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Our aim was to investigate the reason for relatively low detection rates for opioids and fentanyl in particular in post-mortem cases in the State of Hamburg. We re-analysed 822 blood samples from two different time periods, 2011/12 and 2016. These samples had been previously analysed in accordance with post-mortem routine by a case selected strategy. All samples were re-analysed with an LC-MS/MS method specific for prescription opioids. The main point in the evaluation was to determine whether the previous analysis strategy had led to underreporting of drug-related deaths (DRD), especially with regard to fentanyl. Another aim was to evaluate changes in prescribing prevalence of opiates and opioids. We compared pharmacy claims data in Hamburg with Germany. The analyses showed that the number of DRD remained unaffected by the new analytical strategy. Detection rates in DRD, however, increased for fentanyl 3.4-fold from 1.2% to 4.1%, buprenorphine from 5.9% to 7.6%, oxycodone from 0% to 1.8%, tilidine from 1.8% to 2.4%. The most frequently detected opioids in DRD cases were methadone (39.4%) and heroin (20%). Prescription rates between 2011-2017 decreased in Hamburg for nearly all opioids, morphine by - 43.5%, buprenorphine - 43%, codeine - 57%, fentanyl - 25%, tilidine -17%, tramadol - 31%, and hydromorphone -6%. Oxycodone, tapentadol, and piritramide prescription rates increased. For Germany, a decrease in the prescription rates for fentanyl was also found during this period (-12.9 %), although not as pronounced as in Hamburg. Prescription rates for methadone were three to greater than five times higher in Hamburg as compared to the German average due to the higher number of substituted persons per inhabitant. Conclusion: Despite the global problem of opioid abuse, there are significant regional differences in the nature and extent of opioid abuse. It is necessary to collect data at the national level to develop appropriate prevention strategies.

Purpose Changes in water diffusion can be quantified by diffusion-weighted MR imaging. However, there are only few reports about changes in post mortem brain. The aim of this study was to investigate the temporal pattern of the apparent diffusion coefficient (ADC) in the brain after death, to compare the values to in vivo brain and to assess the value of ex vivo DWI as a forensic tool. Material and methods The study was approved by the local Ethics Committee, and informed consent was obtained from all relatives and the control subjects. Twenty-one corpses, died of natural cause, were examined (13 males, 8 females; age: 70.5 ± 8.7 y, weight 74 ± 18 kg). Diffusion-Weighted Imaging (DWI) was performed with b -values of 0 and 1000 s/mm 2 at 1.5 T. Scans were repeated in intervals of 1 h. ADC-maps were calculated in thalamus, cerebrum and cerebellum. The obtained values were statistically compared to healthy volunteers ( n = 3) and to literature data. Results The ADC in the three regions decreased characteristically during the examination time. In the cerebrum there was a significant difference between ex vivo and in vivo ADC ( p p p = 0.045). Conclusion DWI of the postmortal brain can be added to the MRI methods for a post mortem imaging.

The wrappings and contents of 683 drug containers (bubbles) seized from 154 street dealers have been analysed since 2001, when the law enforcement policy in Hamburg, Germany, allowed the application of emetics to be used by so-called body stuffers for the recovery of swallowed drug packages. Of the bubbles recovered 96% contained cocaine. Cases of intoxication have not yet been observed but a 20-year-old man with a previously unknown toxic cardiomyopathy died 3 days after a sudden cardiac arrest which followed the forced application of ipecacuanha via correctly placed nasogastral tube.

By German law organ and tissue donation may only be done if explicit consent is given during lifetime, e.g. by a donor card, or if the family grants informed consent after death in line with the deceased's last will, what is discussed to mean an additional emotional load in the situation of mourning. Every year about 35 musculoskeletal tissue donations and 250 donations of corneoscleral discs (means 125 donors) are performed in the Hamburg Institute of Legal Medicine. Talking to the next of kin plays a key role in the consenting process for donation. We show our guidelines according to the family contact by telephone and present the results of a catamnestic review referring to the donors of one year's period. Methods: One year after procurement had been completed we requested the consenting person to answer a questionnaire and asked for an evaluation of the contact to the institute's coordinator and furthermore the emotional impact of the consenting process. Results: 26 (72.2% of 36 only musculoskeletal donors) and 77 (73.3% of 114 only cornea donors) consenting persons answered and gave a positive feedback in the dimensions of information, support and consent. Discussion: The telephone contact with families of deceased persons out of the Institute of Legal Medicine is perceived to be helpful in an acute stress situation caused by a sudden death and an accepted way to establish the deceaseds’ wishes in respect to donation through the relatives. Conclusion: According to the letter of the German Transplantation Act asking for donation is an obligation for every physician and our data show that this means no additional burden for relatives, if the question is placed appropriately. Forensic institutes play a key role in the recognition of tissue donors and take up the challenge to act as an interface between donors and recipients. But caring for the sufficient supply with tissue transplants needs considerable resources. Therefore additional support is necessary to fulfill this task.

For the time-frame of February 1st, 2003 until December 31st, 2005, all forensic medical experts at the Medico-Legal Center of the Institute of Legal Medicine in Hamburg, Germany, completed a standardized questionnaire for every consenting surviving violence victim (n=2733) age 14 and older. Central to the quantitative analysis of the data collected was the extraction of specific injury characteristics from the sample population. A correlation was demonstrated between injury typologies and four possible perpetrator-victim constellations, each of which was subcategorized into sexual and non-sexual assaults. Language: en

Drug-related fatal poisonings were analysed in Hamburg from 1990 to 30th June 1999 with special attention to the role of methadone. The first methadone-related fatalities were observed in Hamburg three years after methadone maintenance treatment (MMT) was introduced in 1990. Meanwhile more than half of all fatal poisonings among drug addicts are monovalent or polydrug intoxications with evidence for methadone. From January 1997 until June 1999 methadone was the predominant cause of death in about 39% of all drug-related fatal poisonings while the proportion of mixed heroin/methadone intoxications was about 10%. The rising problem of methadone-related fatalities goes with a decline of monovalent heroin intoxications which decreased in the last 9 years from 60% to 11%. Sixty-five per cent of those who died of fatal methadone-related poisonings had no history of MMT (60% of those with methadone as predominant cause of death). Since take-home doses for up to 7 days are prescribed to the patient due to a change in the German Narcotics Act in 1998, the diversion of methadone into illegal markets may have been accelerated. This results in rising numbers of non-intentional methadone-related fatalities among addicts who have never been in MMT. The prerequisites for the prescription of take-home doses should be taken more serious. There is no doubt that MMT reduced the mortality rate among the great majority of patients in Hamburg but supreme efforts should be made to prevent or reduce fatal intoxications by methadone in the non-treatment group.