Unintentional and intentional drug poisoning deaths, Australia, 2012–2016: Drug pattern profile and demographic characteristics

Chrzanowska, Agata; Man, Nicola; Darke, Shane; Degenhardt, Louisa; Farrell, Michael; Moran, Lauren; Peacock, Amy

doi:10.1016/j.drugalcdep.2021.109112

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…Acute poisoning is a significant public health problem and is a frequent reason for referral to emergency departments 1 . Poisoning can be intentional or unintentional 2 . Accidental poisonings remain a common cause of intoxication in children.…”

Section: Introductionmentioning

confidence: 99%

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Naseri

Kiani

Sajadi

et al. 2023

Sci Rep

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Information on the pattern of acute poisonings in hospitals of Birjand city, Iran, is limited. This study aimed to address this knowledge gap by examining the admissions in a major poisoning center in eastern Iran. This cross-sectional study included patients admitted to the Imam Reza Hospital in Birjand over 12 months. Medical records of the poisoned patients were reviewed, and the study variables were used for data analysis. During the study period, 534 cases of acute poisonings were evaluated. The patient's ages ranged from 12 to 84 years, with a high rate of poisonings between 15 and 35 years. The female predominance in poisoning cases was 52.1%. Most cases of poisonings occurred in spring, and the common route of exposure was oral (93.1%). The incidence of poisoning in married couples, uneducated patients, and residents of urban areas was 56.5%, 90.1%, and 74.6%, respectively. Patients with a previous medical history experienced addiction and psychiatric disorders. Intentional poisoning accounted for 23.4% of acute poisoning cases referred to the hospital in the current study. The main groups of toxicants were pharmaceutical products (48.1%), narcotics (25.8%), chemical products (10.1%), envenomation (7.1%), and alcohol (1.7%). The mean hospital stay was 2.5 ± 3.0 days, and the final treatment outcome was complete recovery, except for one patient intoxicated by warfarin and alprazolam. Our results indicate that the high toxicity cases were related to pharmaceutical product and opioids abuse, especially methadone (8.4%), alprazolam (7.9%), clonazepam (7.5%), and acetaminophen (9.9%) taken orally and more commonly happened at home. Due to the high rate of deliberate poisonings, especially among young adults and students, monitoring drug distribution and exceptional attention to mental health should be seriously considered by national health authorities to prevent suicide attempts.

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Section: Introductionmentioning

confidence: 99%

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Naseri

Kiani

Sajadi

et al. 2023

Sci Rep

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“…In contrast to some settings, opioid-related deaths in Australia are largely due to natural and semi-synthetic opioids (e.g. codeine, oxycodone) and heroin [23,24]. Deaths were included if they were coded with any of three subtypes of ICD-10 code F11: F11.1, F11.2 and F11.9 and termed 'F11 deaths'.…”

Section: Opioid-related Mortalitymentioning

confidence: 99%

Prevalence of opioid dependence in New South Wales, Australia, 2014–16: Indirect estimation from multiple data sources using a Bayesian approach

et al. 2023

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AimsTo estimate the prevalence of, and number of unobserved people with opioid dependence by sex and age group in New South Wales (NSW), Australia.DesignWe applied a Bayesian statistical modelling approach to opioid agonist treatment records linked to adverse event rate data. We estimated prevalence from three types of adverse event separately: opioid mortality, opioid‐poisoning hospitalizations and opioid‐related charges. We extended the model and produced prevalence estimates from a ‘multi‐source’ model based on all three types of adverse event data.Setting, Participants and MeasurementsThis study was conducted in NSW, Australia, 2014–16 using data from the Opioid Agonist Treatment and Safety (OATS) study, which included all people who had received treatment for opioid dependence in NSW. Aggregate data were obtained on numbers of adverse events in NSW. Rates of each adverse event type within the OATS cohort were modelled. Population data were provided by State and Commonwealth agencies.FindingsPrevalence of opioid dependence among those aged 15–64 years in 2016 was estimated to be 0.96% (95% credible interval [CrI] = 0.82%, 1.12%) from the mortality model, 0.75% (95% CrI = 0.70%, 0.83%) from hospitalizations, 0.95% (95% CrI = 0.90%, 0.99%) from charges and 0.92% (95% CrI = 0.88%, 0.96%) from the multi‐source model. Of the estimated 46 460 (95% CrI = 44 680, 48 410) people with opioid dependence in 2016 from the multi‐source model, approximately one‐third (16 750, 95% CrI = 14 960, 18 690) had no record of opioid agonist treatment within the last 4 years. From the multi‐source model, prevalence in 2016 was estimated to be 1.24% (95% CrI = 1.18%, 1.31%) in men aged 15–44, 1.22% (95% CrI = 1.14%, 1.31%) in men 45–64, 0.63% (95% CrI = 0.59%, 0.68%) in women aged 15–44 and 0.56% (95% CrI = 0.50%, 0.63%) in women aged 45–64.ConclusionsA Bayesian statistical approach to estimate prevalence from multiple adverse event types simultaneously calculates that the estimated prevalence of opioid dependence in NSW, Australia in 2016 was 0.92%, higher than previous estimates.

