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A 5-year prospective assessment of the risk associated with individual benzodiazepines and doses in new elderly users.

https://arctichealth.org/en/permalink/ahliterature176448
Source
J Am Geriatr Soc. 2005 Feb;53(2):233-41
Publication Type
Article
Date
Feb-2005
Author
Robyn Tamblyn
Michal Abrahamowicz
Roxane du Berger
Peter McLeod
Gillian Bartlett
Author Affiliation
Department of Medicine, McGill University, Montreal, Quebec, Canada. robyn.tamblyn@mcgill.ca
Source
J Am Geriatr Soc. 2005 Feb;53(2):233-41
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Aged
Benzodiazepines - administration & dosage - adverse effects - pharmacokinetics
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Half-Life
Hospitalization
Humans
Male
Proportional Hazards Models
Prospective Studies
Quebec - epidemiology
Risk assessment
Risk factors
Wounds and Injuries - epidemiology
Abstract
To determine the risk of injury associated with the new use of individual benzodiazepines and dosage regimens in the elderly.
Prospective database cohort study with 5 years of follow-up.
Quebec, Canada.
Two hundred fifty-three thousand two hundred forty-four persons aged 65 and older who were nonusers of benzodiazepines in the year before follow-up.
Population-based hospitalization and prescription and medical services claims databases were used to compare the risk of injury during periods of benzodiazepine use with those of nonuse. Periods of use were measured for 10 insured benzodiazepines by drug and dose as time-dependent covariates. Injury was defined as the first occurrence of a nonvertebral fracture, soft-tissue injury, or accident-related hospital admission. Patient age, sex, previous injury history, concomitant medication use, and comorbidity were measured as fixed and time-dependent confounders. Cox proportional hazards models were used to estimate the risk of injury with benzodiazepine use and to determine the extent to which patient characteristics, differences in dosage, or in the effect of increasing dosage for individual drugs explained differences between drugs.
More than one-quarter (27.6%) of 253,244 elderly were dispensed at least one prescription for a benzodiazepine, and 17.7% of elderly were treated for at least one injury during follow-up, of which fractures were the most common. Patient characteristics, systematic differences in the risk of injury in elderly prescribed different benzodiazepines, and differences in dosage prescribed for individual drugs confounded the risk of injury with benzodiazepine use. The risk of injury with increasing dosage varied by drug from a hazard ratio of 0.92 (95% confidence interval (CI)=0.60, 1.42) for alprazolam to 2.20 (95% CI=1.39, 3.47) for flurazepam per 1 standardized adult dose increase.
The risk of injury varied by benzodiazepine, independent of half-life, as did the risk associated with increasing dosage for individual products. Higher doses of oxazepam, flurazepam, and chlordiazepoxide are associated with the greatest risk of injury in the elderly.
Notes
Comment In: ACP J Club. 2005 Jul-Aug;143(1):2415989312
PubMed ID
15673346 View in PubMed
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Abnormally high concentrations of amphetamine in blood of impaired drivers.

https://arctichealth.org/en/permalink/ahliterature9098
Source
J Forensic Sci. 2005 Sep;50(5):1215-20
Publication Type
Article
Date
Sep-2005
Author
A W Jones
A. Holmgren
Author Affiliation
Department of Forensic Toxicology, University Hospital, 581 85 Linköping, Sweden. wayne.jones@RMV.se
Source
J Forensic Sci. 2005 Sep;50(5):1215-20
Date
Sep-2005
Language
English
Publication Type
Article
Keywords
Adult
Amphetamine - blood
Amphetamine-Related Disorders - blood - diagnosis
Automobile Driving
Benzodiazepines - blood
Central Nervous System Stimulants - blood
Databases
Female
Forensic Medicine
Hallucinogens - blood
Humans
Male
Mass Fragmentography
Middle Aged
Substance Abuse Detection
Sweden
Tetrahydrocannabinol - blood
Abstract
We present a case series (N = 46) of individuals apprehended in Sweden for driving under the influence of drugs (DUID). These cases were selected because the concentrations of amphetamine in blood were abnormally high (> 5.0 mg/L), the highest being 17 mg/L. In comparison, the median blood-amphetamine concentration in a population of DUID offenders (N = 6,613) was 0.70 mg/L. Among the DUID suspects with extremely high blood-amphetamine concentrations there were 38 men (83%) with mean age of 37.8 y (SD 6.8 y) and 8 women (17%) with a mean age of 34.1 y (SD 4.3 y). All had previously been registered in our database (mean 12 times, median 9 times) for drug-related offences, including DUID. The concentration of amphetamine in blood of female offenders was slightly higher than the concentration in male offenders (6.6 mg/L vs. 5.8 mg/L), although this difference was not statistically significant (p > 0.05). The drugs other than amphetamine most frequently encountered in the blood samples were tetrahydrocannabinol and benzodiazepines (diazepam and nordiazepam). The commonest signs of drug use reported by the arresting police officers were bloodshot and glazed (watery) eyes, restlessness, talkativeness, exaggerated reflexes and slurred speech. Unsteady gait and dilated pupils were observed in some but not all individuals. These very high concentrations of amphetamine were tolerated without any fatalities indicating a pronounced adaptation to the pharmacologic effects of this central stimulant. Anecdotal information indicated that those with the very highest concentrations of amphetamine in blood had swallowed the drug to prevent being apprehended in possession of an illicit substance.
PubMed ID
16225234 View in PubMed
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[Abuse of benzodiazepines among heroin addicts in Copenhagen].

