Opioids kill, especially if you're alone: Study

They slow down breathing. First, you lose consciousness, then your heart stops beating.

The opioids methadone and morphine are the most common cause of fatal drug poisoning in Denmark. A study from the Department of Forensic Medicine at Aarhus University has investigated the circumstances behind morphine-, heroin-, and methadone-related deaths in the period 2013 to 2020 in the four police districts covered by the department—North Jutland, East Jutland, Central and West Jutland and Southeast Jutland.

One of the conclusions is that it is more dangerous to use opioids when you are alone.

The study shows that 64 percent of the 327 people who died were alone at the time of death, and the majority seemed to be unaffected by drugs when they were last seen alive.

"It's important to recognize that sleep is a precursor to opioid poisoning. People don't usually die immediately after an overdose, it can take hours before oxygen deficiency causes in a sleep-like state and organs shut down," says Charlotte Uggerhøj Andersen, a clinical associate professor at the Department of Forensic Medicine at Aarhus University. She and her colleagues are behind the study, which has just been published in Forensic Science International.

"If you have the right knowledge, you'll be ready to react. It's about waking people up, and if you can't do that, call the emergency services. The risk of a fatal outcome is much higher if there's no one to intervene," she says.

Blood analyses from deceased

The study describes where opioid poisonings occur. It looks at whether the person was alone at the time of death and whether sleep and snoring were observed before death. It also provides an analysis of toxicological findings in the deceased's blood. During an autopsy, forensic pathologists perform a toxicological analysis of the blood of the deceased and screen it for more than 700 drugs and metabolites.

A forensic autopsy is mandatory for deaths related to illegal narcotics. Autopsies are performed at the request of the police, and the most common cause of death in these cases is opioid poisoning.

"There's a particular risk of poisoning from opioid use because of the relatively narrow gap between an intoxicating dose to give a high and a fatal overdose," says Andersen.

An autopsy report also includes a description of death written by a forensic pathologist based on information from the police investigation. The description includes statements from the deceased's general practitioner and witnesses, and there is a description of conditions at the place of death, if available. By scrutinizing these reports, researchers have been able to study various determining factors related to fatal opioid poisonings, which cannot be collected from health data or cause-of-death registries.

Among other things, the study shows that people aged 15-34 are more likely to die from opioid poisoning while others are present at the address than people over the age of 44.

"In many cases, other people had seen the deceased asleep after taking the drug. It's important to speak up if you've taken opioids. Young people need to know that they should keep an eye on each other, and it's important that you don't just leave anyone who is sleeping if you suspect that they may have taken drugs—you have to wake them up," says Andersen.

The vast majority of people in the study over the age of 44 died alone.

The study also shows that, in fatal cases, the opioids were almost always taken in combination with other drugs, such as benzodiazepines, which are used to treat anxiety and sleep problems.

"It's important to communicate the risks of cocktail drug usage to all age groups, especially the use of sedatives or alcohol with opioids, as this can amplify their effects," says the researcher.

"Our study emphasizes the need for harm-reduction initiatives in both urban and rural areas. It's important to communicate the risks and warning signs of opioid use and to recognize sleep as a precursor to fatal poisoning, especially among younger age groups," says Andersen.

Still a lack of knowledge

The study was conducted in collaboration with Antidote Danmark, an NGO of doctors, nurses, and volunteers who provide information on how to recognize overdoses and stop opioid overdoses with an antidote nasal spray.

"There is generally very little knowledge about opioid abuse in Denmark," says Michael Lodberg Olsen, the general manager of Antidote Danmark. The organization has a wide range of contacts with drug communities, addiction centers, shelters, music venues, schools, and youth networks.

"It's particularly important to disseminate the results of the study to young people who use opioids or are in environments where this happens. It's crucial that they know the signs of poisoning. Because you can't save yourself from an overdose—someone else has to intervene," he says.

"The message from the authorities is: Say no to drugs. We stress: Don't do drugs alone. Now there's even more weight behind our words."

Facts—numbers from the study

• The study looked at autopsy reports on 327 people who died after poisoning with the opioids methadone and morphine in the period 2013-2020.
• The deceased came from one of four police districts: North Jutland, East Jutland, Central and West Jutland and Southeast Jutland.
• 92 of the 327 deceased were between 15 and 34 years old.
• 202 of the deceased (62%) died or were found dead in their own home.
• 68 people (21%) died or were found dead in another private home—most often on a bed or sofa.
• 210 (64%) were alone at the time of death, and the majority appeared unaffected by drugs when they were last seen alive.
• In 97 cases (30%), other people were at the same address when the death occurred.