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1.
J Pediatr ; 219: 188-195.e6, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32005542

RESUMO

OBJECTIVE: To identify types of containers from which young children accessed solid dose medications (SDMs) during unsupervised medication exposures and the intended recipients of the medications to advance prevention. STUDY DESIGN: From February to September 2017, 5 US poison centers enrolled individuals calling about unsupervised solid dose medication exposures by children ≤5 years. Study participants answered contextually directed questions about exposure circumstances. RESULTS: Sixty-two percent of eligible callers participated. Among 4496 participants, 71.6% of SDM exposures involved children aged ≤2 years; 33.8% involved only prescription medications, 32.8% involved only over-the-counter (OTC) products that require child-resistant packaging, and 29.9% involved ≥1 OTC product that does not require child-resistant packaging. More than one-half of exposures (51.5%) involving prescription medications involved children accessing medications that had previously been removed from original packaging, compared with 20.8% of exposures involving OTC products (aOR, 3.39; 95% CI, 2.87-4.00). Attention deficit hyperactivity disorder medications (49.3%) and opioids (42.6%) were often not in any container when accessed; anticonvulsants (41.1%), hypoglycemic agents (33.8%), and cardiovascular/antithrombotic agents (30.8%) were often transferred to alternate containers. Grandparents' medications were involved in 30.7% of prescription medication exposures, but only 7.8% of OTC product exposures (aOR, 3.99; 95% CI, 3.26-4.87). CONCLUSIONS: Efforts to reduce pediatric SDM exposures should also address exposures in which adults, rather than children, remove medications from child-resistant packaging. Packaging/storage innovations designed to encourage adults to keep products within child-resistant packaging and specific educational messages could be targeted based on common exposure circumstances, medication classes, and medication intended recipients.


Assuntos
Embalagem de Medicamentos , Medicamentos sem Prescrição/envenenamento , Medicamentos sob Prescrição/envenenamento , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
3.
Physiol Res ; 68(Suppl 1): S31-S38, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31755288

RESUMO

Although the risks of medication poisoning in children are often reported, there is a lack of studies addressing this issue. The majority of papers deal with a wide range of xenobiotics poisoning and, in particular, alcohol intoxications. All hospital admissions during three years were prospectively recorded. Patients younger than 19 years of age admitted for acute drug intoxications were further evaluated. A total of 15,069 children were admitted. Of them, 55 were hospitalized for acute medication poisoning. The condition was more common in girls (72.7 % vs. 27.3 %, p<0.01). Toddlers were the largest patient group (36.4 %). Non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently used agents, with ibuprofen being the leading drug (20 % of all cases). The route of intoxication was almost exclusively oral. Solid drug forms were involved in 40 (72.7 %) cases. There was one fatal accidental poisoning. The highest occurrence of accidental drug intoxications was in the age group from one to three years. Attempted suicides were most frequent among adolescents. We are currently actively dealing with the issue. The cohort has been expanded to include a period of ten years and is being analyzed.


Assuntos
Hospitalização/estatística & dados numéricos , Envenenamento/epidemiologia , Adolescente , Criança , Pré-Escolar , Uso Indevido de Medicamentos/efeitos adversos , Uso Indevido de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicamentos sob Prescrição/envenenamento , Estudos Prospectivos , Tentativa de Suicídio/estatística & dados numéricos
4.
BMC Emerg Med ; 19(1): 55, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615421

