Suicide by drug poisoning

This article is about suicide. For those at risk, there is a wide network of offers of help in which ways out are shown. In acute emergencies, the telephone counseling and the European emergency number 112 can be reached continuously and free of charge. After an initial crisis intervention , qualified referrals can be made to suitable counseling centers on request.

Suicide by poisoning with drugs (in the literature as ) (deliberate suicide by drugs / suicide with medication , suicide by self-poisoning with drugs and (suicide by) taking an overdose of drugs referred to, and with further descriptions) is a form of Suizides , wherein a person kills himself by deliberately overdosing on medication. In the Federal Republic of Germany around 13.7% of the recorded suicides are carried out through drug poisoning (as of 2013).

frequency

In the Federal Republic of Germany, deliberate self-poisoning with medication after hanging is currently the second most common suicide method of all fatal acts of suicide (status: surveys for the years 1998 to 2013). The number of all suicides carried out in this way has consistently exceeded 1000 cases per year in recent years (2011: 1,410; 2012: 1,323; 2013: 1,385). The official total number of people who died from suicide through self-poisoning with medication in Germany between 1998 and 2012 is 20,997 people. However, it is a difficult to appraising real figure to be included in the bill, because in this way committed suicide - unlike relatively straightforward suicide than to be identified actions such as self-shooting or hanging - are relatively often not recognized as such and therefore a relatively large number carried out in this way Suicides are mistakenly mistaken for accidents (disintentional suicide) or even natural deaths.

Suicide by self-poisoning with medication reached its highest prevalence in the recent past in 2003, in which 1,483 people died in this way in Germany. Since the turn of the millennium, the number of suicides completed in this way has stabilized at a level of more than 1,200 and less than 1,500 recorded deaths per year.

In terms of gender, self-poisoning is the second most common suicide method of women in Germany and that of men (after hanging and shooting ) the third most frequently chosen suicide method for completed suicides: In the years 2011 to 2013, 702 (2011), 635 ( 2012) 705 women and 708, 688, 680 men this way.

Medical knowledge and assessment

In the International Classification of Diseases and Related Health Problems (ICD), drug suicide is recorded under the codes E950 (9th revision, 1980) or - with more precise differentiation of various types of drugs - X62 to X64 (10th revision 2006).

Suicide by ingesting an overdose of medication is commonly classified in the literature as a "soft suicide method"; H. as a non-violent and (theoretically) low-pain suicide method used primarily by people whose death wish is associated with a rather low level of autoaggression .

Substances

Most often, people who attempt suicide with drugs use drugs that have a depressant effect on the central nervous system, as well as the analogue antipyretic paracetamol . According to the poison control centers, the latter was by far the most widely used drug in Germany in all (i.e. fatal and non-fatal) suicide attempts at least from 1997 to 2005 . Suicide attempts with antihypertensive drugs ( beta blockers , calcium channel antagonists , ACE inhibitors ) are also quite common . Among the antidepressants, tricyclic antidepressants in particular are often used as a means of carrying out suicide attempts: poisoning with tricyclic antidepressants is the second most common intoxication in adults with suicidal intent. Other drugs used to a significant extent are benzodiazepines , barbiturates and other sleeping pills.

Rarely do people indiscriminately resort to any drug that they currently have that they consider toxic. Suicide attempts with substances such as pesticides , antifreeze , solvents or other chemicals that are available to private individuals for the household, the garden or the hobby area are also rare .

A common scenario is that people attempt a suicide attempt in a combined manner using several different drugs or drugs in connection with alcohol . Acute consumption of paracetamol in combination with high percentage alcohol is a common suicide drug in England. According to surveys by the Federal Institute for Occupational Safety and Health , around 30% of all suicide attempts in Germany combine drugs with alcohol.

An occasionally occurring practice is that people who take a suicide with drugs, previously anti-emetic ( anti-emetics ) to take to ensure that the then occupied by them - i. d. Usually larger amounts of medication are not rejected by the body as a result of activation of the nausea (which often occurs when taking larger amounts of medication), but rather they remain in the body so that they develop their effect.

toxicity

Precise information about which dose of a certain drug is lethal (or which drugs in which combination with which dosages are lethal) can in most cases only be made with great restrictions. The reason for this is that the lethal or non-lethal effect of a certain amount of ingestion of a certain drug (or a drug combination) depends on a number of factors, such as age, height, physique, body weight, general constitution and health, individual susceptibilities or resistances etc. a. more depends on the person taking this drug.

Since it is hardly possible to collect definitive guide values ​​for the question of which dose of a drug is fatal by carrying out experiments with living people for reasons of medical ethics, research can generally only be based on data from the emergency wards of hospitals , in morgues and similar places through the assessment of people who died of drug suicides. The information basis on which such examinations of the deceased are based is naturally only very limited in most cases, since only the data can be collected that is derived from the corpse as such (above all from anatomical-physiological knowledge obtained from the inspection and / or autopsy of the body), while further information vital for gaining scientific knowledge (e.g. at what speed or at what time intervals what quantities of the ultimately fatal tablets were taken), due to the impossibility of such To obtain information from the deceased person (who is usually the only one to whom this information is known) often has to remain unexplained.

