{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T18:39:34Z","timestamp":1762540774833,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011\u20132015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD \u00b1 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (n = 27, 64.3%) followed by accidents (n = 15; 35.7%). Among the suicide cases, alcohol was the main substance used (33.3%) followed by opioids (25.9%). A total of 58.5% (n = 24) deaths occurred within a year of their last visit while 41.5% (n = 17) were dead more than a year after their last visit. Of the total cases (n = 41), 63% had a history of mental illness with depressive disorder (53.8%) being the most common. History of suicide attempts were reported in 34.1% (n = 14) of cases and 50% of the subjects (n = 21) had a history of suicidal ideation. Drug related offences were reported in 57.1% of the subjects, of which 60% (n = 18) committed suicide. The findings support the need for appropriate treatment resources to reduce the untimely deaths among substance users.<\/jats:p>","DOI":"10.3390\/ijerph16152743","type":"journal-article","created":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T11:39:37Z","timestamp":1564659577000},"page":"2743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8215-5214","authenticated-orcid":false,"given":"Asharani","family":"PV","sequence":"first","affiliation":[{"name":"Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9522-5792","authenticated-orcid":false,"given":"Tan","family":"Jun Wen","sequence":"additional","affiliation":[{"name":"National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Zakir","family":"Karuvetil","sequence":"additional","affiliation":[{"name":"National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvin","family":"Cheong","sequence":"additional","affiliation":[{"name":"National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Cheok","sequence":"additional","affiliation":[{"name":"Forensic Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gomathinayagam","family":"Kandasami","sequence":"additional","affiliation":[{"name":"National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.drugalcdep.2013.03.014","article-title":"All-cause mortality in criminal justice clients with substance use problems\u2014A prospective follow-up study","volume":"132","author":"Hakansson","year":"2013","journal-title":"Drug Alcohol Depend"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1001\/archpsyc.1985.01790240060006","article-title":"Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality","volume":"42","author":"Martin","year":"1985","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1001\/archpsyc.1985.01790240049005","article-title":"Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality","volume":"42","author":"Martin","year":"1985","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.drugalcdep.2016.03.009","article-title":"Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems","volume":"162","author":"Olsson","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"ref_5","unstructured":"United Nations Office on Drugs and Crime (2019, June 03). World Drug Report 2018. Available online: http:\/\/www.unodc.org\/doc\/wdr2018\/prelaunch\/WDR18_Booklet_1_EXSUM.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1360-0443.2010.03140.x","article-title":"Mortality among regular or dependent users of heroin and other opioids: A systematic review and meta-analysis of cohort studies","volume":"106","author":"Degenhardt","year":"2011","journal-title":"Addiction"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.drugpo.2016.12.003","article-title":"Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan","volume":"43","author":"Chang","year":"2017","journal-title":"Int. J. Drug Policy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/j.1465-3362.2010.00255.x","article-title":"Causes of death of patients with methamphetamine dependence: A record-linkage study","volume":"30","author":"Kuo","year":"2011","journal-title":"Drug Alcohol Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1136\/jcp.2010.078741","article-title":"Alcohol and unnatural deaths in the West of Ireland: A 5-year review","volume":"63","author":"Ingoldsby","year":"2010","journal-title":"J. Clin. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1111\/j.1530-0277.2000.tb04649.x","article-title":"Role of alcohol in unnatural deaths: A study of all deaths in Sweden","volume":"24","author":"Sjogren","year":"2000","journal-title":"Alcoholclin Exp. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/add.12191","article-title":"Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high-range alcohol concentrations","volume":"108","author":"Darke","year":"2013","journal-title":"Addiction"},{"key":"ref_12","first-page":"110","article-title":"Accidental alcohol poisoning mortality in the United States, 1996-1998","volume":"27","author":"Yoon","year":"2003","journal-title":"Alcohol Res. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/oxfordjournals.bmb.a072886","article-title":"Alcohol and accidents","volume":"50","author":"Glucksman","year":"1994","journal-title":"Br. Med. Bull."},{"key":"ref_14","first-page":"28","article-title":"Traffic accidents under the influence of alcohol","volume":"1","author":"Rabenberg","year":"2016","journal-title":"J. Health Monit."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1136\/emj.2003.006130","article-title":"Alcohol related falls: An interesting pattern of injuries","volume":"21","author":"Johnston","year":"2004","journal-title":"Emerg. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"231","DOI":"10.15288\/jsa.1983.44.231","article-title":"The role of alcohol in accidental falls","volume":"44","author":"Honkanen","year":"1983","journal-title":"J. Stud. Alcohol"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ahlm, K., Saveman, B.-I., and Bj\u00f6rnstig, U. (2013). Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs\u2013a retrospective study, 1992\u20132009. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-216"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Darvishi, N., Farhadi, M., Haghtalab, T., and Poorolajal, J. (2015). Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: A meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0126870"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.annepidem.2014.05.008","article-title":"Use of alcohol before suicide in the United States","volume":"24","author":"Kaplan","year":"2014","journal-title":"Ann. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/1088767913493629","article-title":"The prevalence of alcohol-involved homicide offending: A meta-analytic review","volume":"18","author":"Kuhns","year":"2014","journal-title":"Homicide Stud."