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Accidental poisoning, intentional self-harm and event of undetermined intent mortality over 20 years in Iceland: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature305853
Source
BMJ Open. 2020 05 20; 10(5):e034590
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-20-2020
Author
Oddny Sigurborg Gunnarsdottir
Vilhjálmur Rafnsson
Author Affiliation
Office of Education, Research and Development, Landspitali-the National University Hospital of Iceland, Reykjavík, Iceland.
Source
BMJ Open. 2020 05 20; 10(5):e034590
Date
05-20-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Accidents, Traffic - mortality
Adolescent
Adult
Aged
Child
Child, Preschool
Cohort Studies
Drug Overdose - mortality
Female
Humans
Hypnotics and Sedatives - poisoning
Iceland
Infant
Infant, Newborn
Longitudinal Studies
Male
Middle Aged
Models, Statistical
Narcotics - poisoning
Poisoning - mortality
Registries
Self-Injurious Behavior - mortality
Sex Factors
Suicide - statistics & numerical data
Abstract
The aim was to study mortality due to suicide, accidental poisoning, event of undetermined intent and drug-related deaths through 20 years in Iceland.
A population-based register study.
Individuals who died due to road traffic injury, suicide, accidental poisoning, event of undetermined intent and drug-related deaths in the population of Iceland during the years 1996-2015. Annual age-standardised rates were calculated, and the trend analysed by Pearson correlation and joinpoint regression.
The population of Iceland framed the study material, and the data were obtained from nationwide registries for information on number of deaths and age-specific mean population in each year by gender.
The crude overall suicide rate during the last 10 years was 12.2 per 100?000 persons per year (95%?CI 7.4 to 18.1), while the crude overall rate due to road traffic injuries was 4.6 per 100?000 persons per year (95%?CI 2.0 to 8.3). Among men, suicide rates decreased, however not significantly (r(19)=-0.22, p=0.36), and for overdose by narcotics the rates increased significantly (r(19)=0.72, p
PubMed ID
32439692 View in PubMed
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Source
Br J Psychiatry. 1996 Jul;169(1):75-80
Publication Type
Article
Date
Jul-1996
Author
A. Ohberg
E. Vuori
I. Ojanperä
J. Lonngvist
Author Affiliation
Department of Forensic Medicine, University of Helsinki, Finland. Annakatri.Ohberg@helsinki.fi
Source
Br J Psychiatry. 1996 Jul;169(1):75-80
Date
Jul-1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcoholic Intoxication - mortality
Antidepressive Agents - poisoning
Antipsychotic Agents - poisoning
Cause of Death
Drug Overdose - mortality
Female
Finland - epidemiology
Humans
Male
Middle Aged
Risk factors
Sex Factors
Suicide - statistics & numerical data
Abstract
Alcohol and drugs use were assessed in a nationwide one year suicide study in Finland.
Alcohol and drugs use were analysed in 1348 suicides, 96.5% of all suicides in the study year. Relative suicide risks for drugs were defined by relating the number of suicides committed by use of various drugs to drug availability.
Alcohol was detected twice as often in men as in women; the opposite was the case with drugs. The drugs most commonly used for suicide were neuroleptics and antidepressants, which were, in 74.3% and 77.4% of the cases, respectively, the victims own prescribed drugs. Antidepressants were found in 19.0% of women and only 4.8% of men. Relative suicide risk for antidepressants varied substantially between different compounds.
Undertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.
Notes
Comment In: Br J Psychiatry. 1996 Oct;169(4):5268894214
PubMed ID
8818372 View in PubMed
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Are overdoses treated by ambulance services an opportunity for additional interventions? A prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature278646
Source
Addiction. 2015 Nov;110(11):1767-74
Publication Type
Article
Date
Nov-2015
Author
Linn Gjersing
Anne Line Bretteville-Jensen
Source
Addiction. 2015 Nov;110(11):1767-74
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adult
Ambulances
Cohort Studies
Drug Overdose - mortality - therapy
Emergency medical services
Female
Heroin Dependence - mortality - therapy
Humans
Longitudinal Studies
Male
Norway
Opiate Substitution Treatment
Proportional Hazards Models
Prospective Studies
Registries
Substance Abuse, Intravenous - mortality - therapy
Abstract
To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1?week, 1?month, 3?months, 6?months, 1?year, 5?years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods).
A prospective cohort study.
Oslo, Norway.
A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004.
Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated.
Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI?=?0.6, 2.6, P?=?0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI?=?3.5, 25.4) in the month after an overdose to 13.9 (95% CI?=?6.4, 30.2) in the 5-year period.
Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods.
Notes
Comment In: Addiction. 2015 Nov;110(11):1775-626471158
PubMed ID
26118947 View in PubMed
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Clustering of opioid prescribing and opioid-related mortality among family physicians in Ontario.

