Revised Assessments of Correlation Between Prescribed Medications and Forensic Toxicology Findings in Sweden
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By
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Heidi Taipale
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Jari Tiihonen
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Antti Tanskanen
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Jonas Forsman
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September 24, 2026
Clinical Report: Revised Assessments of Correlation Between Medications and Toxicology
Background
Accurate modeling of medication exposure is essential for pharmacoepidemiological research, particularly in forensic contexts. The PRE2DUP method reconstructs continuous drug use from dispensing records, which is crucial for understanding the relationship between pharmacotherapy and toxicological outcomes. This study aims to refine previous analyses by addressing inconsistencies in toxicological testing and enhancing the predictive performance of the exposure model.
Data Highlights
No numerical data provided in the source material.
Key Findings
- The updated analysis focused on 10,060 individuals for substances with consistent testing from September 2011 to December 2013.
- For substances tested throughout the entire 2006-2013 period, the complete population of 18,627 individuals was included.
- Individual-level agreement metrics included sensitivity, specificity, predicted adherence, and Cohen's κ.
- Improvements in agreement metrics were observed compared to the original study.
- Observations from periods with inconsistent testing were excluded to enhance methodological consistency.
Clinical Implications
The findings underscore the importance of consistent toxicological testing in evaluating medication exposure. Clinicians should consider the implications of drug exposure modeling in forensic assessments to improve accuracy in understanding pharmacotherapy outcomes.
Conclusion
The revised assessments provide a framework for correlating prescribed medications with forensic toxicology findings.
Related Resources & Content
- BMJ Mental Health, 2023 -- Association of psychotropic medications with the use of coercive measures and recidivism during forensic psychiatric care: a Swedish nationwide register-based study
- Drug Safety, 2022 -- Immediate Risk of Accidental Poisoning Following the Start of Central Nervous System Medications in Elderly Swedish Patients: A Case-Crossover Analysis Using Registry Data
- Drug Safety, 2024 -- Zopiclone-Related Fatal Intoxications: An Emerging Concern?
- National Prescribed Drug Register - Socialstyrelsen
- Methodological Guide - European Network of Centres for Pharmacoepidemiology and Pharmacovigilance
- Drugs - Real World Outcomes — Adverse Reactions Associated with Herbal Medicines and Natural Remedies in Sweden (2007–2015): Insights from the Medical Products Agency
- National Medication List - E-hälsomyndigheten
- PRE2DUP-R method • PRE2DUPR
- National Prescribed Drug Register - Socialstyrelsen
- Methodological Guide - European Network of Centres for Pharmacoepidemiology and Pharmacovigilance
- [Guide on Methodological Standards in Pharmacoepidemiology (2nd edition) (T/CPHARMA 002-2025)].
- Standardisation of terminology, calculation and reporting for assigning exposure duration to drug utilisation records from healthcare data sources: the CreateDoT framework | medRxiv
- TIAFT – The International Association of Forensic Toxicologists
- Standard for Metrological Traceability in Forensic Toxicology | American Academy of Forensic Sciences
- Balancing the (uncertainty) budget—postmortem toxicology laboratory conformance to ANSI/ASB Standard 056: Standard for Evaluation of Measurement Uncertainty in Forensic Toxicology | Journal of Analytical Toxicology | Oxford Academic
- Application of professional best practices in postmortem forensic toxicology | Journal of Analytical Toxicology | Oxford Academic
- Comparison of dispensed medications and forensic-toxicological findings to assess pharmacotherapy in the Swedish population 2006 to 2013 - PubMed
- Drug prescriptions preceding opioid-related deaths–a register study in forensic autopsy patients | PLOS One
- A nationwide Swedish retrospective study on poisoning deaths between the years 2000 and 2022 - PMC
- Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: a statewide analysis - PMC
- Postmortem Oxycodone Toxicology: A Systematic Review and Meta-Analysis of Concentrations and Interpretative Markers - PMC
Based on findings from:
Updated Estimates of Agreement Between Dispensed Medications and Forensic Toxicology in Sweden
Heidi Taipale, Jari Tiihonen, Antti Tanskanen, Jonas Forsman. Pharmacoepidemiology And Drug Safety, 2026.
https://onlinelibrary.wiley.com/doi/10.1002/pds.70483
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