Mental Illness and Psychotropic Drug Use Among Prescription Drug Overdose Deaths: A Medical Examiner Chart Review
ABSTRACT Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes.
In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program.
Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug.
Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.
Mental Health and Substance Use dual diagnosis 11/2013; 7(4):391-406. DOI:10.1080/17523281.2013.841748
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ABSTRACT: Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent. More serious adverse reactions after naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged hypoxia. One component of the new opioid harm reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. Patients or their close contacts receive a naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of naloxone by intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New naloxone delivery products are being developed for this prehospital application of naloxone in treatment of opioid overdose and prevention of opioid-induced mortality.
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ABSTRACT: Background The non-medical use of pharmaceutical opioids such as codeine is of increasing public health concern. The aim of the study was to describe codeine intoxication experiences amongst recreational drug users, as posted on public internet forums. Methods Internet searches were carried out by using the specific key word ‘codeine’ and in combination with ‘experience’, ‘report’, ‘trip’ and ‘forum’. 96 Trip reports and 156 thread discussions relating to the sole use of codeine were analysed using the empirical phenomenological psychological (EPP) method. Nine themes and 72 categories emerged. Results Narratives illustrated transitions between medical and non-medical use of codeine for dulling of emotional and/or physical pain, opiate withdrawal management and for intoxication. Codeine's appeal centred on access via family medicine cabinets, prescribers and pharmacies. Discussion and dissemination of indigenous harm reduction tactics included the learning to appreciate codeine's effect via moderated use in optimal settings, avoidance of tolerance by use of informed dosing schedules, cold water extraction of codeine, and using codeine as an alternative to stronger opioids. Oral and rectal routes were favoured, with awareness on forums of the harms of intravenous and subcutaneous injection. 250 mg was recommended to optimise recreational outcomes. Forum users describe potentiating practices and using over-the-counter medications to improve intoxication experiences and reduce unpleasant side effects. Dissociative effects, ability to ignore physical and emotional pain, codeine induced synaesthesia and altered states of consciousness were described. Overdose was characterised by anaesthesia, severe chest and stomach pain, respiratory depression, panic and fear of death. Conclusions Efforts to ensure legitimate codeine use for pain and reduction of aberrant behaviours centre on evidence based screening, risk minimisation, prescription monitoring and specific treatment protocols. This study shows that internet drug forums drive communal knowhow and indigenous harm reduction strategies, and warrant consideration as viable public health mechanisms for informing users.International Journal of Drug Policy 01/2014; 26(1). DOI:10.1016/j.drugpo.2014.06.016 · 2.40 Impact Factor