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3.
Lancet ; 394(10208): 1560-1579, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31657732

RESUMO

We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.


Assuntos
Analgésicos Opioides/uso terapêutico , Overdose de Drogas/mortalidade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Saúde Global , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Prevalência , Fatores de Risco
6.
R I Med J (2013) ; 102(6): 24-26, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398964

RESUMO

The opioid epidemic presents an urgent public health problem. Rhode Island has enacted comprehensive rules to address primary prevention of opioid overdose. This study evaluates the efficacy of those regulations in altering prescribing behavior, specifically regarding the initial prescription. Using data extracted from the Rhode Island Prescription Drug Monitoring Program (PDMP), before and after the publication of updated acute pain management regulations, we studied the rate of opioid prescribing using statistical process control (SPC) charts and found that the rate of prescribing unsafe doses of opioids, more than 30 morphine milligram equivalents (MMEs) per day or more than 20 doses to opioid naïve patients, decreased significantly.


Assuntos
Overdose de Drogas/epidemiologia , Prescrição Inadequada/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Programas de Monitoramento de Prescrição de Medicamentos/legislação & jurisprudência , Analgésicos Opioides/uso terapêutico , Overdose de Drogas/prevenção & controle , Humanos , Prescrição Inadequada/prevenção & controle , Análise de Séries Temporais Interrompida , Padrões de Prática Médica/normas , Programas de Monitoramento de Prescrição de Medicamentos/normas , Medicamentos sob Prescrição/uso terapêutico , Rhode Island/epidemiologia
8.
Crit Care Resusc ; 21(3): 188-199, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462206

RESUMO

OBJECTIVE: Acute liver failure (ALF) leads to severe illness and usually requires admission to the intensive care unit (ICU). Despite its importance, little is known about patients with ALF in Australia and New Zealand. DESIGN: Binational observational study to evaluate the aetiology, baseline characteristics, patterns of illness, management, and outcomes for patients with ALF admitted to Australian and New Zealand ICUs. SETTING: All six Australian and New Zealand ICUs in liver transplant centres submitted de-identified data for ten or more consecutive patients with ALF. Data were obtained from the clinical record and included baseline characteristics, aetiology, mode of presentation, illness severity, markers of liver failure, critical care interventions, utilisation of transplantation, and hospital outcome. RESULTS: We studied 62 patients with ALF. Paracetamol overdose (POD) was the underlying cause of ALF in 53% of patients (33/62), with staggered ingestion in 42% of patients (14/33). Among patients with POD, 70% (23/33) were young women, most had psychiatric diagnoses, and most presented relatively early with overt liver failure. This group were transplanted in only 6% of cases (2/33) and had an overall mortality of 24% (8/33). The remaining patients with ALF had less common conditions, such as hepatitis B and non-paracetamol drug-induced ALF. These patients presented later and exhibited less extreme evidence of acute hepatic necrosis. Transplantation was performed in 38% of patients (11/29) in this subgroup. The mortality of nontransplanted non-POD patients was 56% (10/18). Illness severity at ICU admission, initial requirement for organ support therapies and length of hospital stay were similar between patients with POD and non-POD ALF. CONCLUSION: POD is the major cause of ALF in Australian and New Zealand liver transplant centres and is a unique and separate form of ALF. It has a much lower associated mortality and treatment with liver transplantation than non-POD ALF. Non-POD patients have a poor prognosis in the absence of transplantation.


Assuntos
Acetaminofen/administração & dosagem , Acetaminofen/toxicidade , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/toxicidade , Overdose de Drogas/epidemiologia , Falência Hepática Aguda/induzido quimicamente , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Falência Hepática Aguda/epidemiologia , Falência Hepática Aguda/etiologia , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Nova Zelândia/epidemiologia , Resultado do Tratamento , Adulto Jovem
9.
Public Health Rep ; 134(5): 567-576, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365317

RESUMO

OBJECTIVES: High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids. METHODS: We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states. RESULTS: For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations. CONCLUSIONS: These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.


Assuntos
Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/normas , Guias como Assunto , Hospitalização/tendências , Bases de Dados Factuais , Humanos , Análise de Regressão , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos/epidemiologia
11.
West J Emerg Med ; 20(4): 557-572, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316694

RESUMO

Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers ("budtenders") without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Uso da Maconha/efeitos adversos , Uso da Maconha/tendências , Acidentes de Trânsito/tendências , Sintomas Comportamentais/induzido quimicamente , Cannabis/química , Colorado/epidemiologia , Dirigir sob a Influência/tendências , Contaminação de Medicamentos , Overdose de Drogas/epidemiologia , Hospitalização/tendências , Humanos , Legislação de Medicamentos , Transtornos Mentais/induzido quimicamente , Serviços de Saúde Mental/tendências , Envenenamento/epidemiologia , Vômito/epidemiologia
12.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31278211

