Patterns of psychoactive substance detection from routine toxicology of suicides in Mobile, Alabama, between 1990 and 1998

Background: Postmortem toxicology can be useful for reconstructing some cli nically important events occurring before a suicide. Its utility may be imp roved by examining patterns of detected substances in a population over tim e. Methods: Toxicology was performed fur 333 (96%) of the 346 suicides occu rring in Mobile County, Alabama, between October 1990 and September 1998. D etected psychoactive substances were grouped in three categories: alcohol, cocaine, and cannabis; abusable prescription medications; and non-abused ps ychotropic medications. The overlap between these three categories was asse ssed. Results: Psychoactive substances were detected in 227 (68%) of 333 su icides. Of the cases positive for any prescription psychoactive medication, 2/3 were positive for an abusable medication. An abusable substance was fo und in 56% of cases positive for non-abused psychotropic medication. Alcoho l, cocaine and/or cannabis were found in 34% of cases with abusable prescri ption medications and in 33% with non-abused psychotropics. Limitations: Cl inicians must be aware of a number of methodological realities when interpr eting routine postmortem toxicology results. Conclusions: Routine surveilla nce of psychoactive substances among suicides can provide useful data for d irecting and monitoring strategies for suicide prevention in clinical pract ice. (C) 2001 Elsevier Science B.V. All rights reserved.