A study highlights the close relationship between alcohol, drugs and violence

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A study highlights the close relationship between alcohol, drugs and violence





A study highlights the close relationship between alcohol, drugs and violence


A group of researchers from the Faculty of Medicine of the University of São Paulo (USP), in Brazil, published the results of a study regarding the association between alcohol and drug consumption and violent deaths.



It is a job that gives figures to this relationship, in São Paulo in this case, the largest Brazilian city. The discovery indicates that the consumption of alcohol or at least one type of drug is associated with more than half (55%) of the violent deaths that occurred in the city between 2014 and 2015.



This work is the result of the postdoctorate of the epidemiologist Gabriel Andreuccetti, under the supervision of Professor Heráclito Barbosa de Carvalho, of the Department of Preventive Medicine of the School of Medicine of the USP, in collaboration with the Department of Legal Medicine of the same university and with the University of California at Berkeley, and with the support of the Medical Legal Institute (IML) of São Paulo. And an article referring to it, which had the support of the Foundation for Support of Scientific Research of the State of São Paulo - FAPESP, was published in the newspaper Injury.



In order to obtain the data for the realization of the study, Andreuccetti used a probabilistic sampling method in which he used the city of São Paulo as a white population.



"The sampling cases were adult victims, fatally wounded, who had cause of sudden, unexpected, violent or otherwise unnatural death, and who entered the main forensic medical facilities that serve the entire city and its 96 districts", declared.







Consumption of alcohol. (Photo: Marcos Santos / USP Imagens)



According to the legislation, victims of sudden, unexpected or violent deaths must be subjected to an autopsy procedure by the legal medical expert teams (EPML). Annually, there are about 7,000 deaths that fall within this classification in São Paulo. Most of them are homicides (26%), followed by deaths related to traffic (20%) and suicides (10%).



The work regarding the study of cases of violent deaths occurred between June 2014 and December 2015. To obtain a representative sample of the city, Andreuccetti collected blood samples from cadavers during autopsies in charge of the various EPMLs in the city, in different days and at different times of the week, over the course of 19 months.



Victims who received six or more hours of medical treatment due to the causal event of injuries or who survived during the same period of time before death were excluded from the sample.
"There is a large number of cases of people who enter the hospitals and end up in the Legal Medical Institute. In many of these cases, the fatal injuries occurred violently or suddenly, and the victims may have been under the effects of drugs at the time of accidents, crimes or suicides. However, because they go through hospitalization for more than six hours, traces of alcohol and drugs in the blood can be influenced after traumatic events. These cases were excluded from the study, "said Andreuccetti.



The final result of the investigation delimited a sample with 365 deaths, all violent, sudden or unexpected, that entered the IML. Said sample gathered 104 homicides (28.5% of the total), 56 victims of traffic accidents (15.3%), 44 suicides (12.1%), 26 falls (7.1%) and 21 cases of poisoning or poisoning (5.8%). In 114 cases (31.2%), sudden or violent deaths occurred in different ways than before.



"Due to diverse governmental actions carried out at the beginning of this decade (2010), the mortality in the transit of São Paulo was considerably reduced, together with the mortality due to homicides, which has been falling since the last decade. At present, the death rate due to homicides is higher than that of traffic. But São Paulo is an atypical case. In Brazil in general, these fluctuations were much lower, and many deaths continue to be recorded for these two causes, "said Andreuccetti.



Once the situations in which the deaths occurred were established, the next step was to identify which of them had traces of alcohol or drugs in their blood. For this, the blood samples of all the victims were subjected to a vast screening of the positive cases for a variety of drugs, illicit drugs and alcohol.



The concentration of alcohol in the blood was verified (via gas chromatography), as well as the presence of other drugs including amphetamines, sedatives (tranquilizers) and anxiolytics (barbiturates and benzodiazepines), marijuana, cocaine, opiates (methadone, morphine, heroin) and angel dust (phencyclidine). The presence of drugs in the blood was detected by enzyme-linked immunosorbent assays (ELISA), subsequently confirmed by mass spectrometry.



Of the 365 victims, 202 (55.3%) had ingested alcohol before they died or were under the effects of drugs at the time of death, and 63 of them only ingested alcohol, 92 only used drugs and 47 did both.



"Of every two victims, one showed traces of alcohol and / or drugs in the blood. This means that more than half of the victims used alcohol or drugs immediately before they died, "said Andreuccetti.
Alcohol was the most prevalent substance among victims who made use of some type of psychoactive substance, followed by cocaine, marijuana and tranquilizers and anxiolytics. More specifically, among the 202 positive victims for alcohol and / or drugs, 30.1% ingested alcohol, 21.9% cocaine, 14% marijuana and 11.5% benzodiazepines. 16.2% ingested alcohol and some of those drugs.



"We did not expect such a high prevalence of drugs in the sample. Of every five victims who used drugs, four consumed cocaine or marijuana. This is a worrying fact, "said Andreuccetti.
In the cases of victims of traffic accidents, almost half (42.9%) had traces of alcohol in the blood and one in five (21.4%) was under the effect of one or more substances. "This shows that drugs influence more on interpersonal violence and alcohol more on traffic accidents," said Andreuccetti.



With regard to homicides, no less than 59.6% of deaths reported the presence of some psychoactive substance or alcohol in the blood, and 16.3% of alcohol and cocaine together.



Regarding cases of suicides, alcohol had the lowest representation of the entire sample. Only 9.1% of the suicides had ingested alcohol. On the other hand, in this group the use of benzodiazepines was revealed as one of the most prevalent. One in five victims was under the effect of those medications (18.2%).



positive for the use of alcohol or drugs, there were nine men for each woman. And about one in three victims was under 30 years old. "In that strip, the largest number of homicide victims in Brazil is concentrated. And it was in this age group that there was a higher prevalence of the use of other drugs, in combination or not with alcohol, "said Andreuccetti.



Ethnic participation was similar: half of the dead corresponded to whites (50.3%) and the other half (49.7%) was composed of individuals of other ethnic groups (mulattoes, blacks, etc.). 60.5% of deaths occurred between six in the afternoon and six in the morning. He dies violently more at night than during the day in the city of São Paulo.



A revealing data indicates that, of the 365 deaths, 15.9% of the victims had some criminal history. Among these, the use of other drugs in addition to alcohol and the multiple use of substances were greater than among victims who did not have a criminal record.



Whenever possible, Andreuccetti sought to quantify the victims according to the place of occurrence of the fatal injury. This was verified by verifying the region of the city where the injury event occurred. In this way it was inferred that the majority of deaths due to violence under the influence of drugs occurs in the center and in the periphery, that is, where the largest centers of commerce and the low-income population are concentrated, respectively.



"This suggests that there is a socioeconomic component; However, to know more about it, it would be necessary to carry out a specific study. On the other hand, the use of alcohol associated with these deaths seems to be more widespread throughout the city of São Paulo, "said Andreuccetti.



According to the epidemiologist, the knowledge of these statistics constitutes an important step to try to begin to reduce the numbers of violent deaths related to the consumption of alcohol and drugs in the city of São Paulo and in other large cities of Brazil.



"All these deaths cause a huge loss to society in terms of hospital services and emergency relief; and what to speak of the pain of relatives and the meaning of the loss of a person who could continue working, studying and producing, caused by violence, "he said. (Source: AGENCIA FAPESP / DICYT)

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