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Devin J, Lyons S, Murphy L, O’Sullivan M, Lynn E. Factors associated with suicide in people who use drugs: a scoping review. BMC Psychiatry 2023; 23:655. [PMID: 37670233 PMCID: PMC10478413 DOI: 10.1186/s12888-023-05131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Suicide is a significant contributor to global mortality. People who use drugs (PWUD) are at increased risk of death by suicide relative to the general population, but there is a lack of information on associated candidate factors for suicide in this group. The aim of this study was to provide a comprehensive overview of existing evidence on potential factors for death by suicide in PWUD. METHODS A scoping review was conducted according to the Arksey and O'Malley framework. Articles were identified using Medline, CINAHL, PsycINFO, SOCIndex, the Cochrane Database of Systematic Reviews and the Campbell Collaboration Database of Systematic Reviews; supplemented by grey literature, technical reports, and consultation with experts. No limitations were placed on study design. Publications in English from January 2000 to December 2021 were included. Two reviewers independently screened full-text publications for inclusion. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. RESULTS The initial search identified 12,389 individual publications, of which 53 met the inclusion criteria. The majority (87%) of included publications were primary research, with an uncontrolled, retrospective study design. The most common data sources were drug treatment databases or national death indexes. Eleven potential factors associated with death by suicide among PWUD were identified: sex; mental health conditions; periods of heightened vulnerability; age profile; use of stimulants, cannabis, or new psychoactive substances; specific medical conditions; lack of dual diagnosis service provision; homelessness; incarceration; intravenous drug use; and race or ethnicity. Opioids, followed by cannabis and stimulant drugs were the most prevalent drugs of use in PWUD who died by suicide. A large proportion of evidence was related to opioid use; therefore, more primary research on suicide and explicit risk factors is required. CONCLUSIONS The majority of studies exploring factors associated with death by suicide among PWUD involved descriptive epidemiological data, with limited in-depth analyses of explicit risk factors. To prevent suicide in PWUD, it is important to consider potential risk factors and type of drug use, and to tailor policies and practices accordingly.
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Affiliation(s)
- Joan Devin
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 1st Floor Ardilaun House Block B, 111 St Stephen’s Green, Dublin 2, Ireland
| | - Suzi Lyons
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Lisa Murphy
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Michael O’Sullivan
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
| | - Ena Lynn
- Health Research Board, Grattan House, 67–72 Lower Mount Street, Dublin 2, Ireland
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Zhu Z, Huang X, Tan Z, Huang J, Chen M, He B, Cai H, Zhang B. Development of a Sensitive and Rapid HPLC-MS Method for Dihydrocodeine and Dihydromorphine: Application to Bioequivalence Studies. J Chromatogr Sci 2022; 60:977-983. [PMID: 35862985 DOI: 10.1093/chromsci/bmac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 11/14/2022]
Abstract
A ultraperformance liquid chromatography-tandem mass spectrometry method has been developed to determine dihydrocodeine (DHC) and dihydromorphine (DHM) in human plasma using dihydrocodeine-d6 and desomorphine as internal standards (IS). Acetonitrile-water-ammonium format was used as the mobile phase, in gradient elution on a C18 column. The concentration of DHC and DHM was determined in the positive ionization mode of mass spectrometry. The total chromatogram run time was 3.2 min, and the linear ranges of DHC and DHM were 1.000-400.0 ng/mL and 0.050-20.00 ng/mL, respectively. The method was fully validated concerning precision, accuracy, selectivity, linearity, recovery, stability and matrix effect. The method had been successfully applied to the bioequivalence test. In addition, we found that a high-fat diet impacts the Tmax and t1/2 of DHC.