Euthanasia organizations as well as prominent advocates of the right to a self-determined death, such as Jean Amery , have, however, on various occasions, due to their practical work in this area or their detailed examination of the matter, data indices that tend to be valid on the question of which dosages of certain medications are the minimum doses must be taken so that there is a chance of a fatal effect, and which dosages practically always (ie cgs "definitely") cause death. There are relevant publications that compile the medical and toxicological findings on this question: The brochures A Guide to Self-Deliverance (published by Exit England 1981), How to Die with Dignity (Exit Scottland 1980), the Leitfaden L ' are known, for example. euthanasie légitimée of the Dutch Association for the Voluntary End of Life or the studies Let me die before I wake by Derek Humphrey and Helmlock's Book of Self-Deliverance for the Dying .

Claude Guillon , who became known as an advocate of the right to suicide , carried the guideline values ​​for lethal doses (LD) of in the 1980s in a cross-sectional analysis of medical, toxicological and forensic works dealing with the subject of suicide with drugs then (in France) common drugs from the relevant studies.

Situation in Germany

In Germany, a paraplegic woman submitted an application to the Federal Office for Drugs (BfArM) in Bonn in 2002 to provide her with a lethal amount of sodium pentobarbital to carry out a suicide. In 2017 the Federal Administrative Court ruled that in justified individual cases, seriously ill people may be provided with this drug or comparable drugs.

Prevention

To prevent suicides, many states in the past few decades have adopted regulations that reduce the quantity of many potentially fatal drugs contained in a single package to such an extent that they can all be taken in one package contained pills (or other administration media contained in a pack) is not sufficient to concentrate the potentially lethal active ingredient of the drug in question in the body to such an extent that there is a risk of a lethal effect.

Complementary to this, doctors and pharmacists have been encouraged for a number of years to counteract the existence of a sufficient quantity of drugs or drug packs in the hands of people at risk of suicide by prescribing or dispensing drugs with caution. This is done by advising doctors that if they consider it necessary for a patient to take a dangerous drug for an extended period of time, not to prescribe the drug in question to that patient en bloc by not prescribing for a large one Issue number of packs, but only prescribe prescriptions for individual (or at least a few) packs and only issue prescriptions for further packs after the pack in question has been used up. Accordingly, pharmacists are advised to limit themselves when handing hard drugs to customers to handing over only a few or a few packs to customers in a transaction and to refrain from handing over a large number of packs at once.

This prescribing and dispensing practice is therefore intended to prevent the conscious accumulation (hoarding) of drugs that are fatal in large quantities, or to prevent people who spontaneously fall into a suicidal mood from being able to take short-circuit actions to commit because there are correspondingly large amounts of medication in their hands.

In many Western countries, different types of prescription drugs that were frequently used to commit suicide in earlier years (after being prescribed for other purposes) are now being prescribed far less than in the past due to changes in prescribing recommendations or guidelines. Some drugs that used to be prescribed frequently are no longer prescribable. The barbiturate veronal, sold as a sleeping pill, was often used for suicides until it was "taken out of circulation" in the 1950s (for example by Nelly Neppach or Stefan Zweig ). Since the turn of the millennium, the legal availability of barbiturates as a group of drugs has been massively reduced due to addiction and suicide considerations. Largely parallel to this, however, there has been a trend since the beginning of the Internet age that the difficult availability of such drugs is circumvented legally with the help of the Internet by purchasing them from foreign Internet pharmacies that offer them without a prescription, with the result that barbiturates continue to be used with a not inconsiderable frequency to carry out suicides.

The pack units of some drugs available without a prescription have also been reduced to smaller doses in order to prevent suicidal drug concentrations in the hands of susceptible persons: for example, the number of tablets contained in a standard package of paracetamol in Great Britain was reduced in 1998 to the amount of To reduce the amount of this drug contained in a pack. Ireland and France followed suit in the early 2000s . In Germany, a corresponding reduction in the number of pills contained in a pack of paracetamol was carried out at the instigation of the Ministry of Health in 2009. An evaluation by the Medical Journal from 1998 to 2009 came to the conclusion in 2013 that the number of suicides and unexplained deaths in Great Britain had fallen by 43% in the eleven years after the limit of the pack size, so that it has fallen in England and Wales Compared to the previous period there was an estimated 765 fewer deaths from paracetamol overdoses.