https://arctichealth.org/en/permalink/ahliterature207018
Source
Ugeskr Laeger. 1997 Oct 27;159(44):6523-7
Publication Type
Article
Date
Oct-27-1997
Author
P. Glyngdal
K. Hansen
Author Affiliation
Københavns Kommune.
Source
Ugeskr Laeger. 1997 Oct 27;159(44):6523-7
Date
Oct-27-1997
Language
Danish
Publication Type
Article
Keywords
Adult
Benzodiazepines - administration & dosage - adverse effects
Denmark
Female
Heroin Dependence - complications - psychology - therapy
Humans
Male
Middle Aged
Retrospective Studies
Socioeconomic Factors
Substance-Related Disorders - complications - psychology - therapy
Abstract
Abuse of benzodiazepines among heroin addicts in Copenhagen. The aim of this study was to investigate the extent of benzodiazepine abuse among heroin addicts, and to examine whether the heroin addicts with and without benzodiazepine abuse differed socially and psychiatrically. Social and medical information was drawn from the records for 98 heroin addicts who were registered for treatment at the institution Distriktscenter Vestre between 1.2-30.9.1994. Information about psychiatric admissions was taken from the Danish Psychiatric Register. The results showed that the heroin addicts with and without benzodiazepine abuse do not differ with regard to psychiatric data and basic demographic data. However, addicts with concomitant benzodiazepine ab-use were worse off concerning housing conditions, employment criminal records and amount and type of heroin abuse, and are thus in need of a more concerted treatment effort.
PubMed ID
9411972 View in PubMed
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[Abuse of phenazepam--new phenomenon in Sweden. Benzodiazepine derivative from Russia caused severe intoxication]

https://arctichealth.org/en/permalink/ahliterature89402
Source
Lakartidningen. 2009 Feb 18-24;106(8):516-7
Publication Type
Article

Acute and chronic drug abuse emergencies in Metropolitan Toronto.

https://arctichealth.org/en/permalink/ahliterature244766
Source
Int J Addict. 1981 Feb;16(2):283-303
Publication Type
Article
Date
Feb-1981
Author
E M Sellers
J A Marshman
H L Kaplan
H G Giles
B M Kapur
U. Busto
S M MacLeod
C. Stapleton
F. Sealey
Source
Int J Addict. 1981 Feb;16(2):283-303
Date
Feb-1981
Language
English
Publication Type
Article
Keywords
Adult
Alcoholic Intoxication - epidemiology
Barbiturates - poisoning
Benzodiazepines - poisoning
Emergencies
Female
Humans
Male
Middle Aged
Ontario
Salicylates - poisoning
Substance-Related Disorders - epidemiology - therapy
Suicide, Attempted
Abstract
From 3,548 drug overdose or abuse cases presenting at 21 Metropolitan Toronto hospitals' Emergency departments, data concerning demographic and medical characteristics, investigative and management procedures, drug analysis services, and disposition of patients were collected. Of the 3,548 cases, 2,723 (77%) were acute overdose and 816 (23%) were drug abuse. Drug overdose was more common than drug abuse for both sexes, but was more characteristic of females. The drugs most frequently alleged ingested were benzodiazepines (34%), ethanol (32%), salicylates (16%), and barbiturates (14%). The frequency with which particular classes of drugs are alleged in overdose corresponds closely to the frequency of prescribing these drugs in Ontario.
PubMed ID
7275381 View in PubMed
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Acute poisonings treated in hospitals in Oslo: a one-year prospective study (I): pattern of poisoning.