RESUMO

OBJECTIVES: Adolescent depression and attempted and completed suicide are increasing in the United States. Because suicide is often impulsive, the means of self-harm are frequently items of convenience like medication. Authors of a recent study compared tricyclic antidepressant overdose to bupropion overdose. Fluoxetine and escitalopram are the only agents with Food and Drug Administration approval for pediatric depression, but off-label bupropion prescriptions are common. We sought to compare the effects of selective serotonin reuptake inhibitors (SSRIs) and bupropion in overdose. METHODS: This was an analysis of the National Poison Data System from June 2013 through December 2017 for adolescent (ages 10-19) exposures to SSRIs or bupropion coded as "suspected suicide." Demographics, clinical effects, therapies, and medical outcome were analyzed. RESULTS: There were 30 026 cases during the study period. Sertraline and fluoxetine accounted for nearly 60%, whereas bupropion was reported in 11.7%. Bupropion exposure was significantly associated with death (0.23% vs 0%; P < .001) or serious outcome (58.1% vs 19%; P < .001) as well as the 10 most common clinical effects, including seizures (27.0% vs 8.5%; P < .001) and hallucinations (28.6% vs 4.3%; P < .001). Bupropion exposure was significantly associated with the need for cardiopulmonary resuscitation (0.51% vs 0.01%; P < .001), intubation (4.9% vs 0.3%; P < .001), vasopressors (1.1% vs 0.2%; P < .001), and benzodiazepines (34.2% vs 5.5%; P < .001). There was a significant increase in all exposures and in proportion of serious outcomes over time. CONCLUSIONS: Adolescents who attempt self-harm are at higher risk for serious morbidity and poor outcomes with bupropion than with SSRIs. These risks, and the patient's propensity for self-harm, should be evaluated when therapy with bupropion is considered.


Assuntos
Antidepressivos de Segunda Geração/toxicidade , Bupropiona/toxicidade , Overdose de Drogas/diagnóstico , Overdose de Drogas/epidemiologia , Inibidores de Captação de Serotonina/toxicidade , Tentativa de Suicídio , Adolescente , Criança , Overdose de Drogas/terapia , Feminino , Humanos , Masculino , Centros de Controle de Intoxicações/tendências , Estudos Retrospectivos , Tentativa de Suicídio/tendências , Adulto Jovem
13.
East Asian Arch Psychiatry ; 29(2): 57-62, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31237247

RESUMO

This article reviews the poisoning epidemiology in Hong Kong, assessment and treatment of acute poisoning, and management of acute psychiatric medication overdose. In 2016, nearly 4000 poisoning cases involving approximately 6000 poisons were reported to Hong Kong Poison Information Centre. About 25% of the poisons involved were psychiatric-related medications. The initial medical assessment on poisoning includes history taking, vital signs monitoring, and focused physical examination. Approaches in managing acute poisoning include supportive measures, decontamination, antidote use, and enhanced elimination. Management on overdose of psychiatric medications (zopiclone, tricyclic antidepressants, selective serotonin reuptake inhibitor, antipsychotics, valproic acid, lithium, and methylphenidate) are discussed with practical tips highlighted.


Assuntos
Overdose de Drogas , Transtornos Mentais , Psicotrópicos , Overdose de Drogas/epidemiologia , Overdose de Drogas/etiologia , Hong Kong/epidemiologia , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Psicotrópicos/classificação , Psicotrópicos/uso terapêutico , Psicotrópicos/toxicidade
14.
BMC Public Health ; 19(1): 670, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146721

RESUMO

As the overdose crisis in North America continues to deepen, public health leaders find themselves responding to sensational media stories, many of which carry forms and themes that mark them as urban legends.This article analyzes one set of media accounts - stories of misuse of naloxone, an opioid overdose antidote distributed to people who use drugs - through the lens of social science scholarship on urban legends. We suggest that these stories have met a public need to feel a sense of safety in uncertain times, but function to reinforce societal views of people who use drugs as undeserving of support and resources.Our field has a duty to speak out in favour of evidence-based programs that support the health of people who use drugs, but the optimal communication strategies are not always clear. Drawing attention to the functions and consequences of urban legends can help frame public health communication in a way that responds to needs without reinforcing prejudices, with application beyond naloxone to the other urban legends that continue to emerge in response to this crisis.


