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A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo.

https://arctichealth.org/en/permalink/ahliterature87156
Source
BMC Psychiatry. 2008;8:8
Publication Type
Article
Date
2008
Author
Bjornaas Mari A
Bekken Anette S
Ojlert Aasa
Haldorsen Tor
Jacobsen Dag
Rostrup Morten
Ekeberg Oivind
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway. mabjornaas@gmail.com
Source
BMC Psychiatry. 2008;8:8
Date
2008
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adolescent
Adult
Cause of Death - trends
Cohort Studies
Female
Follow-Up Studies
Hospital Mortality - trends
Humans
Male
Mathematical Computing
Narcotics - poisoning
Neoplasms - mortality
Opioid-Related Disorders - mortality - rehabilitation
Overdose - mortality - prevention & control
Patient Admission - statistics & numerical data
Risk
Street Drugs - poisoning
Suicide - statistics & numerical data
Sweden
Violence - statistics & numerical data
Abstract
BACKGROUND: To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS: A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS: During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION: The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.
PubMed ID
18271956 View in PubMed
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Caffeine fatalities--do sales restrictions prevent intentional intoxications?

https://arctichealth.org/en/permalink/ahliterature97969
Source
Clin Toxicol (Phila). 2010 May;48(4):354-8
Publication Type
Article
Date
May-2010
Author
Gunilla Thelander
Anna Kristina Jönsson
Mark Personne
Gunilla Sjölin Forsberg
Kristina Magnusson Lundqvist
Johan Ahlner
Author Affiliation
Department of Forensic Genetics and Forensic Toxicology, The National Board of Forensic Medicine, Linköping, Sweden.
Source
Clin Toxicol (Phila). 2010 May;48(4):354-8
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Caffeine - blood - economics - poisoning
Central Nervous System Stimulants - economics - poisoning
Commerce - legislation & jurisprudence
Female
Humans
Male
Middle Aged
Overdose - mortality - prevention & control
Substance-Related Disorders - mortality
Suicide - prevention & control - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
OBJECTIVE: Caffeine is widely available in beverages and in different over-the-counter products, including tablets containing 100 mg caffeine. Because intentional fatal intoxications with caffeine occur, the maximum quantity of caffeine tablets that can be bought over the counter in a single purchase was restricted from 250 to 30 in Sweden in the year 2004. The objective of this article was to study the effect of this decision on the number of fatal caffeine intoxications. METHOD: In Sweden 95% of all cases undergoing forensic autopsy are screened for a number of drugs including caffeine. All cases during January 1993-September 2009 with a caffeine concentration above 80 microg/g blood were recorded. RESULTS: During the study period toxicological investigations were performed in 83,580 forensic autopsies. Caffeine contributed to the fatal outcome in 20 cases (0.02%). Thirteen (65%) of these fatalities occurred before the introduction of the sales restriction. However, no fatal intoxications where caffeine contributed to the cause of death was recorded between May 2007 and September 2009. CONCLUSION: Overdoses of tablets containing caffeine can be fatal, suicides as well as accidents occur. Restricting the maximum quantity of caffeine tablets available over the counter seemed to be effective in preventing suicides because of caffeine although some time elapsed until the effect was noted. Further monitoring is required to ensure that the observed lower caffeine mortality is a sustained effect.
PubMed ID
20170393 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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Dextropropoxyphene deaths in Denmark from the health authority point of view.

https://arctichealth.org/en/permalink/ahliterature68562
Source
Med Law. 1993;12(1-2):141-51
Publication Type
Article
Date
1993
Author
E. Segest
C N Harris
H. Bay
Source
Med Law. 1993;12(1-2):141-51
Date
1993
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cause of Death
Cross-Sectional Studies
Denmark - epidemiology
Drug and Narcotic Control - legislation & jurisprudence
Female
Humans
Incidence
Male
Middle Aged
Overdose - mortality - prevention & control
Propoxyphene - poisoning
Substance-Related Disorders - mortality - prevention & control
Suicide - legislation & jurisprudence - prevention & control
Abstract
All known deaths resulting from poisoning with Dextropropoxyphene (n = 234) in the Municipality of Copenhagen during the period 1982 to 1989 were surveyed. The deaths were found to have occurred in a group characterized by social stress and abuse. A decline was observed in the annual number of deaths after 1985. The influence that the health authorities efforts and debates in the professional press had with regard to this development are discussed. Furthermore, it is recommended that more explicit criteria as to how the cause of death is to be determined in the future should be compiled.
PubMed ID
8377607 View in PubMed
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Methadone maintenance and addicts' risk of fatal heroin overdose.