RESUMO

BACKGROUND: Recreational use of prescription drugs is widespread. We describe acute poisonings related to the recreational use of prescription drugs. METHODS: Retrospective observational study. We retrospectively registered all patients presenting from October 2013 through March 2015 at a primary care emergency outpatient clinic in Oslo, Norway, with an acute poisoning related to recreational drug use. We registered demographic data, toxic agents taken, clinical course and treatment. From this data set we extracted the 819/2218 (36.9%) cases involving one or more prescription drugs. RESULTS: Among the 819 included cases, 190 (23.2%) were female. Median age was 37 years. The drugs most commonly involved were benzodiazepines in 696 (85.0%) cases, methadone in 60 (7.3%), buprenorphine in 53 (6.5%), other opioids in 56 (6.8%), zopiclone/zolpidem in 26 (3.2%), and methylphenidate in 11 (1.3%). Prescription drugs were combined with other toxic agents in 659 (80.5%) cases; heroin in 351 (42.9%), ethanol in 232 (28.3%), amphetamine in 141 (17.2%), cannabis in 70 (8.5%), gamma-hydroxybutyrate (GHB) in 34 (4.2%), cocaine in 29 (3.5%), and other illegal drugs in 46 (5.6%). The patient was given naloxone in 133 (16.2%) cases, sedation in 15 (1.8%), and flumazenil in 3 (0.4%). In 157 (19.2%) cases, the patient was sent on to hospital. CONCLUSIONS: One in three acute poisonings related to recreational drug use involved prescription drugs. Benzodiazepines were by far the most common class of drugs. Prescription drugs had mostly been taken in combination with illegal drugs or ethanol.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicamentos sob Prescrição/envenenamento , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Fatores Etários , Bebidas Alcoólicas/envenenamento , Feminino , Humanos , Drogas Ilícitas/envenenamento , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Sinais Vitais , Adulto Jovem
5.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575622

RESUMO

OBJECTIVES: Little is known about the risk for overdose after opioid prescription. We assessed associations between the type of opioid, quantity dispensed, daily dose, and risk for overdose among adolescents who were previously opioid naive. METHODS: Retrospective analysis of 1 146 412 privately insured adolescents ages 11 to 17 years in the United States captured in the Truven MarketScan commercial claims data set from January 2007 to September 2015. Opioid overdose was defined as any emergency department visit, inpatient hospitalization, or outpatient health care visit during which opioid overdose was diagnosed. RESULTS: Among our cohort, 725 participants (0.06%) experienced an opioid overdose, and the overall rate of overdose events was 28 events per 100 000 observed patient-years. Receiving ≥30 opioid tablets was associated with a 35% increased risk for overdose compared to receiving ≤18 tablets (hazard ratio [HR] = 1.35; 95% confidence interval: 1.05-1.73; P = .02). Daily prescribed opioid dose was not independently associated with an increased risk for overdose. Tramadol exposure was associated with a 2.67-fold increased risk for opioid overdose compared to receiving oxycodone (adjusted HR = 2.67; 95% confidence interval: 1.90-3.75; P < .0001). Adolescents with preexisting mental health conditions demonstrated increased risk for overdose, with HRs ranging from 1.65 (anxiety) to 3.09 (substance use disorders). CONCLUSIONS: One of 1600 (0.06%) previously opioid-naive adolescents who received a prescription for opioids experienced an opioid overdose a median of 1.75 years later that resulted in medical care. Preexisting mental health conditions, use of tramadol, and higher number of dispensed tablets (>30 vs <18) were associated with an increased risk of opioid overdose.


Assuntos
Analgésicos Opioides/uso terapêutico , Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Analgésicos Opioides/envenenamento , Criança , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Oxicodona/envenenamento , Medicamentos sob Prescrição/envenenamento , Medicamentos sob Prescrição/uso terapêutico , Estudos Retrospectivos , Tramadol/envenenamento , Estados Unidos/epidemiologia
6.
Ann Epidemiol ; 38: 65-69, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564485