literature

• Pieter Admiral et. al: Guide to a Humane Self-Chosen Death , Delft 2006. ( digitized version )
• JJ Card: Lethality of Suicide Methods and Suicide Risk. Two Distinct Concepts , in: Omega , 5, pp. 37-45.
• K. Hawton / S. Simkin S / D. Gunnell / L. Sutton / O. Bennewith / P. Turnbull / N. Kapur: A Multicentre Study of Co-Proxamol Poisoning Suicides Based on Coroners' Records in England , in: British Journal of Clinical Pharmacology , Vol. 59, pp. 207-212.
• Kanchan / RG Menezes: Suicidal Poisoning in Southern India. Gender Differences , in: Journal of Forensic Legal Medicine , 15 (1), 2008, pp. 7-14
• N. Kapur / P. Turnbull / K. Hawton / S. Simkin / L. Sutton / K. Mackway-Jones / O. Bennewith / D. Gunnell: Self-poisoning suicides in England: A Multicentre Study , in: Quarterly Journal of Medicine , 98, 2005, pp. 589-597.
• N. Kapur / P. Turnbull / K. Hawton / S. Simkin / K. Mackway-Jones / D. Gunnell: The Hospital Management of Fatal Self-Poisoning in Industrialised Countries: An Opportunity for Suicide Prevention? , in: Suicide and Life-Threatening Behavior , 36, pp. 302-312.
• Ronald W. Maris: Pathways to Suicide. A Survey of Self-Destructive Behaviors , Johns Hopkins University Press, Baltimore 1981.
• JL McIntosh: Methods of Suicide , in: RW Maris / AL Berman // JT Maltsberger / RI Yufit (eds.): Assessment and Prediction of Suicide , New York 1992, pp. 381-397.
• Ronald W. Maris / Alan Lee Berman / Bruce Michael Bongar / Morton M Silverman: Suicide Attempts and Methods , in: Comprehensive Textbook of Suicidology , New York 2000, pp. 284-308.
• S. Simkin / K. Hawton / L. Sutton / D. Gunnell / O. Bennewith / N. Kapur: Co-proxamol and Suicide: Preventing the Continuing Toll of Overdose Deaths , in: Quarterly Journal of Medicine , Vol. 98, 2005 , Pp. 159-170.
• K. Smith / RW Conroy / BD Ehler: Lethality of Suicide Attempt Rating Scale , in: Suicide and Life-Threatening Behavior , 14, pp. 215-242.
• A Weisman / WJ Worden: Risk-Rescure Rating in Suicide Assessment , in: AT Beck / HLP Resnik / DJ Lettieri (eds.): The Prediction of Suicide , 1974, pp. 193-213.

Individual evidence

1. ↑ Of 10,076 recorded suicides in Germany in 2013, 1,385 were carried out through self-poisoning with medication, see: National Suizid Prevention Programm für Deutschland: Suizide in Deutschland 2013 .
2. ^ National Suizid Prevention Program for Germany: Suizide in Deutschland 2011 ; National Suicide Prevention Program for Germany: Suizide in Deutschland 2012 ; National Suicide Prevention Program for Germany: Suizide in Deutschland 2013 .
3. ↑ pack size. Paracetamol suicide attempts, article in focus .
4. ↑ Compendium of drug pain therapy effects, side effects and possible combinations , Vienna 2000, p. 8.
5. ↑ suicide risk , in: Pharmaceutical newspaper 17/2012.
6. ↑ Manfred von Lewinski: Freedom to Death? Approaches and impulses. P. 57; Ingo Wirth / ´, Hansjürg Strauch: Forensic medicine: basic knowledge. 2006, p. 247 ("So that the swallowed tablets are not vomited, the additional use of anti-vomiting agents (antiemetics) can occasionally be determined.")
7. ^ After Claude Guillon: Suicide, mode d'emploi: Histoire, technique, actualité , éd. Alain Moreau, Paris 1982, chapter 10.
8. ↑ Christian Rath: BVerwG on patient rights: suicide on prescription. In: taz.de . March 2, 2017, accessed October 7, 2018 . 
9. ↑ Simone Kaiser: “Ultimate Way Out”. In: Spiegel Online . October 30, 2012, accessed October 7, 2018 . 
10. ^ Pieter Admiraal et al .: Guide to a Human Self-Chosen Death. Delft 2006.
11. ↑ K. Hawton / E. Townsend / J. Deeks / L. Appleby / D. Gunnel / O. Bennwith / J. Cooper: Effects of Pack Legislation Restricting Pack Sizes of Paracetamol and Salicylates on Self-Poisoning in the United Kingdome. Before and after Stuy , in: British Medical Journal , 2001, Vol. 322, pp. 1203-1207; K. Hawton / H. Bergen / S. Simkin / S. Dodd / P. Pocock / W. Bernal / D. Gunnell / N. Kapur: Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyzes , in: British Medical Journal , 2013, vol. 346
12. ↑ Package size: Suicide attempts with paracetamol , Focus of March 17, 2008
13. ↑ Smaller packages save hundreds of lives , Spiegel Online from February 8, 2013

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