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Drug Alcohol Depend. 2019 Aug 1;201:253-259. doi: 10.1016/j.drugalcdep.2019.04.022. Epub 2019 Jun 25.

Opioid-related deaths and previous care for drug use and pain relief in Sweden.

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Department of Clinical Neuroscience, Karolinska Institute, Götgatan 83E, SE-11662 Stockholm, Sweden. Electronic address:
Department of Surgical Sciences, Section for Forensic Medicine, Uppsala University, Box 1024, SE-75140 Uppsala, Sweden. Electronic address:
Department of Public Health and Caring Sciences, Section for Social Medicine, Uppsala University, Box 564, SE-75122, Uppsala, Sweden. Electronic address:
Former National Institute of Public Health, Götgatan 83E, SE-11662 Stockholm, Sweden. Electronic address:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. Electronic address:



In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.


We included 2834 forensically examined individuals (ages 15-64 years) that died of poisoning in Sweden in 2006-2014. For each death we acquired data on previous opioid prescriptions and SUD treatments. We compared three study groups: pain control (n = 788); a SUD treatment group (n = 1629); and a group with no prescription for pain control or SUD treatment (n = 417).


Overall fatal poisonings increased from 2.77 to 7.79 (per 100,000 individuals) from 2006 to 2014 (relative 181% increase). Fatal poisoning increased from 2006 to 2014 by 269% in the pain control group (0.64 to 2.36 per 100,000) and by 238% in the SUD treatment group (1.35 to 4.57 per 100,000). Heroin-related deaths remained constant; consequently, the increase was likely attributable to prescription opioids.


A rapid increase in deaths attributable mainly to prescription opioids for pain control, was reported previously in the United States. Our study indicated that increased access to prescription opioids might contribute to higher death rates also in Sweden among patients seeking pain control and individuals with an established SUD; however, deaths related to prescription opioids mainly occurred among those with SUDs.


Epidemiology; Fatal poisoning; Mortality; Opioid dependence; Prescription opioids

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