RESUMO

PURPOSE: Classification of overdose deaths is often geographically and demographically inconsistent. Incomplete surveillance records may distort estimates of drug overdose rates across time and place. We examined incomplete toxicology reporting among drug overdose decedents by demographic and geographic characteristics, measuring changes in missingness rates and their associations with decedent characteristics over time. METHODS: We estimated the percentage of overdose deaths reported in the National Vital Statistics System with missing toxicology results from 2010 to 2016, overall and by decedents' demographic and geographic characteristics. Multilevel logistic regression models evaluated prevalence of missingness by decedent characteristics, accounting for geographic clustering. RESULTS: Overall, 20.3% of death certificates did not indicate a specific drug, declining from 24.4% in 2010 to 14.6% in 2016. Deaths were less likely to have missing information if they occurred in counties with medical examiners versus coroners. Female decedents were more likely to have missing information than males, as were non-Hispanic whites compared with Hispanics and non-Hispanic blacks. CONCLUSIONS: The percentage of deaths with missing toxicology information declined over time, but demographic and geographic differences in missingness persist. This yields detection biases that skew temporal trends and understanding of groups impacted by the opioid epidemic.


Assuntos
Analgésicos Opioides/envenenamento , Analgésicos Opioides/toxicidade , Médicos Legistas , Coleta de Dados/métodos , Atestado de Óbito , Overdose de Drogas/mortalidade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Medicamentos sob Prescrição/envenenamento , Toxicologia/estatística & dados numéricos , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Médicos Legistas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Toxicologia/métodos , Toxicologia/normas , Estados Unidos , Adulto Jovem
7.
Drug Alcohol Rev ; 38(5): 494-502, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31317593

RESUMO

BACKGROUND AND AIMS: In the US, benzodiazepine overdose deaths increased at an alarming rate in the past two decades. Benzodiazepines were also the most common drugs involved in prescription opioid overdose deaths. Benzodiazepine prescribing has been monitored by Prescription Drug Monitoring Programs (PDMPs), but little was known about whether PDMPs reduced drug overdose deaths involving benzodiazepines. DESIGN AND METHODS: This study used a difference-in-difference design with state-quarter aggregate data on drug overdose deaths. The primary data source was Mortality Multiple Cause Files in 1999-2016. Three age-adjusted rates of drug overdose deaths were examined, including those involving benzodiazepines, those involving prescription opioids, and those involving both benzodiazepines and prescription opioids. The policy variables included PDMP data access for benzodiazepines and mandatory use of PDMP data for benzodiazepines. Linear multivariable regressions were used to assess the associations of PDMP policies specific to benzodiazepines with drug overdose death rates, controlling for other state-level policy and socioeconomic factors, state and time fixed effects, and state-specific time trends. RESULTS: No significant associations were found between PDMP data access for benzodiazepines and changes in drug overdose death rates involving benzodiazepines and/or prescription opioids. Similarly, no significant associations were found between mandatory use of PDMP data for benzodiazepines and changes in drug overdose death outcomes. DISCUSSION AND CONCLUSIONS: This study suggested no evidence that PDMP policies specific to benzodiazepines were associated with reduction in benzodiazepine overdose death rates. Future research is warranted to examine detailed features of PDMPs and continuously monitor the impacts of PDMP policies on benzodiazepine-related consequences.


Assuntos
Analgésicos Opioides/envenenamento , Benzodiazepinas/envenenamento , Overdose de Drogas/epidemiologia , Medicamentos sob Prescrição/envenenamento , Humanos , Incidência , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos , Estados Unidos/epidemiologia
8.
West J Emerg Med ; 20(2): 269-277, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30881547

RESUMO

Introduction: Our aim was to examine potential risk factors and modifiable behaviors that could lead to pediatric poisonings. Our secondary objectives were to explore socioeconomic factors associated with caregiver (parent/guardian) safe medication storage and knowledge of poison control contact information. Methods: We conducted a prospective, cross-sectional survey of caregivers of patients 2-10 years old presenting to an inner city pediatric emergency department. Caregiver and patient demographic data, prescription and nonprescription medication type, storage and when and where taken, were recorded. We used multivariable regression to explore factors associated with secure prescription medication storage and knowledge of poison control center contact information. Results: Of 1457 caregivers, 29% took daily prescription and 17% took daily non-prescription medications. Only 25% of caregivers stored their prescription medications in a secure place, and <3% stored medications in a locked drawer or safe. Of demographic and socioeconomic factors, only income ≥$80,000 was associated with storage of prescription medication in a secure place (odds ratio [OR], 2.47; 95% confidence interval [CI], 1.27-4.81). When asked how they would access poison control in case of an ingestion, the majority, 86%, had an appropriate plan. In multivariable regression, the only factor associated with knowledge of poison control center contact information was college education in the caregiver (OR 1.6; 95% CI, 1.10-2.32). Conclusion: A minority of caregivers store medications in a safe place and even fewer keep prescription medications under lock and key. The majority, however, were aware of how to contact a poison control center in case of ingestion.


