Mortality among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs.

BACKGROUND: Most studies in the field of impaired driving have focused on the hazards represented by impaired drivers to the rest of society; there has been little follow-up of the drivers themselves. The aim of this study was to establish mortality rates among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs, alone or in combination with alcohol. METHODS: A prospective cohort study of all drivers aged 20-49 years, apprehended in Norway in 1992-1996 and testing positive for traffic-hazardous medicinal drugs in blood, outcome variable: death. STUDY POPULATION: 805 drivers (598 males, 207 females). Mean follow-up period: 6.8 years. Information on deaths was collected from Statistics Norway. RESULTS: During the follow-up period, 139 of the previously apprehended drivers died (110 males, 29 females). The calculated standardised mortality ratio (SMR) was 15.8 (95% CI: 13.0-19.0) for male and 20.0 (95% CI: 13.4-28.7) for female drivers. CONCLUSIONS: Apprehension on suspicion of driving under the influence of drugs, combined with detection of traffic-hazardous medicinal drugs in the blood, seems to indicate an elevated risk of premature death in the age group 20-49 years. Secondary prevention of continued drug use could save lives in this drug user group.

[Prescription of selective serotonin reuptake inhibitors 1990-2004]. / Forskrivning av selektive serotoninreopptakshemmere 1990-2004.

BACKGROUND: Antidepressant drugs are important in the treatment of major depression. The use of antidepressants in general and more specifically selective serotonin reuptake inhibitors (SSRIs) has, however, been subject to discussion since their introduction in Norway in 1990. After the introduction of paroxetin in Norway in 1993, the sales of SSRIs rose rapidly. Up until now we have had little knowledge of the patterns of use of these drugs in Norway. This article describes the sales of SSRIs and other antidepressants from 1990 to 2004. The newly established Norwegian Prescription Database (NorPD) is used to establish the figures in more detail. MATERIAL AND METHODS: Sales figures for SSRIs and other antidepressants from the Norwegian Institute of Public Health are presented. NorPD is used to describe age and gender prevalence and incidence of antidepressant use. RESULTS: After their introduction on the Norwegian drug market in the beginning of the 1990s, the SSRIs have held a leading position on this market. In the beginning, paroxetin was the prevalent drug used in Norway. When citalopram was marketed in 1995, it rapidly took over this role. From 2004 escitalopram won a growing share of the market. Two thirds of all antidepressants are prescribed to women. With increasing age, increasing shares of the population are prescribed antidepressants. Elderly people are prescribed relatively more tricyclic antidepressants than younger people. SSRIs are also prescribed to adolescents, though tricyclic antidepressants are predominant below the age of 15. INTERPRETATION: A lower increase in the sales of antidepressants in 2004 could be caused by saturation of the antidepressants market or negative media attention for these drugs. Tricyclic antidepressants are possibly still used in excess by the elderly. The number of girls 15-19 years of age using SSRIs is relatively large. Even though fluoxetin is the only drug recommended for this age group, other SSRIs are more often prescribed.

Use of anxiolytic or hypnotic drugs and total mortality in a general middle-aged population.

PURPOSE: The aim of the study was to evaluate the effect of the consumption of anxiolytic or hypnotic drugs on total mortality in a general population. METHODS: We followed a cohort of 7225 men and 7726 women aged 40-42 years who underwent health surveys in 1985-1989 in two Norwegian counties, with respect to deaths. Mean follow-up period was 18 years. The subjects were categorised according to frequency of anxiolytic or hypnotic drug use during the last month: daily, every week, less than every week and not used during the last month. RESULTS: The proportion of anxiolytic or hypnotic drug users was 6.6% among men and 16.2% among women. Altogether 402 men and 290 women died. There was an increase in risk of death with an increase in frequency of use. Crude hazard ratios for men and women daily using anxiolytics or hypnotics were 3.1 (95%CI 2.0, 4.8) and 2.7 (1.9, 4.0), respectively, as compared with non-users last month. After adjusting painkiller use and smoking the hazard ratios were lowered, being 2.4 (1.5-4.0) (men) and 2.1 (1.4-3.2) (women). After additional adjustments for other possible confounders the hazard ratios were further attenuated to 1.5 (0.9-2.7) for men and 1.7 (1.1-2.6) for women. CONCLUSIONS: Daily users of anxiolytic or hypnotic drugs in our study showed higher crude mortality than non-users. However, after adjusting lifestyle and socio-economic variables the difference was markedly reduced suggesting that the remaining excess mortality is due to residual confounding.