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Affiliation(s)
- Zhenyu Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
| | - Xiaomei Huang
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Zheng Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Changsha Psychiatric Hospital, No. 62 Xiangzhang Road, Yuhua District, Changsha, 410000, Hunan Province, China
| | - Jian Huang
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Mei Chen
- Hunan EverPro Medical Co., Ltd, No. 299 Jiayun Road, Yuelu District, Changsha, 410000, Hunan Province, China
| | - Binbin He
- Xiangya Boai Rehabilitation Hospital, No. 61 Wanjiali North Road, Changsha, 410000, Hunan Province, China
| | - Hualin Cai
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
| | - Bikui Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, 410000, Hunan Province, China.,Institute of Clinical Pharmacy, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410000, Hunan Province, China
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Rock KL, Reynolds LM, Rees P, Copeland CS. Highlighting the hidden dangers of a 'weak' opioid: Deaths following use of dihydrocodeine in England (2001-2020). Drug Alcohol Depend 2022; 233:109376. [PMID: 35248998 DOI: 10.1016/j.drugalcdep.2022.109376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dihydrocodeine (DHC) is considered a 'weak' opioid, but there is evidence of its increasing misuse in overdose deaths. This research aims to analyse trends in DHC-related deaths in England relevant to source and dose of DHC, and decedent demographics. METHODS Cases from England reported to the National Programme on Substance Abuse Deaths (NPSAD) where DHC was identified at post-mortem and/or implicated in death between 2001 and 2020 were extracted for analysis. RESULTS 2071 DHC-related deaths were identified. The greatest number of deaths involved illicitly obtained DHC and a significant increase in these deaths was recorded over time (r = 0.5, p = 0.03). However, there was a concurrent decline in the implication rate of DHC in causing death (r = -0.6, p < 0.01). Fatalities were primarily due to accidental overdose (64.8%) and misuse was highly prevalent in combination with additional central nervous system depressants (95.3%), namely illicit heroin/morphine and diazepam. In contrast, when DHC was obtained over-the-counter (OTC) suicide mortality accounted for almost half of the deaths (42.5%). Differences in polysubstance use were also identified, with less heroin/morphine and benzodiazepine co-detection, but increased OTC codeine co-detection. CONCLUSIONS DHC misuse in England is increasing. The pharmacological consideration of DHC as a 'weak' opioid may be misinterpreted by users, leading to accidental overdosing. There is an urgent need to understand increasing polypharmacy in overdose deaths. Additionally, suicides involving DHC is a potential cause for concern and a review of OTC opioid-paracetamol preparations is necessary to determine whether the benefits of these medications continue to outweigh the risks of intentional overdose.
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Affiliation(s)
- Kirsten L Rock
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK.
| | - Laura M Reynolds
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Paul Rees
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Caroline S Copeland
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Medicine, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK; National Programme on Substance Abuse Deaths, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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Carney T, Van Hout MC, Norman I, Dada S, Siegfried N, Parry CDH. Dihydrocodeine for detoxification and maintenance treatment in individuals with opiate use disorders. Cochrane Database Syst Rev 2020; 2:CD012254. [PMID: 32068247 PMCID: PMC7027221 DOI: 10.1002/14651858.cd012254.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medical treatment and detoxification from opiate disorders includes oral administration of opioid agonists. Dihydrocodeine (DHC) substitution treatment is typically low threshold and therefore has the capacity to reach wider groups of opiate users. Decisions to prescribe DHC to patients with less severe opiate disorders centre on its perceived safety, reduced toxicity, shorter half-life and more rapid onset of action, and potential retention of patients. This review set out to investigate the effects of DHC in comparison to other pharmaceutical opioids and placebos in the detoxification and substitution of individuals with opiate use disorders. OBJECTIVES To investigate the effectiveness of DHC in reducing illicit opiate use and other health-related outcomes among adults compared to other drugs or placebos used for detoxification or substitution therapy. SEARCH METHODS In February 2019 we searched Cochrane Drugs and Alcohol's Specialised Register, CENTRAL, PubMed, Embase and Web of Science. We also searched for ongoing and unpublished studies via ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and Trialsjournal.com. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA We included randomised controlled trials that evaluated the effect of DHC for detoxification and maintenance substitution therapy for adolescent (aged 15 years and older) and adult illicit opiate users. The primary outcomes were abstinence from illicit opiate use following detoxification or maintenance therapy measured by self-report or urinalysis. The secondary outcomes were treatment retention and other health and behaviour outcomes. DATA COLLECTION AND ANALYSIS We followed the standard methodological procedures that are outlined by Cochrane. This includes the GRADE approach to appraise the quality of evidence. MAIN RESULTS We included three trials (in five articles) with 385 opiate-using participants that measured outcomes at different follow-up periods in this review. Two studies with 150 individuals compared DHC with buprenorphine for detoxification, and one study with 235 participants compared DHC to methadone for maintenance substitution therapy. We downgraded the quality of evidence mainly due to risk of bias and imprecision. For the two studies that compared DHC to buprenorphine, we found low-quality evidence of no significant difference between DHC and buprenorphine for detoxification at six-month follow-up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.25 to 1.39; P = 0.23) in the meta-analysis for the primary outcome of abstinence from illicit opiates. Similarly, low-quality evidence indicated no difference for treatment retention (RR 1.29, 95% CI 0.99 to 1.68; P = 0.06). In the single trial that compared DHC to methadone for maintenance substitution therapy, the evidence was also of low quality, and there may be no difference in effects between DHC and methadone for reported abstinence from illicit opiates (mean difference (MD) -0.01, 95% CI -0.31 to 0.29). For treatment retention at six months' follow-up in this single trial, the RR calculated with an intention-to-treat analysis also indicated that there may be no difference between DHC and methadone (RR 1.04, 95% CI 0.94 to 1.16). The studies that compared DHC to buprenorphine reported no serious adverse events, while the DHC versus methadone study reported one death due to methadone overdose. AUTHORS' CONCLUSIONS We found low-quality evidence that DHC may be no more effective than other commonly used pharmacological interventions in reducing illicit opiate use. It is therefore premature to make any conclusive statements about the effectiveness of DHC, and it is suggested that further high-quality studies are conducted, especially in low- to middle-income countries.
