Pattern of benzodiazepine use among death cases in Republic of North Macedonia

Abstract

The aim of this study was to determine the pattern of benzodiazepine related deaths in Republic of North Macedonia. Retrospective survey of post-mortem toxicology data from eight-year period, obtained from Laboratory of Forensic Toxicology was performed, including cases with known gender, age, cause and manner of death and complete toxicology report. Post-mortem toxicology analyses were conducted with Fluorescence Polarization/Enzymatic Immunoassay and Biochip Array Technology method for screening of urine and blood respectively, and confirmation by GC-MS after solid phase extraction. Total of 1169 cases were investigated. Benzodiazepines were detected in 30.05% of the cases, with statistically significant difference between cases of natural and of violent cause of death, as well as between genders, but without statistically significant difference due to the age between both genders. Study revealed women were more likely to use benzodiazepines with the median age to be 52.88 and 49.87 for males and females, respectively. According to post-mortem toxicology data benzodiazepines are the most used drugs in our country. Of them, diazepam was found to be the most often used one. Data analyses have shown that benzodiazepines were often combined with alcohol, psychoactive medicines and drugs of abuse. In 46.6% of all cases with positive findings for benzodiazepines, use of drugs of abuse was detected, mostly heroine and methadone. Important note should be given to the simultaneous use of benzodiazepines with heroine and methadone, which have resulted in increased number of fatal intoxications. Further studies are needed to determine the reason for popular use of benzodiazepines among drug addicts.