Benzodiazepines have been regarded as relatively safe drugs but since triazolam was introduced into Denmark in 1978, six fatal cases of poisoning by triazolam alone or in combination with ethanol, have occurred in East Denmark. In one case where no ethanol was detected, a blood triazolam concentration of 0.11 mg/l was found. In another case in which blood was unavailable because of putrefaction, muscle was analyzed. In the four cases in which the ethanol concentration was in the range 110-202 mg/100 ml, the triazolam concentration range was 0.04-0.22 mg/l. Blood concentrations from these five cases were compared to those from living persons who had also ingested the drug, and these were in the range 0.002-0.03 mg/l (n = 28), with an average concentration of 0.01 mg/l.

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Cases of fatal intoxication with Ketogan.

A survey of 76 cases of fatal intoxication with Ketogan which occurred in Eastern Denmark over the period 1985-1991 showed that the cause of death was Ketogan alone in 27 cases, in combination with alcohol in 23 cases, and in combination with other drugs in 26 cases. The average age, percentage of females, drug addicts and alcohol abusers and the manner of death were also recorded. There was a significant difference between the median values of the blood concentrations of ketobemidone where the blood alcohol concentration (BAC) was zero and where it was greater than 1 mg/g, and also between the median values of the blood concentrations from fatal intoxications and those from living persons.

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PubMedDate not supplied

Prehospital treatment of patients with i.v. heroin overdose: what are we treating?

OBJECTIVE: To measure blood levels of morphine and additional drugs in patients suspected of intravenous (i.v.) heroin abuse and to evaluate the effects of antidote treatment. DESIGN: Prehospital blood sampling in 52 patients. RESULTS: Forty-five patients were blood-positive for heroin, eight of whom were hospitalized. Forty-one patients also had abused additional drugs: minor tranquilizers, ethanol, amphetamine, cocaine, and/or carbamazepine. Seven patients had taken either only methadone or ketobemidione: one was admitted. Treatment with increasing doses of naloxone indicated a necessity for hospitalization. Six of 14 patients treated with naloxone (1.8 mg were hospitalized. Seven patients had an extremely high blood level of morphine (0.2 mg/kg), that could be reverted with naloxone in moderate doses. CONCLUSION: This study indicates that under prehospital conditions, it is difficult to identify a patient intoxicated only with intravenous heroin. Nearly all patients treated were cases of multiple drug/alcohol overdoses. Even the symptoms associated with extremely high blood levels of morphine could be reversed with naloxone in moderate doses.

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