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Jönsson, Anna K.
Alternative names
Publications (10 of 43) Show all publications
Andersson Sundell, K. & Jönsson, A. K. (2016). Beliefs about medicines are strongly associated with medicine-use patterns among the general population. International journal of clinical practice (Esher), 70(3), 277-285
Open this publication in new window or tab >>Beliefs about medicines are strongly associated with medicine-use patterns among the general population
2016 (English)In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, no 3, p. 277-285Article in journal (Refereed) Published
Abstract [en]

AimsTo investigate self-reported beliefs and perceived sensitivity to medicines and their effects in relation to self-reported use of medicines and herbal remedies. MethodsA survey sent to 13,931 randomly selected Swedish adults included the Beliefs about Medicines Questionnaire-General (BMQ-General) Questionnaire and the Perceived Sensitivity to Medicines Scale (PSM). The survey also asked about individuals use of prescribed and over-the-counter (OTC) medicines and herbal remedies in the past month. We examined all associations between scores on the BMQ-General subscales and PSM in relation to the use of medicines and herbal remedies, using analysis of covariance adjusted for potential confounders. ResultsAmong 7099 respondents, those using herbal remedies exclusively believed strongly that prescription and OTC medicines are harmful and overprescribed. Respondents using prescription and OTC medicines reported more positive beliefs [coefficient 0.67 (95% CI 0.47-0.87) and 0.70 (95% CI 0.51-0.90)] on the benefits of medicines compared with those using herbal remedies [-0.18 (95% CI -0.57-0.20)]. Perceived sensitivity to medicines was higher among those using herbal remedies only [1.25 (95% CI 0.46-2.03)] compared with those using no medicines (reference 0) or prescription [-0.44 (95% CI -0.84 to -0.05)] or OTC [-0.27 (95% CI -0.66-0.12)] medicines alone. ConclusionRespondents using prescription and/or OTC medicines reported stronger positive beliefs about the benefits of medicines in general, supporting the hypothesis that beliefs influence medicine use. Therefore, addressing beliefs and concerns about medicines during patient counselling may influence medicine use, particularly regarding unintentional non-adherence.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
General Practice Psychiatry
Identifiers
urn:nbn:se:liu:diva-126819 (URN)10.1111/ijcp.12781 (DOI)000371480900013 ()26916721 (PubMedID)
Note

Funding Agencies|National Corporation of Swedish Pharmacies (Apoteket AB)

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2018-01-10
Tjäderborn, M., Jönsson, A. K., Zverkova Sandstrom, T., Ahlner, J. & Hägg, S. (2016). Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden. Drug And Alcohol Dependence, 161, 77-85
Open this publication in new window or tab >>Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden
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2016 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 161, p. 77-85Article in journal (Refereed) Published
Abstract [en]

Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug impaired driving with a psychoactive prescription drug, and to identify associated factors. Methods: Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non prescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
Prescription drug diversion; Non-prescribed use; Drug-impaired driving; Drug dispensing; Pharmacoepidemiology
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127559 (URN)10.1016/j.drugalcdep.2016.01.031 (DOI)000373419100011 ()26875672 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden [LIO-131751]; Forensic Science Centre, Sweden [CFV 121218]; Linkoping University, Sweden [LIU 2009-01356]

Available from: 2016-05-04 Created: 2016-05-03 Last updated: 2017-04-24
Khedidja, H., Hakkarainen, K. M., Gyllensten, H., Jönsson, A. K., Andersson Sundell, K., Petzold, M. & Hägg, S. (2015). Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?. PLoS ONE, 10(9), Article ID e0137451.
Open this publication in new window or tab >>Adherence to Antihypertensive Therapy and Elevated Blood Pressure: Should We Consider the Use of Multiple Medications?
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0137451Article in journal (Refereed) Published
Abstract [en]

Background

Although a majority of patients with hypertension require a multidrug therapy, this is rarely considered when measuring adherence from refill data. Moreover, investigating the association between refill non-adherence to antihypertensive therapy (AHT) and elevated blood pressure (BP) has been advocated.

Objective

Identify factors associated with non-adherence to AHT, considering the multidrug therapy, and investigate the association between non-adherence to AHT and elevated BP.