Assuntos
Analgésicos Opioides/toxicidade , Meios de Comunicação , Overdose de Drogas/tratamento farmacológico , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Overdose de Drogas/epidemiologia , Comunicação em Saúde , Humanos , América do Norte/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Papel Profissional , Saúde Pública
15.
Int J Ment Health Nurs ; 28(4): 833-844, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31179592

RESUMO

This study explores the patterns and features of methamphetamine-related presentations to emergency departments (EDs) in Queensland. Despite an overall decrease in the use of methamphetamine in Australian, an increase in the use of the crystalized form of methamphetamine has been noted over recent years. A descriptive observational study was utilized to analyse emergency department (ED) injury surveillance data sourced from Queensland Injury Surveillance Unit (QISU) from 2005 to 2017. Data were analysed for presentations related to stimulants (n = 564) with methamphetamine (n = 250) included as a subcategory. Descriptive statistics were used to identify patterns and features of presentations related to methamphetamines. The relationship between demographic variables, service type variables, and drug type was assessed using chi-square and z-tests. Results included the following: 84.4% of methamphetamine-related presentations were allocated a triage score of 1, 2, or 3; 14.8% of all methamphetamine-related presentations required police involvement; 18% were brought in by ambulance; and 15.6% exhibited behaviour that was either, agitated, aggressive, or violent in nature. Methamphetamine-related presentations more frequently required police or ambulance services and more often included aggression or agitation. Methamphetamine-related presentations to ED have a high acuity and often require other emergency resources (police and ambulance). There is a need to develop policy for managing aggressive and agitated people presenting to EDs as a result of methamphetamine use and to further explore the experience of personnel (police and ambulance) managing persons under the influence of methamphetamine.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/terapia , Serviço Hospitalar de Emergência , Metanfetamina/envenenamento , Adolescente , Adulto , Idoso , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Criança , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Queensland/epidemiologia , Estudos Retrospectivos , Triagem , Adulto Jovem
16.
BMJ ; 365: l2147, 2019 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-31189556

RESUMO

OBJECTIVE: To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality. DESIGN: Population based cohort study. SETTING: High quality prescription, patient, death, and crime registers, Sweden. PARTICIPANTS: 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013. MAIN OUTCOME MEASURES: Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics. RESULTS: During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years. CONCLUSIONS: This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Gabapentina/efeitos adversos , Pregabalina/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Overdose de Drogas/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Suicídio/estatística & dados numéricos , Suécia/epidemiologia , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto Jovem
17.
Ann Thorac Surg ; 108(4): 1133-1139, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31178157

RESUMO

BACKGROUND: The national opioid epidemic has expanded the donor pool for heart transplantation, but concerns remain regarding infectious risk and allograft function. This study compared donor and recipient characteristics, outcomes, and reasons for organ discard between overdose-death donors (ODDs) and donors with all other mechanism of death. METHODS: Data on adult cardiac transplants from 2010 to 2017 were provided by the Scientific Registry of Transplant Recipients. Cardiac allografts used in multiple organ transplantations were excluded. Recipient and donor characteristics and organ discard were analyzed with regard to ODDs. Kaplan-Meier curves and log-rank tests described mortality survival. RESULTS: A total of 1,710 of 15,904 (10.8%) cardiac transplantations were from ODDs, approximately a 10-fold increase from 2000 (1.2%). ODDs were more frequently older than 40 years of age (87.2% vs 70.1%; p < 0.001), had higher rates of substance abuse, were more likely hepatitis C positive (1.3% vs 0.2%; p < 0.001), and less frequently required inotropic support at the time of procurement (38.4% vs 44.8%; p < 0.001). Overall survival was not different between the groups (p = 0.066). Discarded ODD allografts were more likely to be hepatitis C positive (30.8% vs 5.3%; p < 0.001) and to be identified as conveying increased risk by the Public Health Services (63.3% vs 13.2%; p < 0.001), but they were less likely to be discarded because of a diseased organ state (28.2% vs 36.1%; p < 0.001). CONCLUSIONS: Rates of ODDs have increased corresponding with the worsening opioid epidemic. Even though ODDs have higher rates of hepatitis C, cardiac allograft quality indices are favorable, and recipient outcomes are similar when compared with non-ODDs, a finding indicating that greater use of this donor pool may be appropriate.


