Detoxication capacity of a multiple (w/o/w) emulsion for the treatment of drug overdose: drug extraction into the emulsion in the gastro-intestinal tract of rabbits.
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Pharmacokinetics of drug overdose.
Drugs ingested in overdose can have altered pharmacokinetics of absorption, distribution, and elimination. The pathophysiologic consequences of overdose can also change a drug's pharmacokinetic properties. Many toxicologic interventions are based on modifying the drug's pharmacokinetics (e.g., impairing absorption or enhancing elimination). Serum drug monitoring, even with its limitations, does have a role in managing the patient who has taken an overdose.
Absorption↗
Epidemiology of drug overdose in children.
Childhood drug overdoses are a continuing important public health problem. Although drug overdoses are no longer the important cause of childhood mortality they once were, such poisonings account for highly frequent and unacceptable instances of childhood injuries. These poisonings exact a high cost from society. They result in many emergency department visits and hospitalisations, with the attendant indirect costs of suffering, parental anxiety, and lost days of work or school. Childhood drug overdoses are preventable; those children and families at highest risk show identifiable characteristics, and the medications which pose the greatest hazard to children have already been identified. These injuries divert expensive and scarce medical resources from society's other health problems. Thus, clinicians must do more to prevent childhood drug overdoses whenever possible.
Adolescent↗
Drug overdose: changing concepts for modern drugs.
Chart review of all patients admitted over a six-month period to the University of Missouri-Columbia Medical Intensive Care Unit after intentional drug overdose revealed that the drugs ingested today are quite different from those used five to 20 years ago. I selected for review cases representative of overdose with three of the more commonly used drugs--acetaminophen, ethylene glycol, and tricyclic antidepressants.
Acetaminophen↗
Diagnosis and management of the drug overdose patient.
The manifestations of drug overdose can be complex and result in a variety of physiological effects. Drug overdose situations involving multiple agents further confuse the clinical picture. The clinician must be able to diagnose and treat the patient to prevent unnecessary morbidity or mortality. Often the risk of treating drug overdose with an additional pharmacological agent outweighs the potential benefit. In these cases, the best treatment may involve observation alone. This review describes the current diagnostic and management techniques for the drug overdose patient. Specific drug groups that are commonly used for overdose are discussed with emphasis on physiological manifestations of intoxication and poisoning and the potential for delayed effects. Treatment options for various groups are also discussed. It appears that invasive procedures such as gastric lavage and whole-bowel irrigation are not appropriate for the majority of overdose situations. The use of oral activated charcoal may also be of limited value. As specific antidotes for drug overdose are not widely available, supportive treatment must be based on the individual patient.
Drug Overdose↗
Drug overdoses: a comparison of drug-dependent and nondependent individuals attending London casualty departments.
During a 1-month prospective study of patients presenting to 62 London Casualty Departments with drug-related problems, 395 drug-dependent individuals were identified. A comparison of these drug-dependent and nondependent patients attending casualty during the same period with the same presenting problem of drug overdose showed statistically significant differences in demographic characteristics and patterns of drug use between the two groups. The importance of identifying previously unrecognized drug-dependent individuals during their casualty attendance is discussed.
Adult↗
Patterns and economic effects of drug overdose mortality in Texas: 1980-1986.
Drug overdose mortality and its economic consequences are explored for ten different drug categories in this article. Data on drug overdose mortality in Texas for the years 1980-1986 are examined and a cost of mortality analysis is presented using the human capital methodology. In addition, mortality rates per 100,000 population are presented for each drug category. The results indicate that the cost of drug overdose mortality has more than doubled over the six-year period. The greatest growth in mortality cost has been for narcotics and cocaine, with commonly prescribed psychoactive drugs remaining fairly constant. The results suggest that men are at far greater risk of drug overdose than women with respect to illicit drugs. Women, however, appear to be at greater risk for overdose from commonly prescribed drugs.
Adult↗
Predictors of accidental fatal drug overdose among a cohort of injection drug users.
