{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T04:53:23Z","timestamp":1784955203895,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brazilian National Secretary of Drug Policies (SENAD) from the Ministry of Justice","award":["903126\/2020"],"award-info":[{"award-number":["903126\/2020"]}]},{"name":"University of Sao Paulo Medical School","award":["LIM 40\/HC-FMSUP"],"award-info":[{"award-number":["LIM 40\/HC-FMSUP"]}]},{"name":"S\u00e3o Paulo Research Foundation (FAPESP), Brazil","award":["#2024\/04999-7"],"award-info":[{"award-number":["#2024\/04999-7"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>External causes account for over four million deaths globally each year, with psychoactive substance use being a major risk factor. However, the true impact and regional patterns of psychoactive substance use in these deaths remains undefined in Brazil. To address this critical knowledge gap, this pioneering four-city study sought to elucidate the prevalence of alcohol and drug use by external cause victims. We collected postmortem blood from 3577 victims of violent death across four distinct Brazilian cities (Bel\u00e9m, Recife, Vit\u00f3ria, and Curitiba), representing the North, Northeast, Southeast, and South regions, respectively, using a standardized protocol to identify alcohol, illicit drugs, and psychoactive medicines. Analysis revealed a predominantly male cohort (89.7%; 56.0% aged 30 years or more), with homicide as the primary manner of death (67.3%). Over half of the victims (53.0%) tested positive for at least one psychoactive substance prior to death; cocaine (29.6%) and alcohol (27.7%) were most common. Substance use was highest among homicide victims (55.7%), especially cocaine (36.0%), and among self-harm cases (54.6%), which showed elevated benzodiazepine prevalence (20.0%). Substance use patterns varied regionally: alcohol-related deaths were more common in Recife (Northeast), drug-only deaths concentrated in Vit\u00f3ria (Southeast) and Bel\u00e9m (North), and Curitiba (South) showed a higher prevalence of alcohol use versus drug use. This widespread, regionally heterogeneous prevalence underscores the urgent need for targeted, region-specific interventions. By critically linking psychoactive substance use to various modes of violent death, these data provide crucial forensic and public health insights to inform tailored preventive strategies.<\/jats:p>","DOI":"10.3390\/toxics14010103","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:16:59Z","timestamp":1769159819000},"page":"103","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence of Psychoactive Substance Use and Violent Death: Toxicological and Geospatial Evidence from a Four-Metropolitan-Area Cross-Sectional Study in Brazil"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3408-7119","authenticated-orcid":false,"given":"Henrique Silva","family":"Bombana","sequence":"first","affiliation":[{"name":"Departamento de An\u00e1lises Cl\u00ednicas e Toxicol\u00f3gicas, Faculdade de Ci\u00eancias Farmac\u00eauticas FCF, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1595-1880","authenticated-orcid":false,"given":"Vanderlei Carneiro","family":"da Silva","sequence":"additional","affiliation":[{"name":"Clinical and Epidemiological Research Center, Universitary Hospital, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-000, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-8873","authenticated-orcid":false,"given":"Ivan Dieb","family":"Miziara","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bio\u00e9tica, Medicina do Trabalho e Medicina F\u00edsica e Reabilita\u00e7\u00e3o Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 01249-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7037-5655","authenticated-orcid":false,"given":"Her\u00e1clito Barbosa","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 01249-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4615-1088","authenticated-orcid":false,"given":"Mauricio","family":"Yonamine","sequence":"additional","affiliation":[{"name":"Departamento de An\u00e1lises Cl\u00ednicas e Toxicol\u00f3gicas, Faculdade de Ci\u00eancias Farmac\u00eauticas FCF, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05508-000, SP, Brazil"},{"name":"Departamento de Medicina Legal, Bio\u00e9tica, Medicina do Trabalho e Medicina F\u00edsica e Reabilita\u00e7\u00e3o Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 01249-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-1290","authenticated-orcid":false,"given":"Vilma","family":"Leyton","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bio\u00e9tica, Medicina do Trabalho e Medicina F\u00edsica e Reabilita\u00e7\u00e3o Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 01249-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization\u2014WHO (2024, December 03). 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