TRENDS IN POLY-DRUG AND COCAINE USE IN DRUG-RELATED DEATHS IN CAMPANIA DURING 2008 - 2014

The drug-related death is a phenomenon that, in the various geographical areas, can be characterized by significant differences in the incidence and prevalence of substances involved. The trends in the use of cocaine and of more than one drug among the drug related deaths in the Campania Region, since 2008 to 2014, were studied. The study regards n. 320 drug related deaths (94% males and 6% females) observed at the Forensic Toxicology Unit of the Second University of Napoli (SUN) – Italy, in the period 2008 - 2014. For each case, autopsy findings and all drugs detected were recorded. Moreover age, race/ethnicity, gender, place and circumstance of death were collected in order to study the territorial dynamics about demand and the supply of drugs. A systematic toxicological analysis (STA) for ethanol, illicit drug and pharmaceuticals has been applied on the biological specimens routinely collected at autopsy and all positive results were confirmed by a quantitative analysis performed by GC-HS (FID), GC/MS or LC-MS/MS. The toxicological results show that simultaneous use of multiple illicit drugs was responsible of the 56.9% of deaths. In these cases the cocaine was the most detected substance (75,2%) while as drug used alone is responsible only of the 4.7% of all deaths. Particularly in the last two years, the finding of methadone is increased from the 30.2% (2008-2012) to 50% of cases, among the deaths related to more than one substance. Conversely the prevalence of Cannabis that regarded 22.3% of deaths, during 2008-2012, is decreased to 14.3%. Furthermore the results about the different incidence, in the considered period, of opiates, ethanol, new drugs and amphetamines were investigated in both cases of poly-drug use and single-drug use. In the distribution by age and gender, males aged over to 40 years and women older than 35 years old, are prevalent. The territorial distribution of the deaths in the different surrounding areas and in the districts of the Naples city demonstrates that the 74% of deaths occurred in a place different from the usual residence. Our results show that among the drug related deaths, in Campania Region, trends in overall mortality reflect a prevalence of the poly-drug use with an increasing involvement of Cocaine and Methadone. Furthermore, the integration of toxicological findings with the other circumstantial data allowed to obtain a territorial map of the risks related to the supply and to the consumption of illicit drug.