OBJECTIVES: This study evaluated factors associated with accidental fatal drug overdose among a cohort of injection drug users (IDUs). METHODS: In a prospective cohort study of 2849 IDUs in King County, Washington, deaths were identified by electronically merging subject identifiers with death certificate records. Univariate and multivariate Cox regression analyses were performed to identify predictors of overdose mortality. RESULTS: Thirty-two overdoses were observed. Independent predictors of overdose mortality were bisexual sexual orientation (relative risk [RR] = 4.86; 95% confidence interval [CI] = 2.30, 13.2), homelessness (RR = 2.30; 95% CI = 1.06, 5.01), infrequent injection of speedballs (RR = 5.36; 95% CI = 1.58, 18.1), daily use of powdered cocaine (RR = 4.84; 95% CI = 1.13, 20.8), and daily use of poppers (RR = 22.0; 95% CI = 1.74, 278). CONCLUSIONS: Sexual orientation, homelessness, and drug use identify IDUs who may benefit from targeted interventions.
Accidents↗
Circadian and circannual rhythms of emergency room drug-overdose admissions.
All Drug Abuse Warning Network (DAWN) records for 1983 from the University of Illinois Emergency Room were collected: a total of 264 drug-overdose (DOD) admissions. Cosinor, multiple linear regression, cross-tab multivariate, and spectral periodicity statistical analyses were performed on the raw data with particular use made of the BMDP statistical package. More DODs present themselves for admission to the ER around the 1820 hr than any other time of the circadian period. Sex, age, and race have no effect on this circadian relationship. No circatrigintan rhythms were found for any sex, race, or age group. However, there is a circannual rhythm for total DOD admissions with more admissions in late July than any other time of the year. Women, however, appear to exhibit a significantly earlier annual acrophase (late May) than males in early August. There is no evidence for circannual, circadiseptan, circaseptan or circabiseptan rhythms for blacks or hispanics. However, whites, particularly males, show evidence of biweekly (i.e., Monday and Friday) as well as circannual rhythms. Multivariate analyses of circannual rhythms vs. age indicated no significant rhythms for the under-21-year-old but a highly significant circannual rhythm for the over-20-year-old. Therefore, ER personnel should be attentive to the sex, age, and race of their patients in order to gain a degree of predictability as to when the greatest number of patients might present themselves at the ER for treatment of their DOD. Awareness of the temporal effects on DOD admissions can thus improve the quality of ER treatment for DOD patients.
Adult↗
Subsequent deaths after attempted suicide by drug overdose in the western region of Adelaide, 1976.
A five-year follow-up of 262 patients in the western region of Adelaide, who attempted suicide in 1976 by taking an overdose of a drug, showed that seven of these subsequently died by suicide and two from other causes. Six of the nine patients who died were migrants. Drug overdoses were most likely to be taken by young women from lower socioeconomic groups. A background of marital separation was common and, although migrants as a whole were underrepresented, German migrants were significantly more likely, while Italian and Greek migrants were significantly less likely, to take drug overdoses. The data suggest that psychiatric assessment is useful in reducing the likelihood of subsequent suicide; general physicians should select patients for further assessment.
Adolescent↗
Pattern and risk factors for intentional drug overdose in Saudi Arabia.
BACKGROUND: Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic. METHODS: Using a retrospective chart review of patients aged 12 years and over with a diagnosis of intentional drug overdose between 1997 and 1999, we studied the demographic characteristics, the risk factors, the most commonly used drugs, and the resulting morbidities and mortalities of study subjects. RESULTS: Most of the patients were young (mean age 22 years, SD 4.6, range 15 to 40 years), and most were Saudi nationals (n = 76; 96%). Eighty percent of the patients were women. The occurrence of intentional drug overdose peaked during the month of September (that is, 20% of total cases). Previous suicide attempts, family conflicts, and psychiatric disorders represented significant risk factors. Single-agent overdose occurred in 30% of the patients, and most of the drugs used were prescribed medications (53%). Acetaminophen represented the most common drug (30%). While some patients required prolonged hospital stay or admission to the intensive care unit, no mortalities occurred. CONCLUSIONS: Intentional drug overdose is a relatively uncommon reason for hospital admission in Saudi Arabia. This study identifies certain risk factors relevant to the Saudi community and raises awareness about intentional drug overdose.