Assuntos
Medicamentos sem Prescrição/envenenamento , Medicamentos sob Prescrição/envenenamento , Criança , Pré-Escolar , Estudos Transversais , Overdose de Drogas , Embalagem de Medicamentos , Armazenamento de Medicamentos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Razão de Chances , Pais/psicologia , Centros de Controle de Intoxicações , Prevalência , Estudos Prospectivos , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos
9.
Health Serv Res ; 54(2): 407-416, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30740691

RESUMO

OBJECTIVE: To examine the effects of a harm reduction policy, specifically Good Samaritan (GS) policy, on overdose deaths. DATA SOURCES/STUDY SETTING: Secondary data from multiple cause of death, mortality records paired with state harm reduction and substance use prevention policy. STUDY DESIGN: We estimate fixed effects Poisson count models to model the effect of GS policy on overdose deaths for all, prescription, and illicit drugs, controlled substances, and opioids, while controlling for other harm reduction and substance use prevention policies. DATA COLLECTION/EXTRACTION METHODS: We merge secondary data sources by state and year between 1999 and 2016. PRINCIPAL FINDINGS: We fail to identify a statistically significant effect of GS policy in reducing overdose deaths broadly. CONCLUSIONS: While we are unable to identify an effect of GS policy on overdose deaths, GS policy may have important effects on first-stage outcomes not investigated in this paper. Given recent state policy changes and rapid increase in many categories of overdose deaths, additional research should continue to examine the implementation and effects of harm reduction policy specifically and substance use prevention policy broadly.


Assuntos
Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Redução do Dano , Política Pública , Analgésicos Opioides/envenenamento , Overdose de Drogas/terapia , Humanos , Drogas Ilícitas/envenenamento , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/terapia , Medicamentos sob Prescrição/envenenamento
10.
Pediatr Emerg Care ; 35(3): 176-179, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27749797

RESUMO

OBJECTIVE: Adolescent intentional ingestions remain a significant public health problem in the United States with little research to date on the over-the-counter or prescription medicines that adolescents abuse. These data are important for anticipatory guidance by primary care providers, preventive health, and poison center outreach. METHODS: This was an observational study using the American Association of Poison Control Centers National Poison Data System. The study population consisted of all cases of patients aged 13 to 19 years from 2004 to 2013 with a coding of "intentional abuse." RESULTS: There were 95,695 patient calls that were coded for intentional abuse between 2004 and 2013 for adolescents aged 13 to 19 years. The most common agent reportedly ingested in intentional-abuse cases was antihistamine and/or decongestant with dextromethorphan, and this agent remained the most common throughout the 10-year study period. The next 4 most common agents remained similar across the study period as well and included ethanol, benzodiazepines, dextromethorphan alone, and marijuana. These 5 agents remained the most commonly reported across the study period for all US regions (West, Midwest, South Northeast, and US territories). CONCLUSIONS: Over a recent 10-year period, common cough preparations remain the most commonly reported intentional abuse ingestion among all years and regions for adolescents.


