Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Victoria, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, 3006, Victoria, Australia.
Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Victoria, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, 3006, Victoria, Australia.
Forensic Sci Int. 2022 Sep;338:111391. doi: 10.1016/j.forsciint.2022.111391. Epub 2022 Jul 18.
Suicide remains a global public health concern and the increased supply and use of synthetic stimulants globally may have implications for the burden of suicides attributable to substance use. This systematic review investigated any potential associations of stimulant use detected in post-mortem biological specimens and suicides. We conducted a systematic review and narrative synthesis (CRD42021237966). Medline, EMBASE, TOXLINE, and Scopus databases were searched for terms related to forensic toxicology, post-mortem toxicology, suicide and stimulants. The primary outcome was to estimate the prevalence of stimulant use in suicides. There were 26 studies whichcontributed to prevalence measures; in studies reporting at the individual compound level, suicides involved cocaine (0.1-23%), caffeine (3.2-22%), 3,4-methylenedioxymethamphetamine (0.1-17%), amphetamine (0.2-9.3%), methamphetamine (3.1-7%), and phentermine (0.9-1%). Overall, stimulant use in suicides was over-represented compared to estimates of stimulant use in the general population and has increased over time. Thirteen case reports used to contextualise suicides involving stimulants found no examples of cocaine or methamphetamine mono-intoxication of suicidal intent. This suggests mechanisms other than acute toxicity involved in stimulant-associated suicide. Future research by in-depth psychological autopsies of suicides involving stimulants, in combination with segmental hair analysis to determine the chronicity of stimulant exposure, may contribute to a better understanding of the burden of suicide attributable to stimulant use.
自杀仍是全球公共卫生关注的问题，全球范围内合成兴奋剂供应和使用的增加可能对因物质使用导致的自杀负担产生影响。本系统评价调查了在死后生物标本中检测到的兴奋剂使用与自杀之间的任何潜在关联。我们进行了系统评价和叙述性综合（CRD42021237966）。我们在 Medline、EMBASE、TOXLINE 和 Scopus 数据库中搜索了与法医毒理学、死后毒理学、自杀和兴奋剂相关的术语。主要结局是估计自杀者中兴奋剂使用的流行率。有 26 项研究有助于流行率评估；在报告个体化合物水平的研究中，涉及可卡因（0.1-23%）、咖啡因（3.2-22%）、3,4-亚甲二氧基甲基苯丙胺（0.1-17%）、苯丙胺（0.2-9.3%）、甲基苯丙胺（3.1-7%）和苯丁胺（0.9-1%）的自杀事件中存在兴奋剂使用。总体而言，与一般人群中兴奋剂使用的估计相比，自杀者中兴奋剂的使用更为普遍，且呈上升趋势。用于将涉及兴奋剂的自杀事件置于上下文中的 13 份案例报告未发现可卡因或甲基苯丙胺单一中毒导致自杀意图的例子。这表明与兴奋剂相关的自杀涉及除急性毒性以外的其他机制。未来通过对涉及兴奋剂的自杀进行深入的心理尸检，并结合分段毛发分析来确定兴奋剂暴露的慢性程度，可能有助于更好地了解因兴奋剂使用导致的自杀负担。