Adolescent↗
Suicide attempt by drug overdose.
Suicide attempts by drug overdose are a growing health care problem, now reaching epidemic proportions. The patient who attempts suicide is typically a young, single adult female with interpersonal conflicts who takes an overdose of a prescribed drug, frequently a benzodiazepine. Patients who have recently been separated or divorced and those who are alcoholic, depressed or previously suicidal are also at risk. The family physician is in the best position to prevent suicide.
Adolescent↗
Pharmacokinetics of drug overdose.
Pharmacokinetics of drugs taken in overdose may differ from those observed following therapeutic doses. Differences are due both to dose-dependent changes and to effects of drugs or pathophysiological consequences of the overdose on kinetics. Dose-dependent changes in rate and extent of absorption, bioavailability (saturation of first-pass metabolism), distribution (saturation of protein binding sites) and metabolism are discussed. Gastrointestinal motility is affected both by specific drug actions, such as delayed gastric emptying by anticholinergic drugs, and by general nervous system depression caused by many drugs. Drug-induced circulatory insufficiency may retard tissue distribution and reduce clearance. Disturbances in blood and urine pH may alter distribution and clearance of weak acids and bases. Drug-induced renal or hepatic failure can significantly decrease clearance. Hypothermia is a common complication of drug overdose and might retard distribution and also reduce clearance. The data concerning pharmacokinetics during overdose are usually incomplete and difficult to interpret. Doses and times of ingestion are uncertain, duration of blood and urine sampling is often inadequate to distinguish absorption from distribution and elimination phases, active metabolites are not measured, protein binding is not determined and clinical features of patients not adequately described. We have, however, reviewed available data for salicylate, paracetamol (acetaminophen), barbiturates, ethchlorvynol, glutethimide, chloral hydrate, tricyclic antidepressants, lithium, phenytoin, ethanol, theophylline, digoxin, amphetamine and phencyclidine.
Acetaminophen↗
Heroin and cocaine dependence and the risk of accidental non-fatal drug overdose.
The relation between illicit drug dependence and the likelihood of drug overdose is unclear. We recruited 1,066 habitual drug users for this analysis through street-based outreach in New York City. In this sample, 99.3% of respondents used heroin in the past year and 87.1% of respondents used cocaine; 819 (77.5%) heroin users and 735 (79.2%) cocaine users were severely dependent on either drug respectively. In multivariable models, among heroin users, persons who were severely heroin dependent were less likely (OR = 0.6; 95% CI = 0.4-0.9) to have overdosed on any drug in the past year; among cocaine users, those who were severely cocaine dependent were more likely (OR = 1.6; 95% CI = 1.0-2.6) to have overdosed in the past year. The relation between illicit drug dependence and risk of overdose may vary for different patterns of drug dependence. These observations suggest that overdose prevention interventions, perhaps even those specifically targeting opiate overdose, may be more efficiently directed at individuals exhibiting cocaine dependence.
Adolescent↗
Trends in suicide from drug overdose in the elderly in England and Wales, 1993-1999.
BACKGROUND: Drug overdose is a common method of suicide in the elderly. Hence, an understanding of current trends in epidemiology of these deaths is important when considering measures to decrease suicide rates. METHODS: Analysis of the Office for National Statistics (ONS) database of deaths from overdose and poisoning. Suicide and undetermined deaths from drug overdose between 1993-1999 in the over 65 year olds were studied. Socio-demographic data from the four drug groups most commonly used in overdose were extracted, and age and sex specific mortality rates calculated. Enumeration districts were ranked into five quintiles based on their Carstairs scores, and death rates in each quintile for men and women calculated. RESULTS: There were 1864 deaths from drug overdose during the study period. Suicide and undetermined death rates from drug overdose remained stable between 1993-1999. Drugs most commonly used in overdose were (in order) paracetamol (and related compounds), benzodiazepines, antidepressants, and opiates. Women comprised 62% of deaths. Death rates increased with age, with highest rates in men over 75 (37.7 deaths per million). Benzodiazepines showed the most marked increase with age. Co-proxamol comprised 32% of deaths from paracetamol compounds, and 95% of antidepressant deaths were due to tricyclic antidepressants. There was no association in women between Carstairs area deprivation and suicide rates; in men rates were highest in the most deprived areas. CONCLUSION: Suicides in the over 65 year olds may be decreased by changes in prescription practice. Paracetamol, co-proxamol, tricyclic antidepressants and benzodiazepines should be prescribed with caution to the elderly with depression or at high risk of depression.
