臺灣桃園地區2008年至2013年濫用海洛因死亡案件分析

Abstract

臺灣近年來濫用藥毒物趨勢愈趨嚴重，常導致意外或自殺之藥毒物過量死亡，在多種藥毒物使用中，又以第一級毒品海洛因濫用最易致意外使用過量而死亡。本研究收集西元2008至2013年臺灣桃園地區濫用海洛因死亡案件，經司法相驗後之偵查資料進行包括人口學特徵、毒物學檢驗結果、相驗及解剖特徵、現場跡證及解剖與相驗各項因子之差異研究分析，結果發現6年共有191例濫用海洛因死亡案例。濫用族群主要以男性(佔90.1%)及25-44歲壯年族群(佔79.6%)為主，未婚之死者為多數(佔50.3%)，有前科者佔91.6%；發生地點以室內之住家環境為多數(佔74.9%)，顯示濫用者以便利及舒適性為考量；戒治後出獄14天內(佔23.8%)最易因耐受性降低致濫用過量死亡；在現場可發現施打工具(50.8%)，遺留遺書(佔3/5)對研判死亡方式極為重要，屍體可發現陳舊注射瘢疤(佔28.3%)及新鮮注射針痕(佔61.8%)；濫用者常見併用其它毒藥物(佔77%)，以酒精(佔31.7%)及苯二氮平類鎮靜安眠藥(佔21.3%)為兩大併用藥物；死亡原因以中毒性休克及中毒性休克併呼吸衰竭為兩大死亡機轉，死亡方式以意外為多數(佔82.2%)；血液中嗎啡濃度顯示與死亡方式較有關係；血液嗎啡濃度平均為0.76μg/ml，已達到文獻上嗎啡濃度為0.2μg/ml之致死濃度，在本研究89.6%之案例其血液嗎啡濃度大於0.2μg/ml；解剖採集之尿液有較高之六乙醯嗎啡陽性檢測率(71.8%)，對判定濫用海洛因與否極為重要。濫用海洛因解剖率為20.4%，希望能提高解剖率，以進一步提高死亡原因及死亡方式研判之正確性，及併用藥物之陽性檢測率。希望藉由本篇之研究可以提供檢警有關濫用海洛因死亡案件偵查之相關資訊及經驗，並期盼本篇研究之相關死亡危險因子能提供給有關法務戒治單位及醫療戒毒機構參考，研擬防治毒品措施及宣導教育課程以降低濫用海洛因死亡的人數。

Drug abuse in Taiwan is becoming more severe in recent years, which often results in accidental or suicidal drug-related death. Among the diverse drugs, heroin is the one that most easily leads to death in accidental drug overdose. This research collects heroin death cases from 2008 to 2013 in Tao-Yuan County of Taiwan and then analyzes the judicially testified data to find out the difference of these cases in terms of demography characteristic,toxicology examination results, post-mortem examination results and the associate evidence at the scene investigation. It turns out that there are 191 cases totally caused by heroin abuse within the 6 years. Most of the deceased are male (90.1%) and the prime of age is 25-44 (79.6%); half of the deceased are unmarried (50.3%); exconvict history takes up 91.6%; the place is mostly indoor(74.9%),which demonstrates the deceased took convenience and comfort of episode place into consideration. Abusers are most easily died from misuse amount because of reduced tolerance (23.8%) within 14 days released from the drug treatment institution. Applying tools could be found in the scene (50.8%); suicide note (60%) is an important point in deciding the manner of death. There are old needle tract (28.3%) and fresh needle mark (61.8%) in the bodies. Combined drug use are found (77%) which alcohol is the most common(31.7%) and benzodiazepines is the second (21.3%). Main cause of death are simple toxicogenic shock or combined respiratory failure; most of them are accidental death (82.2%); morphine concentration in the blood is obviously related to the manner of death, average morphine concentration in blood is 0.76μg/ml, which has reached the lethal concentration 0.2μg/ml and the concentrations are over the index in 89.6% of those cases. Urine collected through post mortem examination has relatively high 6-monoacetylmorphine positive detection rate (71.8%), which is important in judging whether the deceased is dying from heroin abuse or not. Forensic autopsy rate of heroin abuse is 20.4% and how to increase the autopsy rate in the future which may provide correct cause or manner of death even the positive detection rate of combined drug use . This research has the potential becoming the future reference or experience for the detective officers in investigating heroin abuse death cases and it also hopes to help related legal drug treatment departments and medical rehabilitation organizations by providing risk factors that cause the death, thus they can have formulated anti-drug policy and formulate lessons to lower the rate of heroin abuse death .