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Bradvik, L., Berglund, M., Frank, A., Lindgren, A., and Lowenhielm, P. (2009). Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study. BMC Psychiatry, 9.","DOI":"10.1186\/1471-244X-9-48"},{"key":"ref_22","first-page":"253","article-title":"Deadly heroin or the death of heroin\u2014Overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012","volume":"15","author":"Horvath","year":"2013","journal-title":"Neuropsychopharmacol. Hung."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jflm.2012.04.023","article-title":"Fatal poisoning in Estonia 2000\u20132009. Trends in illegal drug-related deaths","volume":"20","author":"Tuusov","year":"2013","journal-title":"J. Forensic Leg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1465-3362.2009.00075.x","article-title":"Mortality and cause of death among 1705 illicit drug users: A 37 year follow up","volume":"29","author":"Stenbacka","year":"2010","journal-title":"Drug Alcohol Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.forsciint.2006.08.002","article-title":"Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002\u20132003","volume":"169","author":"Holmgren","year":"2007","journal-title":"Forensic Sci. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/1556-4029.12999","article-title":"Manners of Death in Drug-Related Fatalities in Florida","volume":"61","author":"Lee","year":"2016","journal-title":"J. Forensic Sci."},{"key":"ref_27","first-page":"125","article-title":"Attempted suicide in people with co-occurring bipolar and substance use disorders: Systematic review and meta-analysis","volume":"167","author":"Bartoli","year":"2016","journal-title":"J. Affect Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1093\/pubmed\/fdv148","article-title":"Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis","volume":"38","author":"Poorolajal","year":"2016","journal-title":"J. Public Health (Oxf.)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1258\/msl.2012.012058","article-title":"Pattern of coroner\u2019s autopsies at Health Sciences Authority, Singapore: A retrospective study (2009\u20132010)","volume":"53","author":"Wang","year":"2013","journal-title":"Med. Sci. Law"},{"key":"ref_30","unstructured":"Department of Statistics Singapore (2019, June 04). Death Rates, Annual, Available online: https:\/\/data.gov.sg\/dataset\/death-rates-annual?view_id=cadd37b8-cd75-40e9-9e0b-a7064c6a187c&resource_id=db3aa9df-d7c2-460c-a50a-0a99ab74ba6a."},{"key":"ref_31","unstructured":"Rachel Au-Yong (2019, June 04). Slight Rise in Number of Suicides Last Year. Available online: https:\/\/www.straitstimes.com\/singapore\/slight-rise-in-number-of-suicides-last-year."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1080\/10826084.2018.1452261","article-title":"Mortality and cause of death-A30 year follow-up of substance misusers in Sweden","volume":"53","author":"Skogens","year":"2018","journal-title":"Subst. Use Misuse"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1046\/j.1360-0443.2002.00079.x","article-title":"A prospective study of mortality among drug misusers during a 4-year period after seeking treatment","volume":"97","author":"Gossop","year":"2002","journal-title":"Addiction"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1046\/j.1360-0443.2002.00214.x","article-title":"Suicide among heroin users: Rates, risk factors and methods","volume":"97","author":"Darke","year":"2002","journal-title":"Addiction"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1007\/s00127-004-0796-7","article-title":"Substance use and male gender as risk factors for deaths and suicide\u2014A 5-year follow-up study after deliberate self-harm","volume":"39","author":"Suominen","year":"2004","journal-title":"Soc. Psychiatry Ppsychiatr. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1111\/ajt.13776","article-title":"Increases in drug and opioid overdose deaths\u2014United States, 2000\u20132014","volume":"16","author":"Rudd","year":"2016","journal-title":"Am. J. Transpl."},{"key":"ref_37","unstructured":"Singapore, C.N.B. (2019, June 04). Two Bundles of Heroin Seized at Woodlands Checkpoint, Available online: https:\/\/www.cnb.gov.sg\/NewsAndEvents\/News\/Index\/two-bundles-of-heroin-seized-at-woodlands-checkpoint."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.psychres.2008.01.008","article-title":"Alcohol use disorders increase the risk of completed suicide\u2014Irrespective of other psychiatric disorders. A longitudinal cohort study","volume":"167","author":"Knop","year":"2009","journal-title":"Psychiatry Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.3390\/ijerph7041392","article-title":"Suicidal behavior and alcohol abuse","volume":"7","author":"Pompili","year":"2010","journal-title":"Int. J. Env. Res. Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/0010-440X(83)90053-6","article-title":"Suicide attempts in treated opiate addicts","volume":"24","author":"Murphy","year":"1983","journal-title":"Compr. E Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"403","DOI":"10.4088\/JCP.v63n0505","article-title":"Characteristics of opiate dependent patients who attempt suicide","volume":"63","author":"Roy","year":"2002","journal-title":"J. Clin. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"473","DOI":"10.5694\/j.1326-5377.2004.tb06402.x","article-title":"Predicting death in young offenders: A retrospective cohort study","volume":"181","author":"Coffey","year":"2004","journal-title":"Med. J. Aust."},{"key":"ref_43","unstructured":"Central Narcotics Bureau Singapore (2019, May 28). Local Drug Situation Report, Available online: http:\/\/www.cnb.gov.sg\/newsandevents\/reports-(overview)\/drug-report\/index\/drug-situation-report-2018."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/15563650.2015.1110590","article-title":"A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment","volume":"54","author":"Tait","year":"2016","journal-title":"Clin. Toxicol. (Phila. Pa.)"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1001\/jama.2018.2844","article-title":"Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010\u20132016","volume":"319","author":"Jones","year":"2018","journal-title":"JAMA"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/15\/2743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:11:57Z","timestamp":1760188317000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/15\/2743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,31]]},"references-count":45,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["ijerph16152743"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16152743","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2019,7,31]]}}}