Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016

Background: Poly drug use is a public health threat causing morbidity and mortality all over the world.Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analyticalstudy, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.Methods: All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran duringthe 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, andprescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquidchromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicologylaboratory. Manner of death, demographic characteristics, and different drug categories in postmortemsamples were analyzed.Findings: A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period.Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16.Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highestcategory for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol(n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.Conclusion: The present study provides information about poly drug use-associated deaths in Tehran andhighlights the major role of substance abuse in death