https://arctichealth.org/en/permalink/ahliterature68486
Source
Subst Use Misuse. 1996 Jan;31(2):177-96
Publication Type
Article
Date
Jan-1996
Author
J R Caplehorn
M S Dalton
F. Haldar
A M Petrenas
J G Nisbet
Author Affiliation
Department of Public Health and Community Medicine, University of Sydney, Australia.
Source
Subst Use Misuse. 1996 Jan;31(2):177-96
Date
Jan-1996
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adult
Cohort Studies
Female
Follow-Up Studies
Heroin - poisoning
Heroin Dependence - mortality - rehabilitation
Humans
Male
Methadone - therapeutic use
New South Wales - epidemiology
Overdose - mortality - prevention & control
Research Support, Non-U.S. Gov't
Risk
Suicide - prevention & control - statistics & numerical data
Abstract
An admission cohort of 296 Australian methadone maintenance patients was followed over 15 years. The relative risks of death in and out of maintenance were calculated for two age groups, 20-29 and 30-39 years. Heroin addicts in both age groups were one-quarter as likely to die while receiving methadone maintenance as addicts not in treatment. This is because they were significantly less likely to die by heroin overdose or suicide while in maintenance. Methadone maintenance had no measurable effect on the risk of death through nonheroin overdose, violence or trauma, or natural causes. A meta-analysis showed the reduction in overall mortality was consistent with the results of cohort studies conducted in the United States, Sweden, and Germany. The combined results of the five studies again indicated that methadone maintenance reduced addicts' risk of death to a quarter, RR 0.25 (95% CI 0.19 to 0.33).
PubMed ID
8834006 View in PubMed
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Mortality and causes of death in a 10-year follow-up of patients treated for self-poisonings in Oslo.

https://arctichealth.org/en/permalink/ahliterature54949
Source
Suicide Life Threat Behav. 1994;24(4):398-405
Publication Type
Article
Date
1994
Author
O. Ekeberg
O. Ellingsen
D. Jacobsen
Author Affiliation
Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway.
Source
Suicide Life Threat Behav. 1994;24(4):398-405
Date
1994
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cause of Death
Cross-Sectional Studies
Female
Humans
Incidence
Male
Middle Aged
Norway - epidemiology
Overdose - mortality - prevention & control - psychology
Patient Admission - statistics & numerical data
Research Support, Non-U.S. Gov't
Substance-Related Disorders - mortality - psychology - rehabilitation
Suicide - prevention & control - psychology - statistics & numerical data
Suicide, Attempted - prevention & control - psychology - statistics & numerical data
Survival Rate
Urban Population - statistics & numerical data
Abstract
The present 10-year follow-up study includes all patients (N = 926; 50% females) treated in the medical departments in Oslo for self-poisonings during one year (1980). Seventeen percent were considered suicidal attempts upon admission, 25% among the non-substance abusers and 8% among the abusers. At follow-up, 207 patients (22%) were dead (62% males). The mortality rate was highest among the abusers. The most common causes of death were suicide (21%), heart disease (17%), opiate abuse (15%), and accidents/wounds (13%). Forty-one percent of the suicides occurred during the first two years of the follow-up period. The suicides were by poisoning (57%), hanging (20%), and other methods (23%). The female mortality rate decreased in the second half of the follow-up period whereas the male rate did not change. The risk of death within 10 years after discharge increased with age and was higher in men and in abusers, whereas social group and motive for suicide were not predictive factors. The females had an excess suicide rate of 182 (36-327, 95% CI) in the first year after the self-poisoning and 61 (36-87, 95% CI) in the total period. The corresponding figures for males were 70 (19-122) and 21 (12-30). The only factor associated with an increased suicide rate was a suicidal motive upon the admission for self-poisoning with a 3.1 (1.7-5.8, 95% CI) times increased risk of suicide in the 10-year follow-up period.
PubMed ID
7740597 View in PubMed
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Social and structural aspects of the overdose risk environment in St. Petersburg, Russia.