Methods

A retrospective cohort study including patients with hypertension, identified from a random sample of 5025 Swedish adults. Two measures of adherence were estimated by the proportion of days covered method (PDC≥80%): (1) Adherence to any antihypertensive medication and, (2) adherence to the full AHT regimen. Multiple logistic regressions were performed to investigate the association between sociodemographic factors (age, sex, education, income), clinical factors (user profile, number of antihypertensive medications, healthcare use, cardiovascular comorbidities) and non-adherence. Moreover, the association between non-adherence (long-term and a month prior to BP measurement) and elevated BP was investigated.

Results

Non-adherence to any antihypertensive medication was higher among persons < 65 years (Odds Ratio, OR 2.75 [95% CI, 1.18–6.43]) and with the lowest income (OR 2.05 [95% CI, 1.01–4.16]). Non-adherence to the full AHT regimen was higher among new users (OR 2.04 [95% CI, 1.32–3.15]), persons using specialized healthcare (OR 1.63, [95% CI, 1.14–2.32]), and having multiple antihypertensive medications (OR 1.85 [95% CI, 1.25–2.75] and OR 5.22 [95% CI, 3.48–7.83], for 2 and ≥3 antihypertensive medications, respectively). Non-adherence to any antihypertensive medication a month prior to healthcare visit was associated with elevated BP.

Conclusion

Sociodemographic factors were associated with non-adherence to any antihypertensive medication while clinical factors with non-adherence to the full AHT regimen. These differing findings support considering the use of multiple antihypertensive medications when measuring refill adherence. Monitoring patients' refill adherence prior to healthcare visit may facilitate interpreting elevated BP.

Place, publisher, year, edition, pages
´PLoS, 2015
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-121822 (URN)10.1371/journal.pone.0137451 (DOI)000361043100040 ()26359861 (PubMedID)
Available from: 2015-10-08 Created: 2015-10-08 Last updated: 2018-01-11
Khedidja, H., Hakkarainen, K. M., Gyllensten, H., Jönsson, A. K., Petzold, M. & Hägg, S. (2015). Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study. European Journal of Clinical Pharmacology, 71(12), 1525-1533
Open this publication in new window or tab >>Potentially inappropriate prescribing and adverse drug reactions in the elderly: a population-based study
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2015 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 12, p. 1525-1533Article in journal (Refereed) Published
Abstract [en]

Purpose

Potentially inappropriate prescriptions (PIPs) criteria are widely used for evaluating the quality of prescribing in elderly. However, there is limited evidence on their association with adverse drug reactions (ADRs) across healthcare settings. The study aimed to determine the prevalence of PIPs, defined by the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, in the Swedish elderly general population and to investigate the association between PIPs and occurrence of ADRs.

Method

Persons ≥65 years old were identified from a random sample of 5025 adults drawn from the Swedish Total Population Register. A retrospective cohort study was conducted among 813 elderly with healthcare encounters in primary and specialised healthcare settings during a 3-month period in 2008. PIPs were identified from the Swedish Prescribed Drug Register, medical records and health administrative data. ADRs were independently identified by expert reviewers in a stepwise manner using the Howard criteria. Multivariable logistic regression examined the association between PIPs and ADRs.

Results

Overall, 374 (46.0 %) persons had ≥1 PIPs and 159 (19.5 %) experienced ≥1 ADRs during the study period. In total, 29.8 % of all ADRs was considered caused by PIPs. Persons prescribed with PIPs had more than twofold increased odds of experiencing ADRs (OR 2.47; 95 % CI 1.65–3.69). PIPs were considered the cause of 60 % of ADRs affecting the vascular system, 50 % of ADRs affecting the nervous system and 62.5 % of ADRs resulting in falls.

Conclusion

PIPs are common among the Swedish elderly and are associated with increased odds of experiencing ADRs. Thus, interventions to decrease PIPs may contribute to preventing ADRs, in particular ADRs associated with nervous and vascular disorders and falls.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Inappropriate prescribing – Elderly – Adverse drug reactions – Retrospective study – Medical records – Registries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-121823 (URN)10.1007/s00228-015-1950-8 (DOI)000365179600013 ()26407684 (PubMedID)
Available from: 2015-10-08 Created: 2015-10-08 Last updated: 2017-12-01Bibliographically approved
Karlsson, S. A., Jacobsson, I., Danell Boman, M., Hakkarainen, K. M., Lövborg, H., Hägg, S. & Jönsson, A. K. (2015). The impact of a changed legislation on reporting of adverse drug reactions in Sweden, with focus on nurses reporting. European Journal of Clinical Pharmacology, 71(5), 631-636
Open this publication in new window or tab >>The impact of a changed legislation on reporting of adverse drug reactions in Sweden, with focus on nurses reporting
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2015 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 71, no 5, p. 631-636Article in journal (Refereed) Published
Abstract [en]