Assuntos
Centros de Controle de Intoxicações/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Comportamento do Adolescente , Bases de Dados Factuais , Ingestão de Alimentos , Feminino , Humanos , Masculino , Medicamentos sem Prescrição/envenenamento , Medicamentos sob Prescrição/envenenamento , Estados Unidos/epidemiologia , Adulto Jovem
11.
Addiction ; 114(2): 248-258, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30207015

RESUMO

BACKGROUND AND AIMS: Prescription drug monitoring programs (PDMP), defined as state-level databases used in the United States that collect prescribing information when controlled substances are dispensed, have varied substantially between states and over time. Little is known about the combinations of PDMP features that, collectively, may produce the greatest impact on prescribing and overdose. We aimed to (1) identify the types of PDMP models that have developed from 1999 to 2016, (2) estimate whether states have transitioned across PDMP models over time and (3) examine whether states have adopted different types of PDMP models in response to the burden of opioid overdose. METHODS: A latent transition analysis of PDMP models based on an adaptation of nine PDMP characteristics classified by prescription opioid policy experts as potentially important determinants of prescribing practices and prescription opioid overdose events. RESULTS: We divided the time-period into three intervals (1999-2004, 2005-09, 2010-16), and found three distinct PDMP classes in each interval. The classes in the first and second interval can be characterized as 'no/weak', 'proactive' and 'reactive' types of PDMPs, and in the third interval as 'weak', 'cooperative' and 'proactive'. The meaning of these classes changed over time: until 2009, states in the 'no/weak' class had no active PDMP, whereas states in the 'proactive' class were more likely to proactively provide unsolicited information to PDMP users, provide open access to law enforcement, and require more frequent data reporting than states in the 'reactive' class. In 2010-16, the 'weak' class resembled the 'reactive' class in previous intervals. States in the 'cooperative' class in 2010-16 were less likely than states in the 'proactive' class to provide unsolicited reports proactively or to provide open access to law enforcement; however, they were more likely than those in the 'proactive' class to share PDMP data with other states and to report more federal drug schedules. CONCLUSIONS: Since 1999, US states have tended to transition to more robust classes of prescription drug monitoring programs. Opioid overdose deaths in prior years predicted the state's prescription drug monitoring program class but did not predict transitions between prescription drug monitoring program classes over time.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Programas de Monitoramento de Prescrição de Medicamentos/tendências , Medicamentos sob Prescrição/envenenamento , Humanos , Análise de Classes Latentes , Estados Unidos/epidemiologia
12.
Workplace Health Saf ; 67(1): 36-45, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30305006

RESUMO

The opioid epidemic is a national public health crisis. It began with the misuse of commonly used prescription opioid pain relievers and has led to the increased use of heroin and illicit fentanyl. Large-scale initiatives have begun on the federal and state level and place an emphasis on improved opioid prescribing, which have important implications for the workplace. Treatment of work injury may initiate the use of prescription opioids and result in misuse and possible overdose. Prescription drug abuse affects all aspects of society so potentially any workplace could be affected. A multifaceted approach is needed to reduce opioid morbidity and mortality and the occupational health nurse should be actively involved. The intent of this article is to provide an overview of the epidemic and its impact on health, the challenges for the workplace, and recommended strategies for the occupational health nurse to impact the problem.


Assuntos
Epidemias , Papel do Profissional de Enfermagem , Enfermagem do Trabalho , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/enfermagem , Analgésicos Opioides/envenenamento , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/mortalidade , Humanos , Medicamentos sob Prescrição/envenenamento , Medicamentos sob Prescrição/uso terapêutico , Estados Unidos/epidemiologia
13.
BMC Emerg Med ; 18(1): 30, 2018 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-30231863

RESUMO

BACKGROUND: Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran. METHODS: This retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records. RESULTS: During the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04). CONCLUSION: Opioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Envenenamento/epidemiologia , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Analgésicos Opioides/envenenamento , Estudos Transversais , Vias de Administração de Medicamentos , Feminino , Mortalidade Hospitalar , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Praguicidas/envenenamento , Envenenamento/etiologia , Envenenamento/mortalidade , Medicamentos sob Prescrição/envenenamento , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
14.
MMWR Morb Mortal Wkly Rep ; 67(34): 945-951, 2018 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-30161105

