Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia

Aim

To study drug-induced mortality and characteristics of overdose deaths in the war (1991-1995), pre-war (1986-1990), and post-war period (1996-2000) in Split-Dalmatia County.

Methods

We retrospectively searched through Databases of the Department of Forensic Medicine, University Hospital Split, the national register of death records, the archives of the Split-Dalmatia County Police, and the Register of Treated Drug Addicts of the Croatian National Institute of Public Health, covering the period from 1986 to 2000, according to drug poisoning codes IX and X of the International Classification of Diseases. The indicators were statistically analyzed.

Results

There were 146 registered drug-induced deaths, with 136 (93%) deceased being men. The median age of all cases was 27 years (interquartile range 8). Most of them were single (70.6%), unemployed (44.6%), and secondary school graduates (69.2%). In the war period, there were 4.8 times more deaths than in the pre-war period (P = 0.014), and in the post-war period there were 5.2 times more deaths than in the pre-war period (P = 0.008). The most common site of death was the deceased person’s home. The toxicological analyses showed that 59 (61%) deaths were heroin related, alcohol use was found in 62 cases (42.5%), and multi-substance use was found in more than a half of the cases. In 133 (91.1%) cases, deaths were classified as unintentional, whereas 13 (8.9%) were classified as suicides.

Conclusion

The war, along with other risk factors, contributed to unfavorable developments related to drug abuse in Split-Dalmatia County, including the increase in the drug-induced mortality rate.Drug abuse is among the main causes of health problems and deaths of young people in Europe (1). Drug abuse-related mortality is one of the epidemiological indicators used for the assessment of prevalence and health-consequences of drug abuse (2). When compared with general population of the same age and sex, drug addicts have an increased risk of death (2). This implies both drug-induced deaths and deaths caused by illnesses linked to years-long drug abuse or risk behavior. An important drug-related cause of death is overdose. According to the definition of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), drug-induced deaths refer to the deaths caused by the use of one or more substances, at least one of which is a psychoactive drug (3). Although there are differences among countries, the number of drug-induced deaths in the world has significantly increased in the recent few years (2-8).At the beginning of the War in Croatia 1991-1995, there was an outbreak of addiction epidemics and an increase in the prevalence of drug addiction (9). In the period from 1991 to 1999, the number of drug-addicts increased more than twice. In addition to this, official data on drug-induced deaths for the last few years show a constant increase (10). The increase in the number of drug addicts and fatal drug poisonings since the 1990s has been observed in Split-Dalmatia County as well (11,12).Several risk factors are identified as related to drug-induced deaths, such as sex, age, comorbid diseases, and pattern and method of drug-taking (taking of more drugs, intravenous use) (13-15).Since the war has been established as a cause of high and growing rates of morbidity and mortality (16-18), this article examines the changes in the drug-induced mortality rates in the war, pre-war, and post-war period, and analyses the characteristics of drug addicts and the circumstances involved.