of women: 34% of all emergencies (n = 304) are caused by women; 66”% (n = 596) by men.

However, there is no indication of a higher mortality risk caused by heroin intoxi- cation for the group with a higher rate of emergencies. Within the last 6 months of

Number of Drug Emergencies

6 5 4 3 2 Month

Time (in Month) before Drug Related Death of Death

BIPS-Bremen

Fig. 4. Frequency of documented drug emergencies, 6-month period, 12.5% (n = IO) of drug-related death.

116 P. Lang, C. Zenker / Forensic Sci. Int. 62 (I 993) 11 l-l 16

their lives only 10 persons (12.5% of all drug-related deaths of the study period) have had drug emergencies. But only 1 person has had a high frequency of intoxications in the month of death (Fig. 4). This indicates that each iv. drug user in Bremen could be a future drug-related death. Therefore prevention strategies have to be aimed not only at victims of drug-related emergencies, but at iv. drug users in general.

Even the frequency of drug-related emergencies per month is no indicator for drug mortality in Bremen. The correlation between cases of emergency and deaths is only 0.08, which does not indicate any statistical correlation at all. However, the period of research was relatively short.