Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines

• The number of Drug-related deaths (DRD) has gradually increased since 2002.
• Overdose of methadone in combination with benzodiazepines is predominant cause of DRD since 2011.
• Number of heroin-related death cases has declined noticeably.
• Results show, males are predominantly victims of DRD.
• Findings indicates that acute intoxications with medications from the group of benzodiazepines increase.

AimThe aim of the study is to assess the trends of overdose and drug related fatalities in the Republic of Macedonia during the 11 years.Material and methodsCross-sectional retrospective survey and reviewed of postmortem toxicological analyses which examined fatal poisonings with illegal drugs in years 2002–2013. Information about gender, age, drug consumption, reported years were analyzed. Narcotics were confirmed with toxicological semi quantitative fluorescence polarization immunoassay (FPIA) in urine (range 250–4000 ng/ml).ResultsTotal of 165 deaths were observed. Out of them 145 (87.9%) were male. There is statistical significant differences between male and female DRD due to age (Mann–Whitney U Test = 925, Z = −2626, p = 0.0087). For p < 0.05 there is significant differences between genders due to cause of overdose (Pearson Chi-square = 9743, df = 4, p = 0.0449). DRD among male were mainly because of overdose due to heroin in 80 (51.17%) cases followed by DRD due to combination of methadone and BZD in 25 (11.72%) cases. Out of all DRD cases 50 (30.3%) are related to polydrug use. For p < 0.01 there is a significant differences between analyzed age groups due to cause of overdose (Pearson Chi-square = 33,886, df = 12, p = 0.0007).ConclusionsDeath cause analysis reveals the difficulties in determining the role of substitution drugs, as many other factors may be involved. The findings also highlight the importance of further enhancing treatment interventions for benzodiazepine misuse among patients on methadone substitution treatment.