Acetaminophen↗
Changes in the pattern of drug overdoses.
OBJECTIVE: To describe changes in the pattern of patients with drug overdoses hospitalized over the past two decades. DESIGN: Retrospective data review. SETTING: A 719-bed university-affiliated hospital. PATIENTS: All adults admitted to the hospital with drug overdoses in 1968, 1979, and 1989. PRIMARY OUTCOME MEASURES: Changes in demographics, drugs used, and discharge disposition. RESULTS: A majority of patients admitted with drug overdoses have had previous suicide attempts; and while women predominate, they make up a decreasing proportion of admissions over time (76% in 1968 to 52% in 1989 (p = 0.003). Benzodiazepines were the drugs most commonly used in 1979 and 1989, and cocaine has shown a marked increase in use over time, while barbiturate overdoses have progressively decreased. The use of two or more drugs is common and has been consistent over time, as has been the concomitant use of alcohol. The mortality rate has remained low at 1%, but mean length of stay has decreased dramatically from 6.6 days in 1979 to 3.2 days in 1989 (p < 0.001) and discharge disposition has shifted from out-patient to inpatient psychiatric care. CONCLUSIONS: The majority of patients admitted to a general acute care hospital following a drug overdose have a history of previous suicide attempts and are followed by a mental health professional. The changing pattern of drugs used over two decades reflects trends in drugs used in the community in general and by patients with mental illness in particular. Discharge disposition has changed over time and is related to patients' insurance status.
Adult↗
HIV infection among victims of accidental fatal drug overdoses in New York City.
AIMS: To determine the factors associated with HIV seroprevalence rates for victims of drug overdoses. DESIGN: Descriptive epidemiologic survey of a complete 3-year sample of accidental fatal drug overdoses. SETTING: New York City (population 7,322,564). PARTICIPANTS: All people over 15 years of age (n = 2159) who died of accidental fatal drug overdoses during 1991-93. MEASUREMENTS: Using medical examiner data and logistic regression analyses were conducted to examine the association between HIV seroprevalence and gender, race, age and type of drug overdose. FINDINGS: There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV positive. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). Victims residing in communities with higher levels of poverty had higher rates of HIV infection but poverty did not account for the high rates of HIV infection among African-Americans. The highest rates of HIV infection were found among victims aged 35-44 years (38.8%) and 45-54 years (33.7%). Dying from an opiate overdose was associated with a 2.4 times increase in the likelihood of being HIV positive. CONCLUSION: If opiate abuse continues to rise in the United States, HIV infection will increase in the next few years. Women who abuse drugs participate in risky sexual practices and are more likely than men to develop HIV infection from receptive sex as well as sharing of needles. Harm reduction programs should address risky sex as well as needle programs. There should be further study of why African-Americans who died of drug overdoses have the highest rates of HIV infection.
Adolescent↗
[What should be kept in mind when a patient with illicit drug overdose is admitted to the emergency department?].
The admission in emergency wards of patients having problems with, or suffering from an overdose of, drugs is a habitual event. The main cause is alcoholic intoxication, followed by heroin abuse until about four or five years ago. Nowadays emergency care for an overdose of cocaine, or its derivatives, and synthetic drugs such as ecstasy or liquid ecstasy is growing. In this article, the author describes the protocols used in the Hospital Clinic and lists the most frequently observed intoxications in the emergency word.
Drug Overdose↗