Basic Principles Epidemiology

Most deaths due to chronic illicit drug abuse involve the consumption of opiates. The increase in the number of drug deaths in Europe and the USA is due mainly to the increase in the number of intravenous drug addicts. At present, the annual number of drug-related deaths is approximately 2,000 in Germany (Deutsches Bundeskriminalamt - cf. Oehmichen 1997) and 5,000 in the USA (Drug Abuse Warning Network). As there is no international agreement on the definition of a drug-induced death, the epidemiological data of different countries are not comparable. The German statistics include deaths classified according to the following criteria (Oehmichen and Staak 1988):

1. Direct toxic effect of the drug or its metabolites (accidental or suicidal overdose).

2. Direct toxic effect of adulterants or extraneous substances injected along with the drug.

3. Infections as a complication of the drug culture life-style including needle sharing or depressed immune function (Novick et al. 1989).

4. Death of a drug addict due to causes having no direct connection with drug consumption.

Fig. 19.1a-d. Ischemic encephalopathy in chronic drug addicts. lateral white matter softening as an indication of demyelination; a Cerebral cortical atrophy in a 20-year-old man who survived d bilateral pallidum necroses an acute drug intoxication for <5 h. b Cerebellar atrophy; c bi-

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