RESUMO

In 2016, 63,632 drug overdose deaths occurred in the United States, 42,249 (66.4%) of which involved opioids (1). The development of prevention programs are hampered by a lack of timely data on specific substances contributing to and circumstances associated with fatal overdoses. This report describes opioid overdose deaths (referred to as opioid deaths) for decedents testing positive for prescription opioids (e.g., oxycodone and hydrocodone), illicit opioids (e.g., heroin, illicitly manufactured fentanyl, and fentanyl analogs), or both prescription and illicit opioids, and describes circumstances surrounding the overdoses, in 11 states participating in CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program.* During July 2016-June 2017, among 11,884 opioid overdose deaths, 17.4% of decedents tested positive for prescription opioids only, 58.7% for illicit opioids only, and 18.5% for both prescription and illicit opioids (type of opioid could not be classified in 649 [5.5%] deaths). Approximately one in 10 decedents had been released from an institutional setting in the month preceding the fatal overdose. Bystanders were reportedly present in approximately 40% of deaths; however, naloxone was rarely administered by a layperson. Enhanced surveillance data from 11 states provided more complete information on the substances involved in and circumstances surrounding opioid overdose deaths. Consistent with other emerging evidence and recommendations,† these data suggest prevention efforts should prioritize naloxone distribution to persons misusing opioids or using high dosage prescription opioids and to their family members and friends. In addition, these data suggest a need to expand treatment and support for persons who have experienced a nonfatal overdose and to expand treatment in detention facilities and upon release.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Drogas Ilícitas/envenenamento , Medicamentos sob Prescrição/envenenamento , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Med Care ; 56(8): 727-735, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29995696

RESUMO

BACKGROUND: Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors. OBJECTIVES: To describe demographic and clinical characteristics, medical utilization, opioid use, concurrent use of benzodiazepines, risk factors, and substances involved in death for Oklahoma's Medicaid members who died of unintentional prescription opioid poisoning. SUBJECTS: Decedents who were Medicaid eligible in Oklahoma during the year of death, had an opioid recorded in cause of death, and had ≥1 opioid prescription claim between January 1, 2011 and June 30, 2016 were cases. Controls were living Medicaid members and were matched 3:1 to cases through propensity score matching. MEASURES: Demographics, clinical characteristics, and medical/pharmacy utilization were examined in the 12 months before the index date. RESULTS: Of 639 members with fatal unintentional prescription opioid overdoses, 321 had ≥1 opioid prescription claim in the year before death; these were matched to 963 controls. Compared with controls, decedents had significantly greater proportions of nonopioid substance use disorders, opioid abuse/dependence, hepatitis, gastrointestinal bleeding, trauma not involving motor vehicle accidents, nonopioid poisonings, and mental illness disorders. Decedents had significantly higher daily morphine milligram equivalent doses (67.2±74.4 vs. 47.2±50.9 mg) and greater opioid/benzodiazepine overlap (70.4% vs. 35.9%). Benzodiazepines were involved in 29.3% of deaths. CONCLUSIONS: Several comorbidities indicative of opioid use disorder and greater exposure to opioids and concomitant benzodiazepines were associated with unintentional prescription opioid overdose fatalities. Prescribers and state agencies should be aware of these addressable patient-level factors among the Medicaid population. Targeting these factors with appropriate policy interventions and education may prevent future deaths.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/mortalidade , Uso Indevido de Medicamentos sob Prescrição/mortalidade , Medicamentos sob Prescrição/envenenamento , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oklahoma/epidemiologia
16.
Arch Phys Med Rehabil ; 99(10): 1941-1948, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29908137