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Affiliation(s)
- Tara Carney
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - Marie Claire Van Hout
- Liverpool John Moores UniversityPublic Health Institute2nd Floor Henry Cotton Campus15‐21 Webster StreetLiverpoolUKL32ET
| | - Ian Norman
- King's College LondonFlorence Nightingale Faculty of Nursing and MidwiferyJames Clerk Maxwell Building , Waterloo RoadLondonUKSE1 8WA
| | - Siphokazi Dada
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl Drive, TygerbergCape TownWestern CapeSouth Africa7505
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl Drive, TygerbergCape TownWestern CapeSouth Africa7505
| | - Charles DH Parry
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitFrancie Van Zijl DriveTygerbergWestern CapeSouth Africa7505
- University of StellenboschDepartment of PsychiatryTygerberg 7505South Africa
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Carico R, Zhao X, Thorpe CT, Thorpe JM, Sileanu FE, Cashy JP, Hale JA, Mor MK, Radomski TR, Hausmann LRM, Donohue JM, Suda KJ, Stroupe K, Hanlon JT, Good CB, Fine MJ, Gellad WF. Receipt of Overlapping Opioid and Benzodiazepine Prescriptions Among Veterans Dually Enrolled in Medicare Part D and the Department of Veterans Affairs: A Cross-sectional Study. Ann Intern Med 2018; 169:593-601. [PMID: 30304353 PMCID: PMC6219924 DOI: 10.7326/m18-0852] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap. OBJECTIVE To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions. DESIGN Cross-sectional. SETTING VA and Medicare. PARTICIPANTS All veterans enrolled in VA and Medicare Part D who filled at least 2 opioid prescriptions in 2013 (n = 368 891). MEASUREMENTS Outcomes were the proportion of patients with a Pharmacy Quality Alliance (PQA) measure of opioid-benzodiazepine overlap (≥2 filled prescriptions for benzodiazepines with ≥30 days of overlap with opioids) and the proportion of patients with high-dose opioid-benzodiazepine overlap (≥30 days of overlap with a daily opioid dose >120 morphine milligram equivalents). Augmented inverse probability weighting regression was used to compare these measures by prescription drug source: VA only, Medicare only, or VA and Medicare (dual use). RESULTS Of 368 891 eligible veterans, 18.3% received prescriptions from the VA only, 30.3% from Medicare only, and 51.4% from both VA and Medicare. The proportion with PQA opioid-benzodiazepine overlap was larger for the dual-use group than the VA-only group (23.1% vs. 17.3%; adjusted risk ratio [aRR], 1.27 [95% CI, 1.24 to 1.30]) and Medicare-only group (23.1% vs. 16.5%; aRR, 1.12 [CI, 1.10 to 1.14]). The proportion with high-dose overlap was also larger for the dual-use group than the VA-only group (4.7% vs. 2.3%; aRR, 2.23 [CI, 2.10 to 2.36]) and Medicare-only group (4.7% vs. 2.9%; aRR, 1.06 [CI, 1.02 to 1.11]). LIMITATION Data are from 2013 and cannot capture medications purchased without insurance; unmeasured confounding may remain in this cross-sectional study. CONCLUSION Among a national cohort of veterans dually enrolled in VA and Medicare, receiving prescriptions from both sources was associated with greater risk for receiving potentially unsafe overlapping prescriptions for opioids and benzodiazepines. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs.
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Affiliation(s)
- Ron Carico
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (R.C., X.Z., F.E.S., J.P.C., J.A.H.)
| | - Xinhua Zhao
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (R.C., X.Z., F.E.S., J.P.C., J.A.H.)
| | - Carolyn T Thorpe
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, and University of North Carolina School of Pharmacy, Chapel Hill, North Carolina (C.T.T., J.M.T.)
| | - Joshua M Thorpe
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, and University of North Carolina School of Pharmacy, Chapel Hill, North Carolina (C.T.T., J.M.T.)
| | - Florentina E Sileanu
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (R.C., X.Z., F.E.S., J.P.C., J.A.H.)
| | - John P Cashy
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (R.C., X.Z., F.E.S., J.P.C., J.A.H.)
| | - Jennifer A Hale
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (R.C., X.Z., F.E.S., J.P.C., J.A.H.)
