Bailey James, Kalk Nicola J, Andrews Rebecca, Yates Sarah, Nahar Limon, Kelleher Michael, Paterson Susan
Department of Primary Care, King's College London, London, UK.
Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK.
Drug Alcohol Rev. 2021 Nov;40(7):1195-1201. doi: 10.1111/dar.13260. Epub 2021 Mar 14.
This study investigates whether there is a relationship between alcohol and cocaine use in deaths where suicide by self-injury is the suspected cause of death.
Adults referred by coroners to the Imperial College London Toxicology Unit for toxicological analysis between 2012 and 2016 were reviewed for inclusion criteria. Those who died by self-injury reasoned to be deliberate were included in the analysis. Femoral blood alcohol concentration (BAC) and presence of cocaine or benzoylecognine (a metabolite of cocaine) in blood and/or urine were tabulated and odds ratios calculated.
A total of 1722 decedents met inclusion criteria. BAC was ≥50 mg/dL in 29% of decedents. Cocaine was detected in 8.4% of cases. The likelihood of testing positive for cocaine increased with BAC and was most frequent between 100 and 199 mg/dL, consistent with moderate to severe intoxication (odds ratio 5.88, 95% confidence interval 3.80, 9.09; P ≤ 0.001) compared to those with BAC <10 mg/dL.
This study demonstrates a correlation between increasing BAC and likelihood of cocaine use prior to suspected suicide, up to a level consistent with severe intoxication. Cocaine use was found in a high proportion of cases relative to the general population reporting regular use. This pattern of drug and alcohol use has previously been given little attention in suicide prevention strategies and clinical prioritisation.
本研究调查了在疑似因自残导致自杀死亡的案例中，酒精使用与可卡因使用之间是否存在关联。
回顾了2012年至2016年间由验尸官转介至伦敦帝国理工学院毒理学单位进行毒理学分析的成年人，以确定纳入标准。那些因自残而被判定为蓄意死亡的人被纳入分析。列出股动脉血酒精浓度（BAC）以及血液和/或尿液中可卡因或苯甲酰爱康宁（可卡因的一种代谢物）的存在情况，并计算比值比。
共有1722名死者符合纳入标准。29%的死者BAC≥50mg/dL。8.4%的案例中检测到可卡因。可卡因检测呈阳性的可能性随BAC升高而增加，在100至199mg/dL之间最为常见，这与中度至重度中毒相符（比值比5.88，95%置信区间3.80，9.09；P≤0.001），与BAC<10mg/dL的人相比。
本研究表明，在疑似自杀前，BAC升高与使用可卡因的可能性之间存在相关性，直至达到与重度中毒一致的水平。相对于报告经常使用可卡因的普通人群，在很大比例的案例中发现了可卡因使用情况。这种药物和酒精使用模式在自杀预防策略和临床优先级中此前很少受到关注。