In March 2007, a legislative amendment was issued in Sweden compelling nurses to report all suspected adverse drug reactions (ADRs) to the national pharmacovigilance system. The aims of this study were to describe the status of ADR reporting, before and after the implementation of the legislative changes, and to describe the general characteristics of suspected ADRs reported by nurses. The Swedish pharmacovigilance system during the study period constituted six regional centres responsible for the handling of all spontaneous ADR reports within their region. In this study, we identified all individual ADR reports from 2005 and 2010, analysed in depth the ADR reports from two regional centres and collated information about the reporter and the nature of the reported ADR. From the two regional centres, a total of 898 and 1074 reports were submitted in 2005 and 2010 respectively. Nurses submitted 31 % (275 reports) of the reports in 2005 and 24 % (260 reports) in 2010. Nurses reporting of serious ADRs was 3 % (seven reports) in 2005 and 7 % (17 reports) in 2010 with reporting of unlabelled ADRs at 4 % (11 reports) in 2005 and 17 % (45 reports) in 2010. Most of the serious and/or unlabelled reactions were related to vaccine administration (14 reports in 2005 and 36 reports in 2010). The overall ADR reporting by nurses did not appear to increase after the change in reporting legislation. The proportion of serious and/or unlabelled ADRs reported by nurses did however appear to increase during the same period. Taken together, our data suggests that further pro-active measures should be considered in order to involve nurses in the reporting of suspected ADRs.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keywords
Adverse drug reaction; Spontaneous reporting; Pharmacovigilance; Nurses
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-118037 (URN)10.1007/s00228-015-1839-6 (DOI)000353059900013 ()25845655 (PubMedID)
Available from: 2015-05-21 Created: 2015-05-20 Last updated: 2017-12-04
Gyllensten, H., Hakkarainen, K. M., Hägg, S., Carlsten, A., Petzold, M., Rehnberg, C. & Jönsson, A. K. (2014). Economic Impact of Adverse Drug Events - A Retrospective Population-Based Cohort Study of 4970 Adults. PLoS ONE, 9(3), 0092061
Open this publication in new window or tab >>Economic Impact of Adverse Drug Events - A Retrospective Population-Based Cohort Study of 4970 Adults
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 3, p. 0092061-Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to estimate the direct costs caused by ADEs, including costs for dispensed drugs, primary care, other outpatient care, and inpatient care, and to relate the direct costs caused by ADEs to the societal COI (direct and indirect costs), for patients with ADEs and for the entire study population. Methods: We conducted a population-based observational retrospective cohort study of ADEs identified from medical records. From a random sample of 5025 adults in a Swedish county council, 4970 were included in the analyses. During a three-month study period in 2008, direct and indirect costs were estimated from resource use identified in the medical records and from register data on costs for resource use. Results: Among 596 patients with ADEs, the average direct costs per patient caused by ADEs were USD 444.9 [95% CI: 264.4 to 625.3], corresponding to USD 21 million per 100 000 adult inhabitants per year. Inpatient care accounted for 53.9% of all direct costs caused by ADEs. For patients with ADEs, the average societal cost of illness was USD 6235.0 [5442.8 to 7027.2], of which direct costs were USD 2830.1 [2260.7 to 3399.4] (45%), and indirect costs USD 3404.9 [2899.3 to 3910.4] (55%). The societal cost of illness was higher for patients with ADEs compared to other patients. ADEs caused 9.5% of all direct healthcare costs in the study population. Conclusions: Healthcare costs for patients with ADEs are substantial across different settings; in primary care, other outpatient care and inpatient care. Hence the economic impact of ADEs will be underestimated in studies focusing on inpatient ADEs alone. Moreover, the high proportion of indirect costs in the societal COI for patients with ADEs suggests that the observed costs caused by ADEs would be even higher if including indirect costs. Additional studies are needed to identify interventions to prevent and manage ADEs.