| | - Maria K Mor
- VA Pittsburgh Healthcare System and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (M.K.M., J.M.D.)
| | - Thomas R Radomski
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (T.R.R., L.R.H., M.J.F., W.F.G.)
| | - Leslie R M Hausmann
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (T.R.R., L.R.H., M.J.F., W.F.G.)
| | - Julie M Donohue
- VA Pittsburgh Healthcare System and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (M.K.M., J.M.D.)
| | - Katie J Suda
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Edward Hines, Jr. VA Hospital and University of Illinois at Chicago College of Pharmacy, Chicago, Illinois (K.J.S.)
| | - Kevin Stroupe
- Edward Hines, Jr. VA Hospital, Chicago, Illinois (K.S.)
| | - Joseph T Hanlon
- VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (J.T.H.)
| | - Chester B Good
- VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, and UPMC Health Plan, Pittsburgh, Pennsylvania (C.B.G.)
| | - Michael J Fine
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (T.R.R., L.R.H., M.J.F., W.F.G.)
| | - Walid F Gellad
- VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (T.R.R., L.R.H., M.J.F., W.F.G.)
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Handley SA, Ramsey JD, Flanagan RJ. Substance misuse-related poisoning deaths, England and Wales, 1993–2016. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2050324518767445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Context In recent years there has been an increase in the availability of ‘novel psychoactive substances (NPS)’ or ‘legal highs’. In turn, there is concern as to the risks these compounds pose as compared to those posed by traditionally misused substances such as illicit diamorphine (heroin), methadone, cocaine, and amfetamines. Methods We reviewed deaths where opiates/opioids, stimulants, hypnosedatives, hallucinogens, or volatile substances were mentioned on the death certificate in England and Wales, 1993–2016 as recorded on the Office for National Statistics drug poisoning deaths database. Deaths were analysed by year of registration of death, age, sex, intent, drug(s) involved, and the presence of alcohol (ethanol). Results There were 68,347 drug-related deaths in England and Wales (includes both licit and illicit substances), of which 15,457 were either coded as, or had mention of, drug dependent/non-dependent substance abuse on the death certificate. Opioids, particularly diamorphine/morphine and methadone, featured in most deaths. Diamorphine/morphine-related deaths (17,402) increased from 155 in 1993 to 981 in 2001, and then remained relatively stable until 2010 (791). Thereafter, annual numbers of deaths fell to 579 in 2012, but have since increased to 1,209 (2016). Deaths in the age group 20–29 years declined from 46% (1993), to 13% (2016), whereas in those aged 40–49 years the percentage of deaths increased from 13% (1993) to 33% (2016). Methadone was mentioned in 7,894 deaths (1993–2016). Annual numbers of such deaths increased from 206 to 437, 1993–7, then declined, but have since increased, reaching 413 in 2016. As to age, a similar pattern as to diamorphine/morphine-related deaths is apparent. Annual numbers of deaths involving cocaine (1993–2016: 3,342), reached 235 in 2008, declined, but have since increased (2011: 112, 2016: 371). Annual numbers of deaths involving methylenedioxyamfetamine/ methylenedioxyethamfetamine/ methylenedioxymetamfetamine (‘ecstasy’) (1993–2016: 853), have also increased steadily in recent years (2010; 8, 2016: 65). There were relatively few mentions of ‘novel stimulants’ (1993–2016: 386) on death certificates and such deaths have declined in recent years (2015: 88, 2016: 57). Mephedrone was most frequently mentioned (122), as was para-methoxyamfetamine/ para-methoxymetamfetamine (88). Conversely, although synthetic cannabinoids were mentioned infrequently (1993–2016: 37), such deaths have increased recently (2015: 8, 2016: 26). Conclusions Illicit diamorphine (heroin) and methadone continue to be the principal drugs of abuse involved in fatal poisonings in England and Wales. The increase in such deaths in recent years has been largely due to an increase in deaths amongst older users, although the role of potent synthetic opioids such as carfentanil is a cause for concern. Overall, stimulants and related compounds have been implicated in an increasing number of deaths annually. The impact of the plethora of NPS that have appeared in recent years on fatal poisonings may have been mitigated by legislation.