https://arctichealth.org/en/permalink/ahliterature155294
Source
Int J Drug Policy. 2009 May;20(3):270-6
Publication Type
Article
Date
May-2009
Author
Traci C Green
Lauretta E Grau
Ksenia N Blinnikova
Mikhail Torban
Evgeny Krupitsky
Ruslan Ilyuk
Andrei Kozlov
Robert Heimer
Author Affiliation
Department of Epidemiology and Public Health, Yale School of Medicine, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA. traci.c.green@yale.edu
Source
Int J Drug Policy. 2009 May;20(3):270-6
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Cardiopulmonary Resuscitation - education - standards
Data Collection
Drug Overdose - mortality - prevention & control
Emergency Medical Services - standards
Female
Harm Reduction
Humans
Male
Naloxone - supply & distribution - therapeutic use
Narcotic Antagonists - supply & distribution - therapeutic use
Opioid-Related Disorders - epidemiology - mortality
Risk factors
Risk-Taking
Russia - epidemiology
Social Environment
Substance Abuse, Intravenous - epidemiology - mortality
Abstract
While overdose is a common cause of mortality among opioid injectors worldwide, little information exists on opioid overdoses or how context may influence overdose risk in Russia. This study sought to uncover social and structural aspects contributing to fatal overdose risk in St. Petersburg and assess prevention intervention feasibility.
Twenty-one key informant interviews were conducted with drug users, treatment providers, toxicologists, police, and ambulance staff. Thematic coding of interview content was conducted to elucidate elements of the overdose risk environment.
Several factors within St. Petersburg's environment were identified as shaping illicit drug users' risk behaviours and contributing to conditions of suboptimal response to overdose in the community. Most drug users live and experience overdoses at home, where family and home environment may mediate or moderate risk behaviours. The overdose risk environment is also worsened by inefficient emergency response infrastructure, insufficient cardiopulmonary or naloxone training resources, and the preponderance of abstinence-based treatment approaches to the exclusion of other treatment modalities. However, attitudes of drug users and law enforcement officials generally support overdose prevention intervention feasibility. Modifiable aspects of the risk environment suggest community-based and structural interventions, including overdose response training for drug users and professionals that encompasses naloxone distribution to the users and equipping more ambulances with naloxone.
Local social and structural elements influence risk environments for overdose. Interventions at the community and structural levels to prevent and respond to opioid overdoses are needed for and integral to reducing overdose mortality in St. Petersburg.
Notes
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PubMed ID
18774283 View in PubMed
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Trends and availability of suicide methods in Finland. Proposals for restrictive measures.

https://arctichealth.org/en/permalink/ahliterature216312
Source
Br J Psychiatry. 1995 Jan;166(1):35-43
Publication Type
Article
Date
Jan-1995
Author
A. Ohberg
J. Lonnqvist
S. Sarna
E. Vuori
A. Penttila
Author Affiliation
Department of Forensic Medicine, University of Helsinki, Finland.
Source
Br J Psychiatry. 1995 Jan;166(1):35-43
Date
Jan-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antidepressive Agents - poisoning
Antidepressive Agents, Tricyclic - poisoning
Antipsychotic Agents - poisoning
Cause of Death
Cross-Cultural Comparison
Cross-Sectional Studies
Drug Overdose - mortality - prevention & control
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Parathion - poisoning
Suicide - prevention & control - trends
Abstract
Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods.
Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, chi 2 test for trends and suicide risks for different medicines.
Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability.
Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.
PubMed ID
7894873 View in PubMed
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8 records – page 1 of 1.