Place, publisher, year, edition, pages
Public Library of Science, 2014
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-106687 (URN)10.1371/journal.pone.0092061 (DOI)000333254100109 ()
Available from: 2014-05-21 Created: 2014-05-19 Last updated: 2018-01-11
Jönsson, A. K., Schioler, L., Lesen, E., Andersson Sundell, K. & Mardby, A.-C. (2014). Influence of refill adherence method when comparing level of adherence for different dosing regimens. European Journal of Clinical Pharmacology, 70(5), 589-597
Open this publication in new window or tab >>Influence of refill adherence method when comparing level of adherence for different dosing regimens
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2014 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 70, no 5, p. 589-597Article in journal (Refereed) Published
Abstract [en]

To examine the impact of two methods when estimating refill adherence in patients using bisphosphonates with different dosing regimens. In the Swedish Prescribed Drug Register, 18,203 new users of bisphosphonates aged 18-85 years were identified between 1 July 2006 and 30 June 2007 and followed for a maximum of 2 years. The patients were categorised based on dosing regimen: one tablet daily, one tablet weekly, switching between these regimens, and other regimens. Refill adherence was estimated with Continuous measure of Medication Acquisition (CMA, adherent if CMA a parts per thousand yenaEuro parts per thousand 80 %) and the maximum gap method (adherent if gaps less than 45 days). Differences in adherence between patients in the groups were assessed with logistic regression models controlling for confounding factors. The proportion of patients classified as adherent was higher using CMA compared with patients classified as adherent using the maximum gap method. Patients on one tablet weekly had significantly lower adherence compared with patients on one tablet daily in the main analyses of both methods (the maximum gap method: 73 % vs. 80 %; adjusted OR = 0.71; 95 % CI 0.57-0.89 and CMA: 84 % vs. 88 %, adjusted OR = 0.75; 95 % CI 0.57-0.99). Patients using the other two dosing regimens had significantly lower adherence compared with patients on one tablet daily using both methods. Choice of method has an impact on the estimates of refill adherence to bisphosphonates. Patients on one tablet weekly dosing had lower adherence compared with patients on one tablet daily dosing using both methods.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2014
Keywords
Medication adherence; Swedish Prescribed Drug Register; Dosing regimen; Bisphosphonates
National Category
Social and Clinical Pharmacy
Identifiers
urn:nbn:se:liu:diva-106673 (URN)10.1007/s00228-014-1649-2 (DOI)000334422700011 ()
Available from: 2014-05-21 Created: 2014-05-19 Last updated: 2018-01-11
Lesen, E., Andersson Sundell, K., Carlsten, A., Mardby, A.-C. & Jönsson, A. K. (2014). Is the level of patient co-payment for medicines associated with refill adherence in Sweden?. European Journal of Public Health, 24(1), 85-90
Open this publication in new window or tab >>Is the level of patient co-payment for medicines associated with refill adherence in Sweden?
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2014 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 85-90Article in journal (Refereed) Published
Abstract [en]

Background: In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patients co-payment level for medicines, with antiepileptic drug (AED) use as an example. Methods: Prevalent AED users aged 18-85 years who purchased an AED between 1 January and 30 June 2007 were identified in the Swedish Prescribed Drug Register and followed for a maximum of 2 years. Patient time was categorized based on patients accumulated co-payment for all drugs per reimbursement period. The continuous measure of medication acquisition (CMA) was used to estimate refill adherence in relation to the patients co-payment level. Associations between patients co-payment for all medicines and refill adherence were assessed with multilevel mixed-effects linear regression, accounting for clustering within patients. Results: The study population included 2210 patients (mean age: 56 years; 54% men). CMA for AED was 91% for patients where the co-payment corresponded to 100% of the price. Compared with these patients, refill adherence for AED was 2-4% higher (P less than 0.001) for patients with reduced co-payment (co-payment of 50% of the price). Higher age, higher income and fenytoin use were also associated with a higher refill adherence for AED. Conclusions: Using AED as an example, a higher level of reimbursement was associated with a higher refill adherence compared with full co-payment in Sweden.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option D, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105245 (URN)10.1093/eurpub/ckt062 (DOI)000330838200019 ()
Available from: 2014-03-14 Created: 2014-03-14 Last updated: 2017-12-05
Hakkarainen, K. M., Gyllensten, H., Jönsson, A. K., Andersson Sundell, K., Petzold, M. & Hägg, S. (2014). Prevalence, nature and potential preventability of adverse drug events - A population-based medical record study of 4970 adults. British Journal of Clinical Pharmacology, 78(1), 170-183
Open this publication in new window or tab >>Prevalence, nature and potential preventability of adverse drug events - A population-based medical record study of 4970 adults
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2014 (English)In: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 78, no 1, p. 170-183Article in journal (Refereed) Published
Abstract [en]

AIMS: To estimate the 3-month prevalence of adverse drug events (ADEs), categories of ADEs, and preventable ADEs, and the preventability of ADEs among adults in Sweden. Further, to identify drug classes and organ systems associated with ADEs and estimate their seriousness.

