MisuMedPT - Morbi-mortality consequences of misuse of psychoactive prescription drugs in Portugal

Background

In Portugal, there are no published data on the health-related consequences of prescription drug misuse, which is therefore a public health issue of unknown dimension in our country. Poison control centres and other pharmacoepidemiological sources can be part of a surveillance system for monitoring medicine's use and misuse.

Methods

Retrospective observational study of intentional exposures to opioid analgesics, antiepileptics, antidepressants, anxiolytics, hypnotics and sedatives reported to the Portuguese Poison Information Centre (CIAV) between 2014 and 2018. Variables studied were demographic characteristics of individuals, geographic distribution of calls, co-exposure to alcohol or illicit drugs, call origin, case evaluation and guidance.

Results

CIAV received 24624 calls reporting 34203 intentional exposures to any medicine, 31169 (91.1%) of which involving one of the studied psychoactive medicines and 20906 exposures having emergency room advice or effective hospitalisation. The most frequently involved medicines were benzodiazepines (62.0%) - alprazolam (15.4%) and diazepam (12.0%) - with trazodone ranking fifth (6.0%). Combination with non-medicinal products was seen in 2169 calls (9.4%), 2052 (94.6%) of which with alcohol.

Conclusions

There is female predominance in the poisonings reported involving any of the medicines studied. Benzodiazepines and antidepressants are the top classes reported. The rate of intentional exposures to psychoactive medicines is higher in Coimbra district, whose significant university student population requires further analysis of data. To adjust for the variability in the level of medicines' use in the population, work is undergoing to include rates of intentional poisonings in patients prescribed the studied medicines. To better characterise the potential consequences of misuse of psychoactive prescription drugs in Portugal, additional data on deaths involving these medicines will also be included in the project.

Key messages

First published Portuguese data on prescription drug poisoning reported to CIAV. First Portuguese project to analyse prescription drug poisoning, forensic and hospitalisation data.

[Intestinal necrosis in children]

The term intestinal necrosis is nothing but a clinical and pathological concept and always includes intestinal ischemia, whether or not occlusive. In a broad sense, necrotizing enterocolitis involves intestinal ischemia associated to an infectious entity. The precipitating factor for necrosis is very often difficult to identify. Necrotizing enterocolitis occurs in 90% of cases in premature neonates and is less frequent amongst other neonates, being rare in older children and adults. The authors present two clinical cases: one 7 year-old with a history of chronic neutropenia and an eleven-year old with severe cognitive impairment, dysmorphic features and behavioural disturbances. They were both admitted to hospital due to an acute abdominal condition and shock. The necrosis implied the resection of a jejunal segment in one of the cases, and a subtotal colonic resection in the other. Despite the surgery and medical support therapy, they both died due to multiple system organ failure--3 hours and fourteen days after surgery, respectively. In the second case, death occurred subsequent to a second surgery for resection of a segment of necrotic ileum. Necropsy showed an extensive necrosis of the remaining intestine in both cases. These two cases evolved as necrotizing enterocolitis of the child. In one of the cases it was possible to establish the exclusion diagnosis of neutropenic enterocolitis. The etiopathogenic mechanisms are reviewed, including thrombotic, obstructive (both extrinsic and endoluminal), inflammatory, non-occlusive ischemic and infectious. The authors stress the general therapeutic measures, the relevance of early surgical intervention and the use of subsidiary diagnostic/therapeutic technologies, such as serum and urine title of intestinal fatty acid binding protein or selective arteriography.