onsdag 2 oktober 2013

Can we trust the Swedish forensic data - especially when it comes to Propoxyphene - Darvon & Darvocet?

Part 1

The answer is an unequivocal YES - at least when we talk about the years from January 1st, 1992 - to date.

The Swedish forensic organization - the National Board of Forensic Medicine – was formed on July 1st 1991. And from January 1st 1992 a new and very modern authority was introduced, which also focused on the latest research regarding such as the best toxicological methods to both regain that measure actual blood sample of the deceased and thus be able to determine what a person may have been poisoned to death by.

The feature of the new organization was that all forensics data would be under one authority, ie a comprehensive legislation would apply to all who belonged to forensic medicine.

The National Board of Forensic Medicine is an agency that works actively to ensure justice in Sweden. Legal issues of right and wrong cannot be resolved on dubious grounds: they must have a solid basis in fact. Additional facts can often be provided through expert analyses and assessments performed by chemists, biologists, doctors, psychologists and counsellors. All this expertise has been accumulated in a single public agency – the National Board of Forensic Medicine.

The blood sampling came to be a very important contribution, which meant that a blood sample would be taken of the deceased as soon as possible on the closest legal medical department - and that blood would be tested against all the medicines - legal drugs - pre-scribed drugs by doctors plus alcohol.

If police or prosecutors wanted to know about the deceased person had narcotic drugs, such as morphine, heroin, amphetamines, or anything else that was not allowed in the blood - the blood sample were checked against these illegal substances.

These fairly simple rules have proven to be very reliable. The blood samples were collected on roughly 90% of the deceased persons, some very young and some very old could sometimes be missing.

The Swedish forensic system has been widely appreciated worldwide. Similar systems have the other two Scandinavian countries Norway and Denmark.

Do I trust the American legal medical system?

Not to the same degree as the Swedish system, but Forensic data in U.S. is getting better nowadays, but still there are major deficiencies in some of the current players. I will briefly describe forensic system in US.

In US there are two different systems in the Forensic Medical world – The Medical Examiners and The Coroner system. It is also very important to mention that there are some 3,400 counties in US – and that makes it more complicated.

The Medical Examiners is an organization with significantly higher trained physicians than The Coroners and that puts more emphasis at forensic examinations, blood test and so on.

The Coroners are investigators more than Medical Doctors, and usually MD's are very important to decide the cause of death.... 

The Swedish Forensic MD's are very well educated, first they are MD´s, then they have several years of special training and after that there are quite many MD´s that also take a PhD

In our work we have used a lot of data from FDLE - The Florida Department of Law Enforcement - and these data are available for those who wish to receive them through FDLE's web-site.

Most of the data is good, a lot of even very good, but when it comes Propoxyhene we found some serious flaws.

In Florida lived an average of 16,363,000 persons under the years that we examined. During the years 2000, 2001 and 2002, there was not one single case of Propoxyphene of the investigated deaths.

During the same years (2000 - 2002), the consumption of Propoxyphene in the US were Year:

2000              98,670 kg,
2001              97,208 respective
2002              110,041 kg (total for three years, 

the total consumption was:

Total              305,900 kg.

(Data from the INCB - The International Narcotic Control Board in Vienna, an organization under the WHO - World Health Organization).

Under the three years (2000 - 2002) large amounts of Propoxyphene were written out. 

In 2000 it was   27 001,000 prescriptions,
In 2001 it was   27 315,000 prescriptions and
In 2002 it was   25 197,000 prescriptions.

Total              79 513, 000 prescriptions for three years, an average of 26 504,000/year.

In conclusion, it is consumed very large quantities of Propoxyphene during the three years mentioned, the number of prescriptions was very high.

Something has obviously missed when there were no people at all who had Propoxyphene in the blood at the death. However, the following year, the staff began measuring Propoxyphenet ...

Ulf Jonasson, Doctor in Public Health
Birgitta Jonasson, Ph D


1). Data from the National Board of Forensic Medicine. (Sweden). 

2). Data from INCB – International Narcotic Control Board – consumption figures about DXP during the years 1982 – 2010. (Vienna, Austria). http://bit.ly/SFIIop

3). Data from DrugTopics, we use data from “Top 200 Generic Drug by Prescription from the years 2000 – 2011 about DXP. (US). http://bit.ly/19f5w8H

to be continued….

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