METHODS: A random sample of 5025 adults in Swedish county council in 2008 was drawn from the Total Population Register. All their medical records in 29 inpatient care departments in three hospitals, 110 specialised outpatient clinics, and 51 primary care units were reviewed retrospectively in a stepwise manner, and complemented with register data on dispensed drugs. ADEs, including adverse drug reactions (ADRs), sub-therapeutic effects of drug therapy (STEs), drug dependence and abuse, drug intoxications from overdose, and morbidities due to drug-related untreated indication, were detected during a 3-month study period, and assessed for preventability.

RESULTS: Among included 4970 individuals, the prevalence of ADEs was 12.0% (95% confidence interval 11.1-12.9%), and preventable ADEs 5.6% (5.0-6.2%). ADRs (6.9%; 6.2-7.6%) and STEs (6.4%; 5.8-7.1%) were more prevalent than the other ADEs. Of the ADEs, 38.8% (35.8-41.9%) was preventable, varying by ADE category and seriousness. ADEs were frequently associated with nervous system and cardiovascular drugs, but the associated drugs and affected organs varied by ADE category.

CONCLUSIONS: The considerable burden of ADEs and preventable ADEs from commonly used drugs across care settings warrants large-scale efforts to redesign safer, higher quality healthcare systems. The heterogeneous nature of the ADE categories should be considered in research and clinical practice for preventing, detecting and mitigating ADEs.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
adverse drug event, medical records, medication error, pharmacoepidemiology, prevalence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105533 (URN)10.1111/bcp.12314 (DOI)000337975400017 ()24372506 (PubMedID)
Available from: 2014-03-26 Created: 2014-03-26 Last updated: 2017-12-05
Jönsson, A. K., Soderberg, C., Arne Espnes, K., Ahlner, J., Eriksson, A., Reis, M. & Druid, H. (2014). Sedative and hypnotic drugs-Fatal and non-fatal reference blood concentrations. Forensic Science International, 236, 138-145
Open this publication in new window or tab >>Sedative and hypnotic drugs-Fatal and non-fatal reference blood concentrations
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2014 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 236, p. 138-145Article in journal (Refereed) Published
Abstract [en]

In postmortem investigations of fatal intoxications it is often challenging to determine which drug/s caused the death. To improve the interpretation of postmortem blood concentrations of sedative and hypnotic drugs and/or clonazepam, all medico-legal autopsies in Sweden - where these drugs had been detected in femoral vein blood during 1992-2006 - were identified in the databases of the National Board of Forensic Medicine. For each drug, concentrations in postmortem control cases - where the cause of death was not intoxication and where incapacitation by drugs could be excluded - were compiled as well as the levels found in living subjects; drugged driving cases and therapeutic drug monitoring cases. Subsequently, fatal intoxications were assessed with regards to the primary substances contributing to death, and blood levels were compiled for single and multiple drug intoxications. The postmortem femoral blood levels are reported for 16 sedative and hypnotic drugs, based on findings in 3560 autopsy cases. The cases were classified as single substance intoxications (N = 498), multiple substance intoxications (N = 1555) and postmortem controls (N = 1507). Each autopsy case could be represented more than once in the group of multiple intoxications and among the postmortem controls if more than one of the included substances were detected. The concentration ranges for all groups are provided. Overlap in concentrations between fatal intoxications and reference groups was seen for most substances. However, the concentrations found in single and multiple intoxications were significantly higher than concentrations found in postmortem controls for all substances except alprazolam and triazolam. Concentrations observed among drugged drivers were similar to the concentrations observed among the therapeutic drug monitoring cases. Flunitrazepam was the substance with the highest number of single intoxications, when related to sales. In summary, this study provides reference drug concentrations primarily to be used for improving interpretation of postmortem drug levels in obscure cases, but which also may assist in drug safety work and in pharmacovigilance efforts.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Postmortem; Intoxication; Poisoning; Forensic toxicology; Toxicity; Benzodiazepines
National Category
Forensic Science
Identifiers
urn:nbn:se:liu:diva-105408 (URN)10.1016/j.forsciint.2014.01.005 (DOI)000331198500023 ()
Available from: 2014-03-21 Created: 2014-03-21 Last updated: 2017-12-05
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