Epidemiologic assessment of benzodiazepine exposure among suicide deaths in Colorado, 2015-2017

Suicide within 1 year of non-fatal overdose: Risk factors and risk reduction with medications for opioid use disorder

OBJECTIVE

Individuals with substance use disorders and overdoses have high risk of suicide death, but evidence is limited on the relationship between interventions following the initial overdose and subsequent suicide death.

METHODS

National Medicare data were used to identify Medicare disability beneficiaries (MDBs) with inpatient or emergency care for non-fatal opioid overdoses from 2008 to 2016. Data were linked with National Death Index (NDI) to obtain dates and causes of death for the sample. Cox proportional hazards models estimated the associations between exposure to interventions (mechanical ventilation, MOUD) and suicide death.

RESULTS

The sample (n = 81,654) had a suicide rate in the year following a non-fatal overdose of 566 per 100,000 person-years. Post-overdose MOUD was associated with an adjusted hazard ratio of 0.20 (95%CI: 0.05,0.85). Risk of suicide was elevated for those whose initial overdoses required mechanical ventilation as part of the treatment (aHR: 1.86, 95%CI:[1.48,2.34]).

CONCLUSIONS

The year following a non-fatal opioid overdose is a very high-risk period for suicide among MDBs. Those receiving MOUD had an 80% reduction in the hazards of suicide, while those whose overdose treatment involved mechanical ventilation had 86% higher hazards of death by suicide. Our findings highlight the importance of psychiatric intervention in this high-risk population. Efforts are needed to initiate and retain more patients in MOUD.

Positive allosteric adenosine A2A receptor modulation suppresses insomnia associated with mania- and schizophrenia-like behaviors in mice

Background: Insomnia is associated with psychiatric illnesses such as bipolar disorder or schizophrenia. Treating insomnia improves psychotic symptoms severity, quality of life, and functional outcomes. Patients with psychiatric disorders are often dissatisfied with the available therapeutic options for their insomnia. In contrast, positive allosteric modulation of adenosine A_2A receptors (A_2ARs) leads to slow-wave sleep without cardiovascular side effects in contrast to A_2AR agonists. Methods: We investigated the hypnotic effects of A_2AR positive allosteric modulators (PAMs) in mice with mania-like behavior produced by ablating GABAergic neurons in the ventral medial midbrain/pons area and in a mouse model of schizophrenia by knocking out of microtubule-associated protein 6. We also compared the properties of sleep induced by A_2AR PAMs in mice with mania-like behavior with those induced by DORA-22, a dual orexin receptor antagonist that improves sleep in pre-clinical models, and the benzodiazepine diazepam. Results: A_2AR PAMs suppress insomnia associated with mania- or schizophrenia-like behaviors in mice. A_2AR PAM-mediated suppression of insomnia in mice with mania-like behavior was similar to that mediated by DORA-22, and, unlike diazepam, did not result in abnormal sleep. Conclusion: A_2AR allosteric modulation may represent a new therapeutic avenue for sleep disruption associated with bipolar disorder or psychosis.

The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

Background and Aims

Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.

Methods

This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.

Results

Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).

Conclusion

These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey

BACKGROUND

Over 92 million prescriptions for benzodiazepines are dispensed in the United States annually, yet little is known about the experiences of those taking and discontinuing them.

OBJECTIVE

The aim of this study is to assess the experiences of those taking, tapering, or having discontinued benzodiazepines.

METHODS

An online survey (n = 1207) elicited information about benzodiazepine use, including long-term use, tapering, discontinuation, and withdrawal symptoms.

RESULTS

Symptoms associated with benzodiazepine use, tapering, and discontinuation were numerous and ranged from symptoms such as anxiety, insomnia, and nervousness to digestive problems, irregular heart rhythms, uncontrollable anger, photosensitivity, balance problems, and others. When asked how benzodiazepine symptoms affected their lives, 82.9% reported work problems, 86.3% had problems with social interactions and friendships, and 88.8% had problems with fun, recreation, and hobbies. Suicidal thoughts or attempted suicide was reported by 54.4%, and 46.8% said benzodiazepines caused lost employment. Most of the respondents for whom benzodiazepines were prescribed (76.2%) stated they had not been informed that benzodiazepines were indicated for short-term use only and that discontinuation might be difficult. About a third (31.5%) reported food allergies and/or seasonal allergies that occurred only after benzodiazepine use.

CONCLUSION

The trajectory of those who taper or discontinue benzodiazepines is unpredictable, and many patients experience a range of protracted and severe symptoms, even years after benzodiazepines were completely discontinued. Greater awareness is needed for both prescribers and patients about the potential for a difficult withdrawal from benzodiazepines.

Epidemiology of Suicide by Medication Overdose: A Population-based Study 2011-2019

BACKGROUNDS

The trend of suicide attempt by medication overdose has shown an increasing trend in recent years. The present study was conducted to investigate the epidemiology of suicide attempts and completed suicide by medication overdoses in Fars's province between 2011 and 2019.

METHODS

This cross-sectional study was performed on 40334 suicide attempts by medication overdose. First, fetal rate, and crude and aged-standardized mortality rate (ASR) were calculated. Then, χ² test was used to calculate the trend of rates of suicide attempt and completed suicide, also to explore differences between qualitative and outcome variables. Finally, logistic regression analysis was performed to identify factors associated with suicide outcome.

RESULTS

The mean age of the participants was 26.66 ± 11.03 years. The highest ASR for suicide attempt by medication overdose was observed in the age range of 15-24 years. The rate of completed suicide by medication overdose was estimated as 1.22%. The odds of completed suicide were 2.7 times higher in men than in women, 2.7 times higher in people with a family history of suicide, and 1.7 times higher in people with a previous history of suicide.

CONCLUSION

The results of our study may help health policymakers to effectively prevent recurrence of suicide attempts through establishing effective strategies for timely identification and appropriate intervention among high-risk individuals with previous history of suicide.

Suicide by Opioid: Exploring the Intentionality of the Act

Opioid toxicity can result in life-threatening respiratory depression. Opioid-overdose mortality in the United States is high and increasing, but it is difficult to determine what proportion of those deaths might actually be suicides. The exact number of Americans who died of an opioid overdose but whose deaths might be classified as suicide remains unknown. It is important to differentiate between those who take opioids with the deliberate and unequivocal objective of committing suicide, that is, those with active intent, from those with passive intent. The passive-intent group understands the risks of opioid consumption and takes dangerous amounts, but with a more ambiguous attitude toward suicide. Thus, among decedents of opioid overdose, a large population dies by accident, whereas a small population dies intending to commit suicide; but between them exists a sub-population with equivocal intentions, waxing and waning between their desire to live and the carelessness about death. There may be a passive as well as active intent to commit suicide, but less is known about the passive motivation. It is important for public health efforts aimed at reducing both suicides and opioid-use disorder to better understand the range of motivations behind opioid-related suicides and how to combat them.