https://arctichealth.org/en/permalink/ahliterature136181
Source
Can Fam Physician. 2011 Mar;57(3):e92-6
Publication Type
Article
Date
Mar-2011
Author
Irfan A Dhalla
Muhammad M Mamdani
Tara Gomes
David N Juurlink
Author Affiliation
Department of Medicine, University of Toronto, Toronto, Ont. dhallai@smh.ca
Source
Can Fam Physician. 2011 Mar;57(3):e92-6
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Analgesics, Opioid - poisoning - therapeutic use
Cross-Sectional Studies
Drug Overdose - mortality
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Mortality - trends
Ontario - epidemiology
Physician's Practice Patterns - statistics & numerical data
Prescription Drugs - poisoning - therapeutic use
Young Adult
Abstract
To examine whether variation in prescribing at the level of the individual physician is associated with opioid-related mortality.
A population-based cross-sectional analysis linking prescription data with records from the Office of the Chief Coroner.
The province of Ontario. Participants Family physicians in Ontario and Ontarians aged 15 to 64 who were eligible for prescription drug coverage under the Ontario Public Drug Program.
Variation in family physicians' opioid prescribing and opioid-related mortality among their patients.
The 20% of family physicians (n = 1978) who prescribed opioids most frequently issued opioid prescriptions 55 times more often than the 20% who prescribed opioids least frequently. Family physicians in the uppermost quintile also wrote the final opioid prescription before death for 62.7% of public drug plan beneficiaries whose deaths were related to opioids. Physician characteristics associated with greater opioid prescribing were male sex (P = .003), older age (P
Notes
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Comment In: Can Fam Physician. 2011 May;57(5):531-2; discussion 532; author reply 537-921571712
Comment In: Can Fam Physician. 2011 May;57(5):532-5; author reply 537-921571713
Comment In: Can Fam Physician. 2011 May;57(5):536; author reply 537-921571715
Comment In: Can Fam Physician. 2011 May;57(5):530-1; author reply 537-921571710
Comment In: Can Fam Physician. 2011 May;57(5):530; author reply 537-921571711
Comment In: Can Fam Physician. 2011 May;57(5):535-6; author reply 537-921642735
Comment In: Can Fam Physician. 2011 Mar;57(3):271-221520666
PubMed ID
21402956 View in PubMed
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Comparison of fatal poisonings by prescription opioids.

https://arctichealth.org/en/permalink/ahliterature121703
Source
Forensic Sci Int. 2012 Oct 10;222(1-3):327-31
Publication Type
Article
Date
Oct-10-2012
Author
Margareeta Häkkinen
Terhi Launiainen
Erkki Vuori
Ilkka Ojanperä
Author Affiliation
University of Helsinki, Hjelt Institute, Department of Forensic Medicine, PO Box 40 (Kytösuontie 11), FI-00014 Helsinki, Finland. margareeta.hakkinen@helsinki.fi
Source
Forensic Sci Int. 2012 Oct 10;222(1-3):327-31
Date
Oct-10-2012
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adolescent
Adult
Analgesics, Opioid - blood - poisoning
Buprenorphine - blood - poisoning
Central Nervous System Depressants - blood
Codeine - blood - poisoning
Dextropropoxyphene - blood
Drug Overdose - mortality
Ethanol - blood
Fentanyl - blood - poisoning
Finland - epidemiology
Forensic Toxicology
Humans
Hypnotics and Sedatives - blood
Methadone - blood - poisoning
Morphine - blood
Opioid-Related Disorders - mortality
Oxycodone - blood - poisoning
Poisoning - mortality
Prescription Drug Misuse
Suicide - statistics & numerical data
Tramadol - analogs & derivatives - blood - poisoning
Young Adult
Abstract
There is a rising trend of fatal poisonings due to medicinal opioids in several countries. The present study evaluates the drug and alcohol findings as well as the cause and manner of death in opioid-related post-mortem cases in Finland from 2000 to 2008. During this period, fatal poisonings by prescription opioids (buprenorphine, codeine, dextropropoxyphene, fentanyl, methadone, oxycodone, tramadol) increased as a share of all drug poisonings from 9.5% to 32.4%, being 22.3% over the whole period. A detailed study including the most prevalent opioids was carried out for the age group of 14-44 years, which is the most susceptible age for drug abuse in Finland. Poisonings by the weak opioids, codeine and tramadol, were found to be associated with large, often suicidal overdoses resulting in high drug concentrations in blood. Methadone poisonings were associated with accidental overdoses with the drug concentration in blood remaining within a therapeutic range. The manner of death was accidental in 43%, 55% and 94% of cases in codeine, tramadol and methadone poisonings, respectively. The median concentration of codeine and the median codeine/morphine concentration ratio were higher in codeine poisonings (1.4 and 22.5 mg/l, respectively) than in other causes of death (0.09 and 5.9 mg/l, respectively). The median concentrations of tramadol and O-desmethyltramadol were higher in tramadol poisonings (5.3 and 0.8 mg/l, respectively) than in other causes of death (0.6 and 0.2 mg/l, respectively). In methadone poisonings, the median concentration of methadone (0.35 mg/l) was not different from that in other causes of death (0.30 mg/l). Sedative drugs and/or alcohol were very frequently found in fatal poisonings involving these prescription opioids.
PubMed ID
22884575 View in PubMed
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Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.

