Evaluation of the role of abstinence in heroin overdose deaths using segmental hair analysis

In the body heroin is rapidly metabolized to 6-acetylmorphine and morphine. Victims of lethal heroin overdose often present with fairly low blood concentrations of morphine. Reduced tolerance due to abstinence has been proposed to account for this finding. The aim of the present study was to examine the role of abstinence in drug-related deaths by comparing recent and past exposure to opioids using segmental hair analysis with the postmortem blood morphine concentrations in deceased heroin users. The study included 60 deceased drug addicts in the Stockholm area, Sweden. In 32 cases, death was not related to heroin intake. In 18 of the 28 heroin fatalities, opioids were absent in the most recent hair segment, suggesting a reduced tolerance to opioids. However, the blood morphine levels were similar to those found in the 10 subjects that showed continuous opioid use. Hair and blood analysis disclosed an extensive use of additional drugs that directly or indirectly may influence the opioid system. The results suggest that abstinence is not a critical factor for heroin overdose death. Obviously tolerant subjects die after intake of similar doses. Other factors, particularly polydrug use, seem to be more causally important for these deaths.     

Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002-2003

Compared with their contemporaries, individuals abusing illicit drugs suffer a higher risk of premature death. In Sweden, a simple protocol for registration of fatalities among abusers of alcohol, pharmaceuticals, illicit drugs, or other substances, has been used by the forensic pathologists since 2001. This routine was introduced to allow for an evaluation of the cause and manner of death, and patterns of abuse among different groups of abusers. We explored the data on drug abusers (i.e. abusers of illicit drugs) subjected to a forensic autopsy 2002-2003. The Swedish forensic pathologists examined 10,273 dead victims during the study period and 7% (743/10,273) of the cases were classified as drug abusers. Toxicological analyses were carried out in 99% (736/743) and illicit drugs were detected in 70% (514/736) of these. On average, 3.8 substances (legal or illegal) were found per case. The most common substances were ethanol and morphine, detected in 43 and 35% of the cases, respectively. When exploring the importance of the different substances for the cause of death, we found that the detection of some substances, such as fentanyl and morphine, strongly indicated a poisoning, whereas certain other substances, such as benzodiazepines more often were incidental findings. In total, 50% (372/743) died of poisoning, whereas only 22% (161/743) died of natural causes. Death was considered to be directly or indirectly due to drug abuse in 47% (346/743), whereas evidence of drug abuse was an incidental finding in 21% (153/743) or based on case history alone in 33% (244/743). We believe that this strategy to prospectively categorize deaths among drug addicts constitutes a simple means of standardizing the surveillance of the death toll among drug addicts that could allow for comparisons over time and between countries.     

Pitfalls in Military Quantitative Intelligence Analysis: Incident Reporting in a Low Intensity Conflict

Incidents are the key data for several of the statistical reports and analyses created within the military intelligence community. This paper discusses factors that affect the utility of quantitative methods in military intelligence analysis when used in a low intensity conflict. The first half of the paper presents the general critique of the use of quantitative methods. The second half applies this critique to the case of incident reporting in Afghanistan.     

Struggles over Identity and Territory: Regional Identities in Ethnoreligious Conflict in Northern Nigeria

This article explores how ethnoreligious conflict over boundaries and territoriality involves a politics of scale, that is, how positions and demands are framed by actors according to, for instance, local, regional, and national scales. The analysis focuses on how Muslim actors in a conflict in Kaduna State in Nigeria frame a regional, northern Nigerian identity that varies in content and form depending on the scalar context in which communal conflict is placed with regional and national politics yielding different identifications.     

Global networks and global change-induced tipping points

The existence of “tipping points” in human–environmental systems at multiple scales—such as abrupt negative changes in coral reef ecosystems, “runaway” climate change, and interacting nonlinear “planetary boundaries”—is often viewed as a substantial challenge for governance due to their inherent uncertainty, potential for rapid and large system change, and possible cascading effects on human well-being. Despite an increased scholarly and policy interest in the dynamics of these perceived “tipping points,” institutional and governance scholars have yet to make progress on how to analyze in which ways state and non-state actors attempt to anticipate, respond, and prevent the transgression of “tipping points” at large scales. In this article, we use three cases of global network responses to what we denote as global change-induced “tipping points”—ocean acidification, fisheries collapse, and infectious disease outbreaks. Based on the commonalities in several research streams, we develop four working propositions: information processing and early warning, multilevel and multinetwork responses, diversity in response capacity, and the balance between efficiency and legitimacy. We conclude by proposing a simple framework for the analysis of the interplay between perceived global change-induced “tipping points,” global networks, and international institutions.     

Look to Sweden: The Making of a New Renewable Energy Support Scheme in Norway

Two renewable energy support schemes have spread across Europe: green certificate schemes (GCSs) and feed‐in tariffs (FITs). After a decade‐long policy‐making process, Norwegian decision makers decided in 2011 to adopt a GCS compatible with the already existing one in Sweden and thereby establish a joint Norwegian‐Swedish GCS. The article explores this process of policy transfer, and asks to what extent competition and policy learning contributed to Norway's choice of a GCS. It finds that competition was a barrier to a joint Norwegian‐Swedish GCS rather than (as predicted by some scholars) a driver of policy transfer. In terms of policy learning, it finds that Norwegian bureaucrats systematically were searching for information about renewable energy policy instruments in a process characterised by rational learning. However, this information was not taken into account by elected policy makers, whose learning was unsystematic and almost exclusively influenced by Sweden – making it a process of bounded learning. Finally, domestic factors that facilitated and constrained the policy transfer process are identified in the article. A reluctant bureaucracy defending the status quo policies constrained the policy transfer process. GCS as a market‐based instrument independent of yearly allocations over the annual national budgets facilitated the process by securing strong support in a broad coalition of stakeholder groups and thereby cross‐partisan support. The latter finding may contribute to the literature by underscoring the importance of domestic political factors.