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Affiliation(s)
- SA Handley
- King's College Hospital NHS Foundation Trust, UK
| | - JD Ramsey
- St. George's University of London, UK
| | - RJ Flanagan
- King's College Hospital NHS Foundation Trust, UK
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Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. Br J Gen Pract 2018; 68:e225-e233. [PMID: 29440012 DOI: 10.3399/bjgp18x695057] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Opioids are a widely prescribed class of drug with potentially harmful short-term and long-term side effects. There are concerns about the amounts of these drugs being prescribed in England given that they are increasingly considered ineffective in the context of long-term non-cancer pain, which is one of the major reasons for their prescription. AIM To assess the amount and type of opioids prescribed in primary care in England, and patterns of regional variation in prescribing. DESIGN AND SETTING Retrospective observational study using publicly available government data from various sources pertaining to opioids prescribed in primary practice in England and Indices of Social Deprivation. METHOD Official government data were analysed for opioid prescriptions from August 2010 to February 2014. The total amount of opioid prescribed was calculated and standardised to allow for geographical comparisons. RESULTS The total amount of opioid prescribed, in equivalent milligrams of morphine, increased (r = 0.48) over the study period. More opioids were prescribed in the north than in the south of England (r = 0.66, P<0.0001), and more opioids were prescribed in areas of greater social deprivation (r = 0.56, P<0.0001). CONCLUSION Long-term opioid prescribing is increasing despite poor efficacy for non-cancer pain, potential harm, and incompatibility with best practice. Questions of equality of care arise from higher prescription rates in the north of England and in areas of greater social deprivation. A national registry of patients with high opioid use would improve patient safety for this high-risk demographic, as well as provide more focused epidemiological data regarding patterns of prescribing.
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Walton G, Dong H, Milloy MJ, DeBeck K, Kerr T, Wood E, Hayashi K. Increasing availability of benzodiazepines among people who inject drugs in a Canadian setting. Subst Abus 2018; 39:69-76. [PMID: 28727956 DOI: 10.1080/08897077.2017.1356798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Benzodiazepine misuse is associated with mortality and is common among people who inject drugs (PWID). This study aimed to examine the temporal trends in the availability of benzodiazepines among PWID in a Canadian setting, and to identify factors associated with more immediate access to benzodiazepines. METHODS Data were derived from 3 prospective cohorts of PWID in Vancouver, Canada, between June 2012 and May 2015. The primary outcome was the perceived availability of benzodiazepines, measured in 3 levels: not available, delayed availability (available in ≥10 minutes), and immediate availability (available in <10 minutes). The authors used multivariable generalized estimating equations to identify factors associated with availability of benzodiazepines. RESULTS In total, 1641 individuals were included in these analyses. In multivariable analyses, factors associated with immediate benzodiazepine availability included incarceration (adjusted odds ratio [AOR]: 1.42, 95% confidence interval [CI]: 1.06, 1.89) and participation in methadone maintenance therapy (MMT) (AOR: 1.35, 95% CI: 1.14, 1.60). Factors associated with delayed benzodiazepine availability included incarceration (AOR: 1.45, 95% CI: 1.02, 2.07) and participation in MMT (AOR: 1.77, 95% CI: 1.48, 2.12). Benzodiazepine availability increased throughout the study period for both immediate (AOR: 1.14, 95% CI: 1.10, 1.18 per 6-month follow-up period) and delayed (AOR: 1.17, 95% CI: 1.12, 1.22 per 6-month follow-up period) availability. CONCLUSIONS Among our sample of PWID, benzodiazepine availability is increasing and was associated with health and criminal justice system characteristics. Our findings indicate a need to examine prescribing practices and educate both PWID and health care providers about the risks associated with benzodiazepine use.
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Affiliation(s)
- Geoffrey Walton
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Huiru Dong
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - M J Milloy
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kora DeBeck
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Thomas Kerr
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Evan Wood
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,b Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Kanna Hayashi
- a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.,d Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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Oluyase AO, Raistrick D, Hughes E, Lloyd C. Prescribers' views and experiences of assessing the appropriateness of prescribed medications in a specialist addiction service. Int J Clin Pharm 2017; 39:1248-1255. [PMID: 29076012 PMCID: PMC5694531 DOI: 10.1007/s11096-017-0541-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 09/26/2017] [Indexed: 11/26/2022]
Abstract
Background Mental and physical health problems are common in people with substance misuse problems and medications are often required in their management. Given the extent of prescribing for service users who attend specialist addiction services, it is important to consider how prescribers in this setting assess the appropriateness of service users’ prescribed medications. Objective To explore prescribers’ views and experiences of assessing the appropriateness of medications prescribed for service users coming in for treatment as well as the differences between prescribers. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with four nurse prescribers and eight doctors. Data were analysed using thematic framework analysis. Main outcome measure Prescribers’ views and experiences of assessing the appropriateness of prescribed medications. Results Assessment of the appropriateness of prescribed medications involved reviewing medications, assessing risk, history-taking, involvement of service users, and comparing guideline adherence and ‘successful’ prescribing. Doctors and nurse prescribers assessed the appropriateness of medications they considered to be within their competency. Doctors provided support to nurse prescribers and general practitioners (GPs) when dealing with issues around prescribing. Conclusion Assessment of the appropriateness of prescribed medications is complex. The recent reduction in medical expertise in specialist addiction services may negatively impact on the clinical management of service users. It appears that there is a need for further training of nurse prescribers and GPs so they can provide optimal care to service users.