https://arctichealth.org/en/permalink/ahliterature112514
Source
Can J Public Health. 2013 May-Jun;104(3):e200-4
Publication Type
Article
Author
Pamela N Leece
Shaun Hopkins
Chantel Marshall
Aaron Orkin
Margaret A Gassanov
Rita M Shahin
Author Affiliation
Public Health and Preventive Medicine Residency Program, University of Toronto, Toronto, ON, Canada.
Source
Can J Public Health. 2013 May-Jun;104(3):e200-4
Language
English
Publication Type
Article
Keywords
Analgesics, Opioid - poisoning
Community Health Services - organization & administration
Drug Overdose - mortality - prevention & control
Health education
Humans
Naloxone - therapeutic use
Narcotic Antagonists - therapeutic use
Needle-Exchange Programs
Ontario - epidemiology
Opioid-Related Disorders - drug therapy - mortality
Program Development
Program Evaluation
Public Health Practice
Resuscitation - methods
Abstract
We describe the development of the first community-based opioid overdose prevention and response program with naloxone distribution offered by a public health unit in Canada (Prevent Overdose in Toronto, POINT).
The target population is people who use opioids by any route, throughout the City of Toronto.
The POINT program is operated by the needle exchange program at Toronto Public Health (The Works) and offered at over 40 partner agency sites throughout Toronto.
POINT is a comprehensive program of overdose prevention and response training, including naloxone dispensing. Clients are instructed by public health staff on overdose risk factors, recognizing signs and symptoms of overdose, calling 911, naloxone administration, stimulation and chest compressions, and post-overdose care. Training is offered to clients one-on-one or in small groups. Clients receive a naloxone kit including two 1 mL ampoules of naloxone hydrochloride (0.4 mg/mL) and are advised to return to The Works for a refill and debriefing if the naloxone kit is used.
In the first 8 months of the program, 209 clients were trained. Clients have reported 17 administrations of naloxone, and all overdose victims have reportedly survived. Client demand for POINT training has been high, and Toronto Public Health has expanded its capacity to provide training. Overall, reception to the program has been overwhelmingly positive.
We are encouraged by the initial development and implementation experience with the naloxone program and its potential to save lives in Toronto. We have planned short-, intermediate-, and long-term process and outcome evaluations.
PubMed ID
23823882 View in PubMed
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Differences between urban and rural suicides.

https://arctichealth.org/en/permalink/ahliterature208845
Source
Acta Psychiatr Scand. 1997 Apr;95(4):297-305
Publication Type
Article
Date
Apr-1997
Author
E. Isometsä
M. Heikkinen
M. Henriksson
M. Marttunen
H. Aro
J. Lönnqvist
Author Affiliation
Department of Mental Health, National Public Health Institute, Helsinki, Finland.
Source
Acta Psychiatr Scand. 1997 Apr;95(4):297-305
Date
Apr-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Comorbidity
Drug Overdose - mortality
Female
Finland - epidemiology
Humans
Life Change Events
Male
Mental Disorders - mortality
Middle Aged
Personality Disorders - mortality
Psychotropic Drugs - poisoning
Rural Population - statistics & numerical data
Substance-Related Disorders - mortality
Suicide - prevention & control - statistics & numerical data
Urban Population - statistics & numerical data
Abstract
As part of a nation-wide psychological autopsy we examined the differences in DSM-III-R mental disorders, recent life events and other characteristics between urban (n = 143) and rural (n = 85) completed suicides in a random sample of 229 cases from the National Suicide Prevention Project in Finland for the period 1987-1988. Psychoactive substance use disorders (48% vs. 34%), cluster B personality disorders (24% vs. 9%) and psychiatric comorbidity (66% vs. 42%) were found more commonly among urban than rural suicides. Urban suicides were also more often reported to be preceded by a recent separation (25% vs. 8%), whereas rural suicide victims tended to have lacked a close companion of the opposite sex (36% vs. 18%) and to have had physical disorders (56% vs. 40%). Overall, urban and rural suicides may vary with regard to the prevalence of some mental disorders, their comorbidity, and physical disorders, as well as the preceding life situation. This variation may also imply the need for differences in strategies for suicide prevention in each setting.
PubMed ID
9150823 View in PubMed
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Diversity in causes and characteristics of drug-induced deaths in an urban setting.

