Analysis of psychotropic drug-related deaths in south Osaka

Figures & data

Figure 1 Age-specific psychotropic drug-related deaths (n=133).

Figure 2 Ratio of government welfare-payment recipients to the total number of unemployed individuals.

Note: The occupational status was as follows: 20 cases (15% of total) employed, 99 cases (74% of total) unemployed, and 14 cases (11% of total) unknown.

Table 1 Study items with regard to psychotropic drug-related deaths

Study items	Male (n=78)		Female (n=55)		Total (n=133)
	n	%	n	%	n	%
Living situation
Lived with family/other cohabitants	27	35	29	53	56	42
Lived alone	34	44	22	40	56	42
Unknown	17	22	4	7	21	16
Circumstances of death discovery
Deaths discovered within 12 hours	57	73	35	64	92	69
Deaths discovered after 12 hours	21	27	20	36	41	31
Medical history
Mental illness	38	49	44	80	82	62
Gastrointestinal disease	14	18	4	7	18	14
Endocrine metabolic disease	6	8	5	9	11	8
Hematological disease	9	12	3	5	12	9
Cardiovascular disease	5	6	2	4	7	5
Respiratory disease	3	4	2	4	5	4
Central nervous system disease	3	4	–	–	3	2
Genital disease	1	1	–	–	1	1
Unknown	28	36	8	15	36	27
Presence/absence of self-injury
Present	11	14	12	22	23	17
Absent	67	86	43	78	110	83
Nutritional status (BMI)
≥30 kg/m^2 (obese)	4	5	4	7	8	6
25–29.9 kg/m^2 (overweight)	10	13	4	7	14	11
18.5–24.9 kg/m^2 (normal weight)	38	49	23	42	61	46
18.5 kg/m^2 (underweight)	8	10	9	16	17	13
Unknown	18	23	15	27	33	25

Abbreviation: BMI, body mass index.

Figure 3 Causes of death related to psychotropic drug administration.

Figure 4 Underlying disease identified on performing autopsy in cases of psychotropic drug-related deaths.

Table 2 Detected drug concentrations in Schedules III and IV in the “Convention on Psychotropic Substances”

Drugs	10s (male/female)	20s (male/female)	30s (male/female)	40s (male/female)	50s (male/female)	60s (male/female)	70s (male/female)	80s (male/female)	90s (male/female)	Number(male/female)	Right heart blood (median) (µg/mL)
Phenobarbital	–	1 (1/0)	4 (0/4)	14 (11/3)	7 (5/2)	12 (7/5)	3 (2/1)	–	–	41 (26/15)	0.162–52.8
Zolpidem	–	2 (1/1)	–	3 (2/1)	1 (0/1)	1 (1/0)	1 (1/0)	1 (0/1)	–	9 (5/4)	0.004–0.891 (0.117)
Estazolam	–	2 (0/2)	1 (0/1)	–	1 (1/0)	2 (1/1)	–	1 (0/1)	1 (1/0)	8 (3/5)	0.032–1.14 (0.186)
Diazepam	–	2 (1/1)	3 (3/0)	–	–	–	–	1 (0/1)	–	6 (4/2)	0.006–1.17 (0.079)
Midazolam	–	–	–	1 (1/0)	1 (0/1)	1 (1/0)	1 (1/0)	–	–	4 (3/1)	0.058–0.736 (0.249)
Bromazepam	–	–	1 (0/1)	–	–	–	1 (1/0)	1 (0/1)	–	3 (1/3)	0.015–0.159 (0.021)
Pentobarbital	–	–	1 (0/1)	1 (0/1)	–	1 (1/0)	–	–	–	3 (1/2)	6.55–69.8 (14.7)
Alprazolam	–	1 (0/1)	–	–	–	1 (1/0)	–	–	–	2 (1/1)	0.013–0.036 (0.024)
Flurazepam	–	–	1 (0/1)	1 (1/0)	–	–	–	–	–	2 (1/1)	0.003–0.040 (0.021)
Amobarbital	–	–	–	–	–	1 (1/0)	–	–	–	1 (1/0)	3.66
Flunitrazepam	–	–	–	–	–	1 (1/0)	–	–	–	1 (1/0)	0.424
Total	–	8 (3/5)	11 (3/8)	20 (15/5)	10 (6/4)	20 (14/6)	6 (5/1)	4 (0/4)	1 (1/0)	80 (46/34)

Table 3 Detected drug concentrations except for those in Schedules III and IV in the “Convention on Psychotropic Substances”

Drugs	Number (male/female)	Right heart blood (median) (µg/mL)
Acetaminophen	3 (2/1)	0.280–19.8 (0.330)
Amitriptyline	2 (2/0)	0.420–0.586 (0.503)
Chlorpheniramine	1 (1/0)	0.840
Chlorpromazine	22 (12/10)	0.012–42.3 (0.212)
Desalkylflurazepam	1 (0/1)	0.084
Desipramine	1 (1/0)	0.406
Dihydrocodeine	1 (1/0)	0.719
Diphenhydramine	2 (0/2)	0.023–0.077 (0.050)
Imipramine	1 (1/0)	0.186
Levomepromazine	10 (7/3)	0.005–0.821 (0.259)
Lidocaine	5 (2/3)	0.001–0.647 (0.172)
Methotrimeprazine	1 (1/0)	0.030
Methylephedrine	2 (1/1)	0.032–0145 (0.089)
Olanzapine	2 (2/0)	0.030–1.71 (0.870)
Promethazine	32 (16/16)	0.027–78.4 (0.188)
Sertraline	1 (1/0)	0.037

Table 4 Blood alcohol concentrations in cases of psychotropic drug-related deaths (postmortem period<48 hours)

Table S1 Causes of death related to psychotropic drugs

Causes of death	Male (n=78)		Female (n=55)		Total (n=133)
	n	%	n	%	n	%
Drug intoxication	13	17	21	38	34	26
Fire fatality	22	28	8	15	30	23
Asphyxia	10	13	10	18	20	15
Blunt injury	12	15	1	2	13	10
Hypothermia	3	4	4	7	7	5
Drowning	3	4	4	7	7	5
Sharp instrument injury	4	5	2	4	6	5
Acute alcohol poisoning	1	1	2	4	3	2
Heat stroke	3	4	–	–	3	2
Acute carbon monoxide poisoning	2	3	1	2	3	2
Acute myocardial infarction	2	3	–	–	2	2
Heart failure	1	1	1	2	2	2
Pneumonia	1	1	–	–	1	1
Unknown	1	1	1	2	2	2

Table S2 Underlying disease identified based on performing autopsies in cases of psychotropic drug-related deaths

Underlying disease	Male (141 diseases)		Female (78 diseases)		Total (219 diseases)
	n	%	n	%	n	%
Gastrointestinal disease	59	42	20	26	79	36
Cardiovascular disease	49	35	29	37	78	36
Respiratory disease	11	8	9	12	20	9
Hematological disease	6	4	8	10	14	6
Central nervous system disease	9	6	4	5	13	6
Urological disease	4	3	4	5	8	4
Endocrine metabolic disease	2	1	2	3	4	2
Genital disease	1	1	2	3	3	1

Table S3 Compound drug detection and number of cases

Note:

a Except for Schedules III and IV in the “Convention on Psychotropic Substances”.