Patterns of psychoactive substance detection from routine toxicology of suicides in Mobile, Alabama, between 1990 and 1998

Background: Postmortem toxicology can be useful for reconstructing some clinically important events occurring before a suicide. Its utility may be improved by examining patterns of detected substances in a population over time. Methods: Toxicology was performed for 333 (96%) of the 346 suicides occurring in Mobile County, Alabama, between October 1990 and September 1998. Detected psychoactive substances were grouped in three categories: alcohol, cocaine, and cannabis; abusable prescription medications; and non-abused psychotropic medications. The overlap between these three categories was assessed. Results: Psychoactive substances were detected in 227 (68%) of 333 suicides. Of the cases positive for any prescription psychoactive medication, 2/3 were positive for an abusable medication. An abusable substance was found in 56% of cases positive for non-abused psychotropic medication. Alcohol, cocaine and/or cannabis were found in 34% of cases with abusable prescription medications and in 33% with non-abused psychotropics. Limitations: Clinicians must be aware of a number of methodological realities when interpreting routine postmortem toxicology results. Conclusions: Routine surveillance of psychoactive substances among suicides can provide useful data for directing and monitoring strategies for suicide prevention in clinical practice.