https://arctichealth.org/en/permalink/ahliterature117383
Source
Scand J Public Health. 2013 Mar;41(2):119-25
Publication Type
Article
Date
Mar-2013
Author
Linn Gjersing
Kristine V Jonassen
Stian Biong
Edle Ravndal
Helge Waal
Jørgen G Bramness
Thomas Clausen
Author Affiliation
Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway. lgjersing@gmail.com
Source
Scand J Public Health. 2013 Mar;41(2):119-25
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cause of Death
Drug Overdose - mortality
Female
Humans
Male
Middle Aged
Norway - epidemiology
Registries
Retrospective Studies
Risk factors
Sex Distribution
Substance Abuse Treatment Centers - utilization
Substance-Related Disorders - mortality
Urban Population - statistics & numerical data
Young Adult
Abstract
To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies.
Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006-2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected.
Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment.
The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.
Notes
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PubMed ID
23302498 View in PubMed
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Drug-related causes of death: Socioeconomic and demographic characteristics of the deceased.

https://arctichealth.org/en/permalink/ahliterature270221
Source
Scand J Public Health. 2015 Aug;43(6):571-9
Publication Type
Article
Date
Aug-2015
Author
Ellen J Amundsen
Source
Scand J Public Health. 2015 Aug;43(6):571-9
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Cause of Death - trends
Cluster analysis
Disabled persons - statistics & numerical data
Drug Overdose - mortality
Female
Humans
Male
Middle Aged
Norway - epidemiology
Pensions - statistics & numerical data
Registries
Socioeconomic Factors
Substance-Related Disorders - mortality
Suicide - statistics & numerical data
Young Adult
Abstract
The aim of this study was to describe subgroups of those who died from a drug-related cause of death employing demographic and socioeconomic data.
A total of 1,628 persons with registered drug-related deaths in the Norwegian Cause of Death Registry between 2003 and 2009 were matched with research registers of data on demographic and socioeconomic factors during the five years prior to their deaths.
Three equal-sized clusters were identified: persons with very low socioeconomic status, disability pensioners and people on the edge of the workforce.
Socioeconomic situation prior to drug-related deaths was more heterogeneous than expected. Greater knowledge about the members of the disability pensioner and the edge of the workforce clusters must be established in order to make prevention efforts towards these groups more precise and goal oriented.
PubMed ID
25969166 View in PubMed
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Drug-related overdose deaths in British Columbia and Ontario, 1992-2004.

https://arctichealth.org/en/permalink/ahliterature166404
Source
Can J Public Health. 2006 Sep-Oct;97(5):384-7
Publication Type
Article
Author
Benedikt Fischer
Svetlana Popova
Jürgen Rehm
Andrew Ivsins
Author Affiliation
Centre for Addiction and Mental Health, Toronto, ON. benedikt_fischer@camh.net
Source
Can J Public Health. 2006 Sep-Oct;97(5):384-7
Language
English
Publication Type
Article
Keywords
British Columbia
Drug Overdose - mortality
Humans
Linear Models
Ontario
Street Drugs - poisoning
Urban Population
Abstract
To compare rates of fatal drug-related overdose death (OD) cases--a major harm outcome of illicit substance use--in the two provinces of British Columbia (BC) and Ontario, and the two largest municipalities in those provincial jurisdictions, namely the cities of Vancouver and Toronto, between 1992 and 2004.
Provincial coroners' data of drug-related OD cases for the provincial jurisdictions of BC and Ontario, and the municipal jurisdictions of Vancouver and Toronto, are descriptively presented and compared.
After drastic increases in the initial part of the observation period, OD rates in BC have been declining; moreover, due to major reductions of OD cases in Vancouver, the ratio of OD cases between Vancouver and the province of BC has fallen considerably. Conversely, OD rates in Ontario have remained stable at low levels, whereas Toronto has seen a slight decline in such rates during the observation period.
The recent establishment and expansion of treatment and harm reduction interventions may have influenced the decline of ODs in BC, yet similar interventions in Ontario did not have a similar effect, perhaps due to different patterns of illicit drug use. OD rates in jurisdictions across Canada need to be monitored and analyzed to inform evidence-based policy development.
PubMed ID
17120877 View in PubMed
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38 records – page 1 of 4.