RESUMO

OBJECTIVE: To identify risk and protective factors for unintentional death related to drug poisoning from prescription medications, including opioid-related deaths, and death due to all other causes among participants with spinal cord injury (SCI). DESIGN: Prospective cohort study. SETTING: Large specialty hospital in the southeastern United States. PARTICIPANTS: Two cohorts of SCI participants (N=3070) (>18y) with chronic (>1y) traumatic SCI. Cohort 1 was enrolled in 1997-1998 (n=1386), and cohort 2 was enrolled in 2007-2009 (n=1684). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Participants completed self-report assessments including multiple behavioral variables (alcohol, smoking, prescription medication), as well as the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). The primary outcome is unintentional death related to drug poisoning. Mortality status was determined as of December 31, 2014, using the National Death Index. The Centers for Disease Control guidelines were used for classifying participants into 3 groups: (1) unintentional death related to drug poisoning, (2) other death, and (3) alive. RESULTS: There were 690 deaths (23%), including 24 unintentional deaths related to drug poisoning (11 from opioids). Binge drinking, medication usage total score, and impulsive-sensation seeking were risk factors for unintentional death related to drug poisoning, whereas the ZKPQ activity scale was protective. Risk factors for other causes of death included older age, greater injury severity, being nonambulatory, regular smoker, medication use total score, and greater neuroticism-anxiety scale scores. CONCLUSIONS: Unintentional deaths related to prescription drug overdose are associated with a set of risk factors that differs in meaningful ways from risk of death due to other causes after SCI, and these differences hold the key to prevention strategies.


Assuntos
Analgésicos Opioides/envenenamento , Personalidade , Medicamentos sob Prescrição/envenenamento , Traumatismos da Medula Espinal/mortalidade , Traumatismos da Medula Espinal/psicologia , Adulto , Feminino , Humanos , Comportamento Impulsivo , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Assunção de Riscos , Sudeste dos Estados Unidos , Traumatismos da Medula Espinal/complicações
17.
Health Promot Chronic Dis Prev Can ; 38(6): 224-233, 2018 Jun.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-29911818

RESUMO

INTRODUCTION: This review provides a national summary of what is currently known about the Canadian opioid crisis with respect to opioid-related deaths and harms and potential risk factors as of December 2017. METHODS: We reviewed all public-facing opioid-related surveillance or epidemiological reports published by provincial and territorial ministries of health and chief coroners' or medical examiners' offices. In addition, we reviewed publications from federal partners and reports and articles published prior to December 2017. We synthesized the evidence by comparing provincial and territorial opioid-related mortality and morbidity rates with the national rates to look for regional trends. RESULTS: The opioid crisis has affected every region of the country, although some jurisdictions have been impacted more than others. As of 2016, apparent opioid-related deaths and hospitalization rates were highest in the western provinces of British Columbia and Alberta and in both Yukon and the Northwest Territories. Nationally, most apparent opioid-related deaths occurred among males; individuals between 30 and 39 years of age accounted for the greatest proportion. Current evidence suggests regional age and sex differences with respect to health outcomes, especially when synthetic opioids are involved. However, differences between data collection methods and reporting requirements may impact the interpretation and comparability of reported data. CONCLUSION: This report identifies gaps in evidence and areas for further investigation to improve our understanding of the national opioid crisis. The Public Health Agency of Canada will continue to work closely with the provinces, territories and national partners to further refine and standardize national data collection, conduct special studies and expand information-sharing to improve the evidence needed to inform public health action and prevent opioid-related deaths and harms.


Assuntos
Overdose de Drogas/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Fatores Etários , Canadá/epidemiologia , Overdose de Drogas/mortalidade , Fentanila/envenenamento , Hospitalização/estatística & dados numéricos , Humanos , Drogas Ilícitas/envenenamento , Naloxona/provisão & distribução , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/provisão & distribução , Antagonistas de Entorpecentes/uso terapêutico , Entorpecentes/envenenamento , Transtornos Relacionados ao Uso de Opioides/mortalidade , Medicamentos sob Prescrição/envenenamento , Fatores de Risco , Fatores Sexuais , Populações Vulneráveis/estatística & dados numéricos
18.
Clin Toxicol (Phila) ; 56(8): 782-789, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29334809

