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Psychoactive Substances in Suicides: Comparison of Toxicologic Findings in Two Samples

Dhossche, Dirk M. M.D.; Rich, Charles L. M.D.; Isacsson, Göran M.D., Ph.D.

The American Journal of Forensic Medicine and Pathology: September 2001 - Volume 22 - Issue 3 - p 239-243

The goal in this study was to assess if there is any constancy in detections of psychoactive substances in consecutive suicides. Toxicologic findings in 179 suicides in San Diego County, California, between 1981 and 1982, and 333 suicides in Mobile County, Alabama, between 1990 and 1998, were compared. Alcohol was detected in about 30% of suicides in both samples. Abusable prescription psychoactive substances, i.e., benzodiazepines and opiates, were detected in one fifth of cases in both locations. Nonabusable prescription psychoactive substances, mainly antidepressants, were found in more suicides in Mobile than in San Diego. Detection rates of different classes of psychoactive substances have not changed much in the past decade. Detection of alcohol, cocaine, or cannabis in about 40% of suicides supports the clinical practice of discouraging consumption of these substances in depressed patients. Another challenge is the low rate of detection of antidepressants in suicide, which suggests undertreatment of depression in suicides. Continued reporting of routine, comprehensive, toxicologic findings in suicides is useful to monitor patterns of use of psychoactive substances in this group and to guide suicide prevention in clinical practice and public health policy.

From the Department of Psychiatry, University of South Alabama College of Medicine, Mobile, Alabama, U.S.A. (D.M.D., C.L.R.); and the Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden (G.I.).

Manuscript received June 1, 2000; accepted August 21, 2000.

Dr. Isacsson’s work in Mobile was supported by the University of South Alabama, the Karolinska Institute, the Swedish Society of Medicine, the Söderstrom-König Foundation, and the Bror Gadelius Memorial Foundation. The San Diego Suicide Study was supported by the Veterans Administration.

Address correspondence and reprint requests to Charles L. Rich, M.D., Department of Psychiatry, University of South Alabama College of Medicine, 2451 Fillingim Street, Mobile, Alabama 36617-2293, U.S.A.; email: crich@jaguar1.

© 2001 Lippincott Williams & Wilkins, Inc.