Trend of Methamphetamine (Shyshe) associated death in Tehran province, between 2018-2019

Background: Methamphetamine use is a major public health problem since its ascent to peak popularity in Iran. Iran s Drug Control Headquarters confirms that methamphetamine seizure is increasing year by year. Methamphetamine is the most popular and abused amphetamine type stimulants in Iran. United Nations Office on Drugs and Crime (UNODC) reported that although opiates remain drug of abuse, methamphetamine use has emerged as one of the drugs of concern in recent years in Iran. Despite the increase in methamphetamine use in Iranian population, few studies have examined the toxicology of methamphetamine associated deaths. The present study aimed to assess methamphetamine-associated deaths in Tehran, Iran.Methods: A cross sectional analytical study was designed. The study drew on death certificate records from 21March2018 through 20March2019. All methamphetamine associated deaths were included in the study. Postmortem samples had been analyzed in Forensic Toxicology Department using high performance liquid chromatography (HPLC), gas chromatography/mass spectrometry (GC/MS) and headspace gas chromatography (HSGC) for the detection and confirmation of the presence of methamphetamine and other licit and illicit drugs and also poisons.Results: Results of the present study showed that methamphetamine-associated death rate was 2.49 per 100,000 population of Tehran province, Iran in 2018-2019. In other words 299 cases of methamphetamine-associated deaths were explored in one year. Most number of deaths were in male (93.6%) in the early thirties (41-45 years old). The most common manner of death was toxicity due to polydrug use (168 cases, 74.6%). Only 81 deaths were attributed solely to methamphetamine. In the majority of cases substances other than methamphetamine and its primary metabolite, amphetamine were detected in postmortem samples. Most frequently detected drugs were opium alkaloids, methadone, tramadol, tricyclic antidepressants and selective serotonin reuptake inhibitors. The most prominent cause of death was acute respiratory distress and cardiovascular complications, and ischemic heart disease in particular.Conclusion: Results of the present study raise attention of the public health to the dangerous use of illicit drugs with the need for strict regulatory policy to restrict access to control drugs.

Keywords:

Methamphetamine , street drugs , forensic toxicology , cause of death , myocardial ischemia