RESUMO

INTRODUCTION: Pharmacological poisonings in young children are avoidable. Previous studies report calls to poisons centres, presentations to emergency departments (ED) or hospital admissions. There are limited data assessing concurrent management of poisonings across all three settings. We aimed to describe accidental pharmacological poisonings in young children across our Poisons Information Centre (PIC), EDs and hospitals. METHODS: A population-based study in New South Wales, Australia, of PIC calls, ED presentations and hospital admissions for accidental pharmacological poisoning in children aged <5 years, 2007-2013. We examined trends, medicines responsible and subsequent management. Medicines were coded using ICD10-AM diagnosis codes (T36-50). RESULTS: Over 2007-2013, pharmacological poisonings accounted for 67,816 PIC calls, 7739 ED presentations and 2082 admissions. Rates (per 10,000 children) of PIC calls declined from 220 to 178; ED presentations were stable (∼22-24), with a decrease in emergency cases offset by an increase in semi- or non-urgent presentations; hospital admissions declined (8-5). Most PIC calls related to "non-opioid analgesics" (25%), and "topical agents" (18%). Nearly every day, one child aged <5 years was admitted to hospital for poisoning. "Benzodiazepines", "other and unspecified antidepressants", "uncategorised antihypertensives", and "4-aminophenol derivatives" accounted for over one-third of all admissions. Most PIC calls (90%) were advised to stay home, 6% referred to hospital. One-quarter of ED presentations resulted in admission. CONCLUSIONS: Poisonings reported to PIC and hospitals declined, however, non-urgent ED presentations increased. Strategies to reduce therapeutic errors and access to medicines, and education campaigns to improve Poisons Centre call rates to prevent unnecessary ED presentations are needed.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Centros de Controle de Intoxicações/estatística & dados numéricos , Medicamentos sob Prescrição/envenenamento , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , New South Wales , Preparações Farmacêuticas , Vigilância da População , Estudos Retrospectivos
20.
Inj Prev ; 24(1): 48-54, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28835443

RESUMO

BACKGROUND: In response to increasing opioid overdoses, US prevention efforts have focused on prescriber education and supply, demand and harm reduction strategies. Limited evidence informs which interventions are effective. We evaluated Project Lazarus, a centralised statewide intervention designed to prevent opioid overdose. METHODS: Observational intervention study of seven strategies. 74 of 100 North Carolina counties implemented the intervention. Dichotomous variables were constructed for each strategy by county-month. Exposure data were: process logs, surveys, addiction treatment interviews, prescription drug monitoring data. Outcomes were: unintentional and undetermined opioid overdose deaths, overdose-related emergency department (ED) visits. Interrupted time-series Poisson regression was used to estimate rates during preintervention (2009-2012) and intervention periods (2013-2014). Adjusted IRR controlled for prescriptions, county health status and time trends. Time-lagged regression models considered delayed impact (0-6 months). RESULTS: In adjusted immediate-impact models, provider education was associated with lower overdose mortality (IRR 0.91; 95% CI 0.81 to 1.02) but little change in overdose-related ED visits. Policies to limit ED opioid dispensing were associated with lower mortality (IRR 0.97; 95% CI 0.87 to 1.07), but higher ED visits (IRR 1.06; 95% CI 1.01 to 1.12). Expansions of medication-assisted treatment (MAT) were associated with increased mortality (IRR 1.22; 95% CI 1.08 to 1.37) but lower ED visits in time-lagged models. CONCLUSIONS: Provider education related to pain management and addiction treatment, and ED policies limiting opioid dispensing showed modest immediate reductions in mortality. MAT expansions showed beneficial effects in reducing ED-related overdose visits in time-lagged models, despite an unexpected adverse association with mortality.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/envenenamento , Serviço Hospitalar de Emergência/legislação & jurisprudência , Redução do Dano , Humanos , North Carolina/epidemiologia , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/legislação & jurisprudência , Avaliação de Programas e Projetos de Saúde
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