[Multidisciplinary meetings determining the imputability of xenobiotics in causes of death: What contribution to pharmacovigilance data?]

Abstract

Purpose: In case of xenobiotics induced toxic deaths analyzed at the university hospital of Rennes, a multidisplinary team of forensic analysts, toxicologists, anatomopathologists and pharmacologists assess xenobiotics' contribution to the death.

Methods: A death contribution score (SCRIM) is collectively established during meetings for each death involving xenobiotic drugs. Graded between 1 and 6, lower was this score, more certain was the imputability. Among deaths with the highest imputability, drug poisonings were isolated.

Results: Analysis of 266 deaths presented at meetings over the period 2010-2017 highlight a lot of drug medicine poisonings (60%). The main classes implicated are: opioid substitution treatments (24%) followed by anxiolytics (23%), antidepressants (16%), legal opioids (16%) and antipsychotics (14%). Analysis of these cases by Rennes regional pharmacovigilance center permits to obtain a qualitative signal by establishing a local overview of the main risk classes but also to highlight a specific signal, in particular for oxycodone and antihistamines.

Conclusions: This multidisciplinary approach shows that a majority of toxic deaths are attributed to drugs. Mortality attributed to oxycodone and antihistamines is a specific signal that should be closely monitored.

Keywords: Analyse médicolégale; Antihistaminiques; Cause of death; Causes de la mort; Forensic toxicology; Histamine antagonists; Opiacés; Opiates; Pharmacovigilance; Xenobiotics; Xénobiotiques.