https://arctichealth.org/en/permalink/ahliterature93790
Source
Clin Toxicol (Phila). 2008 Jan;46(1):35-41
Publication Type
Article
Date
Jan-2008
Author
Hovda K E
Bjornaas M A
Skog K.
Opdahl A.
Drottning P.
Ekeberg O.
Jacobsen D.
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway. kehovda@yahoo.no
Source
Clin Toxicol (Phila). 2008 Jan;46(1):35-41
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Acetaminophen - poisoning
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Analgesics, Opioid - poisoning
Benzodiazepines - poisoning
Cross-Sectional Studies
Ethanol - poisoning
Female
Hospitalization - statistics & numerical data
Humans
Hydroxybutyrates - poisoning
Incidence
Male
Middle Aged
Norway - epidemiology
Poisoning - epidemiology
Prospective Studies
Sex Factors
Suicide, Attempted - statistics & numerical data
Abstract
OBJECTIVES. Prospective design is mandatory to study pattern of poisoning and suicidal intention of patients. MATERIAL AND METHODS. Prospective cross-sectional multi-center study of all patients contacting health care services because of acute poisoning during one year in Oslo, irrespective of intention. Data on the adult hospitalized patients (> or = 16 years) are presented here. RESULTS. Of a total of 3,775 such adult contacts (3,025 episodes), there were 947 (31 %) hospitalizations; annual incidence 1.9 (per 1,000) in males and 2.1 in females. Median age was 36 years (range 16-89); 54% females. Benzodiazepines (18%), ethanol (17%), paracetamol (12%), opioids (7%), and gamma hydroxybutyric acid (GHB) (7%) were most frequently taken. Patients stated suicidal intention in 29% of the admissions; physicians in 10%. CONCLUSION. Benzodiazepines and ethanol were the most common agents, but newer illicit drugs were frequent, especially GHB. Males often took ethanol and drugs of abuse; females often used prescription drugs with suicidal intention.
PubMed ID
18167035 View in PubMed
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The additive effects of alcohol and benzodiazepines on driving.

https://arctichealth.org/en/permalink/ahliterature138069
Source
Can J Public Health. 2010 Sep-Oct;101(5):353-7
Publication Type
Article
Author
Hillary G Maxwell
Sacha Dubois
Bruce Weaver
Michel Bédard
Author Affiliation
St. Joseph's Care Group, Research Department, Thunder Bay, ON. maxwellh@tbh.net
Source
Can J Public Health. 2010 Sep-Oct;101(5):353-7
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Adult
Alcohol Drinking - adverse effects - blood
Automobile Driving - statistics & numerical data
Benzodiazepines - adverse effects - blood
Canada - epidemiology
Central Nervous System Depressants - adverse effects - blood
Drug Synergism
Female
Humans
Male
Middle Aged
Risk factors
Abstract
To examine the relationship between the combination of alcohol and benzodiazepines and the risk of committing an unsafe driver action.
We used data from the Fatality Analysis Reporting System (1993-2006) on drivers aged 20 or older who were tested for both alcohol and drugs. Using a case-control design, we compared drivers who had at least one unsafe driver action (UDA; e.g., weaving) recorded in relation to the crash (cases) to drivers who did not (controls).
Drivers who tested positive for intermediate- and long-acting benzodiazepines in combination with alcohol had significantly greater odds of a UDA compared to those under the influence of alcohol alone, up to blood alcohol concentrations (BACs) of 0.08 and 0.05 g/100 ml, respectively. The odds of a UDA with short-acting benzodiazepines combined with alcohol were no different than for alcohol alone.
This study demonstrates that the combination of alcohol and benzodiazepines can have detrimental effects on driving beyond those of alcohol alone. By describing these combined effects in terms of BAC equivalencies, this study also allows for the extrapolation of simple, concrete concepts that communicate risk to the average benzodiazepine user.
PubMed ID
21214047 View in PubMed
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Adolescents and benzodiazepines: prescribed use, self-medication and intoxication.

https://arctichealth.org/en/permalink/ahliterature12013
Source
Acta Psychiatr Scand. 1991 Jul;84(1):94-8
Publication Type
Article
Date
Jul-1991
Author
W. Pedersen
N J Lavik
Author Affiliation
Department of Psychiatry, University of Oslo, Norway.
Source
Acta Psychiatr Scand. 1991 Jul;84(1):94-8
Date
Jul-1991
Language
English
Publication Type
Article
Keywords
Adolescent
Alcohol Drinking
Benzodiazepines - administration & dosage
Cannabis
Drug Utilization
Female
Humans
Imitative Behavior
Longitudinal Studies
Male
Norway - epidemiology
Parents - psychology
Prescriptions, Drug
Research Support, Non-U.S. Gov't
Self Medication
Social Perception
Street Drugs
Substance-Related Disorders - epidemiology
Abstract
In a longitudinal study of 1230 people aged 13-18 years from the Greater Oslo Area, the past-year prevalence of anxiolytic or hypnotic use was 10%, which is higher than previously reported. The majority gave therapeutic reasons as a motive for using these drugs. However, most of the use was unprescribed. The parents, and especially the mother, were the most important suppliers. A minority gave intoxication as a motive for using these drugs. In this group, the suppliers were mainly peers and the illegal market. Neither the unprescribed nor the prescribed therapeutic use show any association with use of drugs such as alcohol and cannabis. There is, however, a strong association between the unprescribed use of benzodiazepines by young people and by their parents. This suggests a pattern of learning and role modelling, which must be regarded as problematic for public health policy. Those who use the drugs to become intoxicated have particularly poor mental health, and they use many other drugs as well. This group probably runs a special risk of developing more serious drug abuse.
PubMed ID
1927572 View in PubMed
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418 records – page 1 of 42.