Assuntos
Seleção do Doador/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Adulto , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos
18.
Am J Public Health ; 109(8): 1084-1091, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219718

RESUMO

Objectives. To examine associations of county-level demographic, socioeconomic, and labor market characteristics on overall drug mortality rates and specific classes of opioid mortality. Methods. We used National Vital Statistics System mortality data (2002-2004 and 2014-2016) and county-level US Census data. We examined associations between several census variables and drug deaths for 2014 to 2016. We then identified specific classes of counties characterized by different levels and rates of growth in mortality from specific opioid types between 2002 to 2004 and 2014 to 2016. We ran multivariate and multivariable regression models to predict probabilities of membership in each "opioid mortality class" on the basis of county-level census measures. Results. Drug mortality rates overall are higher in counties characterized by more economic disadvantage, more blue-collar and service employment, and higher opioid-prescribing rates. High rates of prescription opioid overdoses and overdoses involving both prescription and synthetic opioids cluster in more economically disadvantaged counties with larger concentrations of service industry workers. High heroin and "syndemic" opioid mortality counties (high rates across all major opioid types) are more urban, have larger concentrations of professional workers, and are less economically disadvantaged. Syndemic opioid counties also have greater concentrations of blue-collar workers. Conclusions. Census data are essential tools for understanding the importance of place-level characteristics on opioid mortality. Public Health Implications. National opioid policy strategies cannot be assumed universally applicable. In addition to national policies to combat the opioid and larger drug crises, emphasis should be on developing locally and regionally tailored interventions, with attention to place-based structural economic and social characteristics.


Assuntos
Censos , Overdose de Drogas/mortalidade , Mortalidade , Transtornos Relacionados ao Uso de Opioides/mortalidade , Saúde Pública/estatística & dados numéricos , Overdose de Drogas/epidemiologia , Humanos , Governo Local , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia
19.
PLoS One ; 14(5): e0216317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048918

RESUMO

BACKGROUND: Intentional drug overdose is the most common method of self-harm. As psychiatric disorders are very common in self-harm patients, the medication used to treat these disorders can become the means for the self-harm act. The present study aimed at investigating an association between the use of prescribed medication (analgesics and antipyretics, anti-epileptics, antipsychotics, antidepressants and psychostimulants) as a method of self-harm and prescription rates of this medication in Flanders. We investigated the possible effect of gender, alcohol use during the self-harm act and a history of self-harm. METHODS: Data from the multicenter study of self-harm in Flanders between 2008 and 2013 were used. The significance of differences in percentages was calculated by GEE and the strength by odds ratios (OR). RESULTS: There was an increase in the odds of using antidepressants (0.8%) and antipsychotics (2%) among females when the rate of prescription increases. Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were the most commonly prescribed drugs among females. Antidepressants (63.9/1,000) and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among males. Antidepressants and analgesics and antipyretics were the most frequently used medications for self-harm. Analgesics and antipyretics during the self-harm act were more common among first-timers, while repeaters more commonly overdosed using antipsychotics and antidepressants. CONCLUSION: These findings suggest that the availability of medication via prescriptions plays an important role in the choice of the medication ingested during the self-harm act. Precautions are necessary when prescribing medication, including restrictions on the number of prescriptions and the return of unused medication to pharmacies after cessation of treatment. These issues should be a focus of attention in the education and training of physicians and pharmacists.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Medicamentos sob Prescrição/efeitos adversos , Psicotrópicos/efeitos adversos , Tentativa de Suicídio , Adulto , Bélgica/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Medicamentos sob Prescrição/administração & dosagem , Psicotrópicos/administração & dosagem , Fatores Sexuais
20.
Soc Psychiatry Psychiatr Epidemiol ; 54(10): 1209-1218, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31041467

RESUMO

PURPOSE: To investigate small-area variation in risks associated with suicide deaths across four regional communities in New South Wales, Australia, and to determine whether these areas have unique demographic and socioeconomic risk profiles that could inform targeted means restriction suicide prevention efforts. METHODS: Archival data on suicide mortality for all deaths in New South Wales, Australia, over the period 2006-2015 were geospatially attributed to four high-risk priority regions. Deaths in the four regions were compared to each other, and to NSW, on demographic factors, indicators of economic deprivation, and suicide means. RESULTS: Priority means restriction targets were identified for all sites. In Murrumbidgee, suicide deaths were significantly more likely to involve firearms and older males (p < 0.001). The Central Coast had a greater proportion of overdose deaths (p < 0.001), which were associated with being female and unemployed. Suicide deaths in Newcastle were associated with being younger (p = 0.001) and involving 'jumping from a height' (p < 0.001), while economic deprivation was a major risk for suicide death in Illawarra Shoalhaven (p < 0.001). CONCLUSIONS: Local regions were significantly differentiated from each other, and from the State, in terms of priority populations and means of suicide, demonstrating the need for locally based, targeted interventions. There were, however, also some risk constancies across all sites (males, hanging, economic deprivation), suggesting that prevention initiatives should, optimally, be delivered within multilevel models that target risk commonalities and provide tailored initiatives that address risk specific to a region.


Assuntos
Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Overdose de Drogas/epidemiologia , Overdose de Drogas/psicologia , Feminino , Armas de Fogo/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Fatores de Risco , Análise de Pequenas Áreas , Suicídio/prevenção & controle , Violência/estatística & dados numéricos , Adulto Jovem
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