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“…In Australia, there are an average of 3000 deaths by suicide every year . Almost two-thirds of intentional poisoning deaths in Australia involved 2 or more substance classes combined . Poisoning deaths involving multiple substances are more difficult to interpret as not every substance is necessarily contributory to the death .…”

Section: Introductionmentioning

confidence: 99%

“…2 Commonly detected medicine classes in poisoning suicides in Canada, the US, Europe, New Zealand, and Australia include hypnosedatives, tricyclic antidepressants, benzodiazepines, neuroleptics, and over-the-counter medicines. [3][4][5][6][7][8] Opioids, both prescribed and illicit, remain a concern in high-income countries. 4,8 In contrast, pesticides often predominate in poisoning suicides in lower-income countries.…”

mentioning

confidence: 99%

“…15 Almost two-thirds of intentional poisoning deaths in Australia involved 2 or more substance classes combined. 6 Poisoning deaths involving multiple substances are more difficult to interpret as not every substance is necessarily contributory to the death. 14,16 Substance combinations can also contribute to death by synergistic toxicity, and concentrations do not have to be at toxic levels to cause poisoning.…”

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confidence: 99%

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Substances Detected During Coroner Postmortem Toxicology Analyses in Poisoning- and Nonpoisoning-Related Suicides

et al. 2023

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ImportanceDetermining the association between drug use and suicide is complicated but can help to inform targeted suicide prevention strategies.ObjectiveTo examine the substances prevalent in poisoning- and nonpoisoning-related suicides in Australia.Design, Setting, and ParticipantsThis was a multiple-year, cross-sectional study of suicides from July 2013 to October 2019 in Australia with toxicology data available in a national coronial database. The cause of death was classified as poisoning related if any type of poisoning was determined by the coroner to contribute to the cause of death. Prevalence ratios (PRs) were calculated to compare substance detection in poisoning- vs nonpoisoning-related suicides. Data were analyzed from October 2021 to April 2023.ExposuresAll substances detected in decedents at the time of death according to toxicology reports were recorded.Main Outcome(s) and Measure(s)The most common individual substances and substance classes were identified. From these, blood concentrations of substances of interest were analyzed, and the most commonly occurring combinations of substance classes were listed.ResultsToxicology was performed on 13 664 suicide decedents (median [IQR] age, 44 [31-57] years; 10 350 male [76%]). From these, 3397 (25%) were poisoning-related suicides (median [IQR] age, 50 [38-63] years; 2124 male [63%]). The remainder were classified as nonpoisoning-related suicides (median [IQR] age, 42 [29-55] years; 8226 male [80%]). PRs for common medicine classes being detected in poisoning-related suicides compared with nonpoisoning-related suicides were as follows: antidepressants (PR, 1.63; 95% CI, 1.54-1.73), benzodiazepines (PR, 2.01; 95% CI, 1.90-2.13), nonopioid analgesics/anti-inflammatory drugs (PR, 1.88; 95% CI, 1.78-2.00), and opioids (PR, 2.72; 95% CI, 2.58-2.87). Alcohol (as ethanol ≥0.03 g/100 mL) was almost equally prevalent in poisoning- and nonpoisoning-related deaths (PR, 1.07; 95% CI, 1.01-1.14), whereas amphetamines (PR, 0.68; 95% CI, 0.61-0.77) and cannabinoids (PR, 0.67; 95% CI, 0.60-0.74) were detected more often in nonpoisoning-related suicides. Combinations of multiple sedative agents in poisoning-related suicides were common.Conclusions and RelevanceBoth poisoning- and nonpoisoning-related suicide deaths featured a high prevalence of psychotropic medicines or potential intoxication, which suggests the association of suicide with poor mental health and substance misuse. Findings suggest that substances with a high involvement in poisoning-related suicides should be prescribed cautiously, including antidepressants that are toxic in overdose, sedatives, opioids, and potentially lethal combinations.

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Unintentional and intentional drug poisoning deaths, Australia, 2012–2016: Drug pattern profile and demographic characteristics

Cited by 19 publications

References 26 publications

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Prevalence of opioid dependence in New South Wales, Australia, 2014–16: Indirect estimation from multiple data sources using a Bayesian approach

Substances Detected During Coroner Postmortem Toxicology Analyses in Poisoning- and Nonpoisoning-Related Suicides

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