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Affiliation(s)
- Adejoke Obirenjeyi Oluyase
- Department of Health Sciences, University of York, Room 208b, Area 4 ARRC Building, Heslington, York, YO10 5DD, UK.
| | - Duncan Raistrick
- Leeds and York Partnership NHS Foundation Trust, 19 Springfield Mount, Leeds, LS2 9NG, UK
| | - Elizabeth Hughes
- School of Health and Human Sciences, University of Huddersfield, Harold Wilson Building, Queensgate, Huddersfield, HD1 3DH, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, Room 208b, Area 4 ARRC Building, Heslington, York, YO10 5DD, UK
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10
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Walton GRT, Hayashi K, Bach P, Dong H, Kerr T, Ahamad K, Milloy MJ, Montaner J, Wood E. The Impact of Benzodiazepine Use on Mortality Among Polysubstance Users in Vancouver, Canada. Public Health Rep 2017; 131:491-9. [PMID: 27252569 DOI: 10.1177/003335491613100315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Illicit drug use is a well-established risk factor for increased morbidity and mortality. However, little is known about the impact of benzodiazepine use on mortality among populations of polysubstance users. This study aimed to identify the effect of benzodiazepine use on mortality among a prospective cohort of people in Canada who inject drugs (PWID). METHODS A cohort of PWID in Vancouver, Canada, was prospectively followed from May 1996 through November 2013. Data on participants were linked to the provincial vital statistics registry to ascertain mortality rates and causes of death. Multivariable extended Cox regression with time-dependent variables was used to investigate the relationship between benzodiazepine use and time to all-cause mortality. RESULTS During the study period, 2,802 participants were followed for a median of 67 months (interquartile range: 25-107). In total, 527 (18.8%) participants died, for an incidence density of mortality of 2.9 (95% confidence interval [CI] 2.7, 3.2) deaths per 100 person-years. After adjusting for HIV infection and other potential confounders, benzodiazepine use was independently associated with increased all-cause mortality (adjusted hazard ratio = 1.86, 95% CI 1.38, 2.51) and had a higher risk for mortality than all other traditional substances of abuse among this population. Results were consistent when non-overdose mortality was considered. CONCLUSION In this setting, benzodiazepine use was more strongly associated with mortality than any other substance of abuse. Greater recognition of the safety concerns related to benzodiazepines and strategies to prevent diversion to illicit use are needed.
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Affiliation(s)
- Geoffrey R T Walton
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Paxton Bach
- University of British Columbia, Department of Medicine, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Keith Ahamad
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada; University of British Columbia, Department of Medicine, Vancouver, BC, Canada
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11
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Rönkä S, Katainen A. Non-medical use of prescription drugs among illicit drug users: A case study on an online drug forum. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 39:62-68. [DOI: 10.1016/j.drugpo.2016.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
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12
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Codeine Shopping Behavior in a Retrospective Cohort of Chronic Noncancer Pain Patients: Incidence and Risk Factors. THE JOURNAL OF PAIN 2016; 17:1291-1301. [DOI: 10.1016/j.jpain.2016.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 02/02/2023]
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13
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Carney T, Van Hout MC, Norman I, Dada S, Parry CDH. Dihydrocodeine for detoxification and maintenance treatment in illicit opiate-dependent individuals. Hippokratia 2016. [DOI: 10.1002/14651858.cd012254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tara Carney
- South African Medical Research Council; Alcohol, Tobacco and Other Drug Research Unit; Francie van Zyl Drive, Tygerberg, 7505, Parow Cape Town Western Cape South Africa 7505
| | - Marie Claire Van Hout
- Waterford Institute of Technology; Health Sciences; Cork Road Waterford Co. Waterford Ireland
| | - Ian Norman
- King's College London; Florence Nightingale Faculty of Nursing and Midwifery; James Clerk Maxwell Building , Waterloo Road London UK SE1 8WA
| | - Siphokazi Dada
- South African Medical Research Council; Alcohol, Tobacco and Other Drug Research Unit; Francie van Zyl Drive, Tygerberg, 7505, Parow Cape Town Western Cape South Africa 7505
| | - Charles DH Parry
- South African Medical Research Council; Alcohol, Tobacco and Other Drug Research Unit; PO Box 19070 Tygerberg South Africa 7505
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Caudarella A, Dong H, Milloy MJ, Kerr T, Wood E, Hayashi K. Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs. Drug Alcohol Depend 2016; 162:51-5. [PMID: 26993373 PMCID: PMC4833586 DOI: 10.1016/j.drugalcdep.2016.02.024] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the relationship between non-fatal overdose and risk of subsequent fatal overdose. METHODS We assessed risk factors for overdose death among two prospective cohorts of persons who inject drugs (PWID) in Vancouver, Canada. Extended Cox regression was used to examine if reports of non-fatal overdose were associated with the time to fatal overdose while adjusting for other behavioral, social and structural confounders. RESULTS Between May, 1996 and December, 2011, 2317 individuals were followed for a median of 60.8 months. In total, 134 fatal overdose deaths were identified for an incidence density of 8.94 (95% confidence interval [CI]: 7.55-10.59) deaths per 1000 person-years. During the study period there were 1795 reports of non-fatal overdose. In a multivariate model, recent non-fatal overdose was independently associated with the time to overdose mortality (adjusted hazard ratio [AHR]=1.95; 95% CI: 1.17-3.27). As well, there was a dose response effect of increasing cumulative reports of non-fatal overdose on subsequent fatal overdose. CONCLUSION Reports of recent non-fatal overdose were independently associated with subsequent overdose mortality in a dose-response relationship. These findings suggest that individuals reporting recent non-fatal overdose should be engaged with intensive overdose prevention interventions.
