The role of benzodiazepines in elderly suicides

Abstract

Aims: In Sweden, suicides by drug poisoning have decreased in the population at large during the past two decades. However, drug poisoning suicides increased among the elderly during this period. Suicides by benzodiazepine poisoning increased in this age group despite a reduction in prescription sales of these drugs. This study aims therefore to determine the role of benzodiazepines in suicide late in life. Methods: Information concerning all definite suicides and deaths due to ``undetermined'' causes recorded among Swedish citizens aged 65 and above during 1992 - 96 was obtained from the Cause-of-Death Register. Death certificates were scrutinized to determine the type of drug employed in drug-related suicides. Results of the post mortem screening for drugs and alcohol were then examined. Results: A benzodiazepine was implicated in 216/548 (39%) of the drug poisoning suicides recorded among the elderly. Death certificates revealed that a benzodiazepine was the sole agent in 72% of these cases. Flunitrazepam or nitrazepam were implicated in 90% of the single benzodiazepine suicides. In addition to the suicides classified as drug poisonings, 82 cases were found in which a drug may have contributed to the cause of death. Benzodiazepines predominated. The terminal cause of death was drowning, often in the victim's own bathtub, in three-quarters of these cases. The annual fatality ratios for the newer benzodiazepine-like hypnotics zopiclone and zolpidem appear to be on the rise. Conclusion: Benzodiazepines, especially the hypnotics flunitrazepam and nitrazepam, are common in drug poisoning suicides in the elderly and should be prescribed with caution for this age group.

Keywords

benzodiazepine drug poisoning elderly suicide.

Get full access to this article

View all access options for this article.

References

Isacsson G.

Suicide prevention - a medical breakthrough?

Acta Psychiatr Scand 2000; 102: 113 - 17.

Coleridge J. , Cameron PA , Drummer OH , McNeil JJ Survey of drug-related deaths in Victoria . Med J Aust 1992; 157: 459 - 62.

Buckley NA , Whyte IM , Dawson AH , McManus PR , Ferguson NW Self-poisoning in Newcastle, 1987 - 1992. Med J Aust 1995; 162: 190 - 3.

Michel K. , Arestegui G. , Spuhler T. Suicide with psychotropic drugs in Switzerland. Pharmacopsychiatry 1994; 27: 114 - 18.

Mendelson WB , Rich CL Sedatives and suicide: the San Diego study. Acta Psychiatr Scand 1993; 88: 337 - 41.

Serfaty M. , Masterton G. Fatal poisonings attributed to benzodiazepines in Britain during the 1980s . Br J Psychiatry 1993; 163: 386 - 93.

Isacsson G. , Holmgren P. , Druid H. , Bergman U. Psychotropics and suicide prevention. Implications from toxicological screening of 5281 suicides in Sweden 1992 - 1994. Br J Psychiatr 1999; 174: 259 - 65.

Ericsson H. , Holmgren P. , Jakobsson S. , et al. Benzodiazepine findings in an autopsy series. A study showing interacting factors at death in fatal cases. Läkartidningen 1993; 90: 3954 - 7 (English summary).

Drummer OL , Ranson DL Sudden death and benzodiazepines. A J Forensic Med Pathol 1996; 17: 336 - 42.

10.

Carlsten A. , Waern M. , Allebeck P. Suicides by drug poisoning among elderly in Sweden 1969-1996. Soc Psychiatry Psychiatr Epidemiol 1999; 34: 609 - 14.

11.

Nordic statistics of medicines 1993-1995. Nordic Council of Medicines, NLN publications No 43. Stockholm: NLN 1996.

12.

Järbrink K. , Carlsten A. , Frederiksen S-O. Swedish physicians' inclination to prescribe benzodiazepines: differences between regions and characteristics of the prescriber . Scand J Public Health 1999; 1: 22 - 9.

13.

Burman K. Swedish drug sales statistics (Svensk Läkemedelsstatistik) 1997. Stockholm: Apoteket AB 1998.

14.

ATC Index with DDDs 1997 . WHO Collaborating Centre for Drug Statistics Methodology. Oslo: WHO, 1996.

15.

Öhberg A. , Lönnquist J. , Sarna S. , Vuori E. , Pentilla A. Trends and availability of suicide methods in Finland. Proposals for restrictive measures. Br J Psychiatr 1995; 166: 35 - 43.

16.

Jonasson B. , Jonasson U. , Saldeen T. Suicides may be overreported and accidents underreported among fatalities due to dextropropoxyphene. J Forensic Sci 1999; 44: 334 - 8.

17.

Öhberg A. , Lönnqvist J. Suicides hidden among undetermined deaths. Acta Psychiatr Scand 1998; 98: 214 - 18.

18.

Druid H. , Holmgren P. , Ahlner J. Flunitrazepam: an evaluation of use, abuse and toxicity. Forensic Sci Int 2001; 122: 136 - 41.

19.

Druid H. , Holmgren P. A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci 1997; 42: 79 - 87.

20.

Large RG , Epston A. , Kirker JM , Kydd RR Self poisoning: who supplies the drugs? 100 examples. N Z Med J 1980; 91: 218 - 21.

21.

Alsén M. , Ekedahl A. , Löwenhielm P. , et al. Medicine, self-poisoning and the source of drug in Lund, Sweden . Acta Psychiatr Scand 1994; 89: 255 - 61.

22.

Öhberg A. , Vuori E. , Ojanpera I. , Lönnqvist J. Alcohol and drugs in suicides. Br J Psychiatr 1996; 169: 75-80.

23.

Dåderman A. , Lidberg L. Flunitrazepam should be classified as a narcotic . Läkartidningen 1999; 96: 1005 - 7(English summary).

24.

Harwood DM , Hawton K. , Hope T. , Jacoby R. Suicide in older people: mode of death, demographic factors, and medical contact before death. Int J Geriatr Psychiatry 2000 ; 8: 736 - 43.