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Affiliation(s)
- Alexander Caudarella
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - M J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Department of Medicine, University of British Columbia, Vancouver, Canada
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15
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Tjäderborn M, Jönsson AK, Sandström TZ, Ahlner J, Hägg S. Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden. Drug Alcohol Depend 2016; 161:77-85. [PMID: 26875672 DOI: 10.1016/j.drugalcdep.2016.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 12/20/2022]
Abstract
AIMS To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a psychoactive prescription drug, and to identify associated factors. METHODS Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was our outcome, defined as a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. RESULTS In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with non-prescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with non-prescribed use. CONCLUSIONS Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.
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Affiliation(s)
- Micaela Tjäderborn
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Tatiana Zverkova Sandström
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Ahlner
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Staffan Hägg
- Division of Drug Research/Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
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16
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Zhang WM, Duan YP, Li W, Qiu JF, Zhang ZY. UPLC-MS-MS Determination of Dihydrocodeine in Human Plasma and Its Application to a Pharmacokinetic Study. J Chromatogr Sci 2015; 54:569-73. [PMID: 26689716 DOI: 10.1093/chromsci/bmv188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Indexed: 11/12/2022]
Abstract
A sensitive and rapid ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS-MS) method was developed to determine dihydrocodeine (DHC) in human plasma using diazepam as the internal standard (IS). Sample preparation was accomplished through a liquid-liquid extraction procedure with ethyl acetate. The analyte and IS were separated on an Acquity UPLC BEH C18 column (2.1 × 50 mm, 1.7 μm) with the mobile phase of acetonitrile and 1% formic acid in water with gradient elution at a flow rate of 0.4 mL/min. The detection was performed on a triple quadrupole tandem mass spectrometer equipped with positive-ion electrospray ionization by multiple reaction monitoring (MRM) of the transitions at m/z 302.3 → 199.2 for DHC and m/z 285.1 → 193.1 for IS. The linearity of this method was found to be within the concentration range of 0.5-100 ng/mL with a lower limit of quantification of 0.5 ng/mL. The overall run time was 4.0 min. The method herein described was superior to previous methods and was successfully applied to the pharmacokinetic study of DHC in healthy Chinese volunteers after oral administration.
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Affiliation(s)
- Wei-min Zhang
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Yan-pei Duan
- Department of Pharmacy, Xinxiang Central Hospital, Xinxiang, Henan 453000, PR China
| | - Wei Li
- The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Jian-fei Qiu
- Medical College of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
| | - Zhi-yin Zhang
- Medical College of Henan University of Science and Technology, Luoyang, Henan 471003, PR China
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17
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Abstract
Dihydrocodeine (DHC) is a semi-synthetic analogue of codeine, which was formed by the hydrogenation of the double tie in the main chain of the codeine molecule - instead of a double bond between carbons 7 and 8 DHC possesses a single bond. DHC is used as an analgesic and antitussive agent and for the management of dyspnea and opioid addiction. Limited data is available on the potency of DHC to other opioids. The analgesic effect of DHC is similar to codeine and approximately twice as potent as tramadol for an oral route. In contrast to codeine and tramadol, DHC analgesia seem to be irrespective of CYP2D6 activity due to parent compound analgesic effects, multiple metabolic pathways and limited role of dihydromorphine in DHC analgesia. As the drug is commonly available appropriate titration and dosing and knowledge of its metabolism and possible adverse effects are important for safe prescription of DHC.
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Affiliation(s)
- Wojciech Leppert
- a 1 Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Jarosław Woroń
- b 2 Medical College Jagiellonian University, Krakow, Poland
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18
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Claire Van Hout M. “Doctor shopping and pharmacy hopping”: practice innovations relating to codeine. DRUGS AND ALCOHOL TODAY 2014. [DOI: 10.1108/dat-03-2014-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues.
Design/methodology/approach
– A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine.
Findings
– The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity.
Practical implications
– Further development of real-time monitoring processes with process evaluation is advised.
Originality/value
– This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.
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Rönkä S, Karjalainen K, Vuori E, Mäkelä P. Personally prescribed psychoactive drugs in overdose deaths among drug abusers: a retrospective register study. Drug Alcohol Rev 2014; 34:82-9. [PMID: 25110189 DOI: 10.1111/dar.12182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Psychoactive prescription drug (PPD) abuse-related overdose deaths have increased in many countries in recent decades. We aimed to investigate the role of personally prescribed psychoactive drugs in abuse-related overdose mortality and explore any associations with level of social disadvantage. DESIGN AND METHODS This register linkage study included all 243 people who had died of abuse-related drug-induced poisoning in Finland in 2000 and 2008. Data on registered purchases of psychoactive drugs within one and three years of death were linked to data on the psychoactive drug/s contributing to death in each case. Social disadvantage was measured by receipt of income support, long-term unemployment and disability pension. RESULTS Thirty-six percent of those abusers who had died of a drug overdose had purchased a similarly acting drug within three years of death. In all overdoses, the proportion increased from 20% in 2000 to 49% in 2008 (P < 0.001). A similar increase was seen in purchases within one year of death; from one-tenth in 2000 to one-third of all cases in 2008 (P < 0.001). The majority (83%) of the deceased had received income support, while only 13-14% were long-term unemployed or on disability pension. Disability pension recipients had significantly more prescribed psychoactive drug purchases than non-recipients (P < 0.001 for three and one years within death). DISCUSSION AND CONCLUSIONS Personally prescribed PPDs pose a potential threat to people who abuse drugs. Health-care services should invest greater effort in identifying people who abuse drugs and in monitoring their drug prescriptions.
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Affiliation(s)
- Sanna Rönkä
- Department of Social Research, University of Helsinki, Helsinki, Finland
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Abstract
The misuse and abuse of prescription medications in the United States continues to increase despite interventions by health care professionals, regulatory, and law enforcement agencies. Opioid analgesics are the leading class of prescription drugs that have caused unintentional overdose deaths. Benzodiazepines when taken alone are relatively safe agents in overdose. However, a 5-fold increase in deaths attributed to benzodiazepines occurred from 1999 to 2009. Emergency department visits related to opioid analgesics increased by 111% followed by benzodiazepines 89%. During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression. Physician and pharmacy shopping by patients occurs, and prescription drug-monitoring programs can provide important information on benzodiazepine and opioid analgesic prescribing patterns and patient usage. Health care professionals need to inform patients and work closely with regulatory agencies and legislatures to stem the increasing fatalities from prescription drug unintentional overdoses.
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Opioid analgesics and narcotic antagonists. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/b978-0-444-62635-6.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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22
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Management of drug misusers in Glasgow general hospitals. DRUGS AND ALCOHOL TODAY 2013. [DOI: 10.1108/dat-09-2012-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to ascertain an awareness of the management of the drug misusing guidelines in Glasgow general hospitals.
Design/methodology/approach
– A brief literature review was carried out to establish the available evidence for the guidelines. Additionally, a survey questionnaire was sent out to junior medical staff requesting their views on the drug misusing guidelines.
Findings
– A paucity of evidence relating to drug misusing guidelines was found from the literature. The Glasgow Guidelines appear to be a welcome source of information that is both comprehensive and easily accessible for staff. Junior medical staffs have broadly welcomed the guidance but would appreciate additional support on the management of patients prescribed Suboxone.
Research limitations/implications
– There should be an increase in training and development for junior medical staff regarding the guideline.
Originality/value
– The Glasgow Guidelines are aimed primarily at junior medical staff whose knowledge on drug misusing patients may be scarce. Increased training and awareness should improve the management of drug misusers in general hospitals. Consequently, patients should spent less time in hospital.
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Abstract
This paper is the thirty-fourth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2011 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration (Section 16); and immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Häkkinen M, Launiainen T, Vuori E, Ojanperä I. Comparison of fatal poisonings by prescription opioids. Forensic Sci Int 2012; 222:327-31. [DOI: 10.1016/j.forsciint.2012.07.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/11/2012] [Accepted: 07/22/2012] [Indexed: 10/28/2022]
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