OBJECTIVE: To study the association between benzodiazepine prescribing patterns including dose, type and dosing schedule and the risk of drug overdose death among US veterans receiving opioid analgesics. DESIGN: Case-cohort study SETTING: Veterans Health Administration (VHA), 2004 through 2009. PARTICIPANTS: US veterans, primarily male, who received opioid analgesics between 2004 and 2009. All veterans who died of a drug overdose (n = 2,400) while receiving opioid analgesics and a random sample of veterans (n = 420,386) who received VHA medical services and opioid analgesics were included in the study. Main outcome measure: Drug overdose death, defined as any intentional, unintentional or indeterminate poisoning death caused by any medication or drug, determined by cause of death information from the National Death Index. RESULTS: Twenty seven percent of veterans who received opioid analgesics also received benzodiazepines during the study period. Approximately half of the drug overdose deaths (n=1,185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of drug overdose death increased based on benzodiazepine prescription history: formerly prescribed vs. not prescribed (adjusted hazard ratio [HR]=2.33, 95% confidence interval [CI]: 2.05-2.64); currently prescribed vs. not prescribed (HR=3.86, CI:3.49-4.26). Risk of drug overdose death increased as daily benzodiazepine dose increased. When compared to clonazepam, temazepam was associated with a decreased drug overdose death risk (HR=0.63, CI: 0.48-0.82). Benzodiazepine dosing schedule was not associated with drug overdose death risk. CONCLUSIONS: Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of drug overdose death in a dose-response fashion.

Wen Er Ya Jane. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 130-134). / Table of contents --- p.ii / List of tables --- p.iv / List of figures --- p.vi / Abstract --- p.vii / Glossary of abbreviations --- p.ix / Acknowledgments --- p.x / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- DEFINITIONS AND CLASSIFICATIONS...............................Error! Bookmark not defined / Chapter 1.1.1 --- Classification of drug-related problems --- p.2 / Chapter 1.1.2 --- Adverse drug reactions (ADRs) --- p.2 / Chapter 1.1.3 --- Drug interactions (DI) --- p.7 / Chapter 1.1.4 --- Therapeutic failures (TF) --- p.8 / Chapter 1.1.5 --- Non-compliance --- p.10 / Chapter 1.1.6 --- Drug overdoses (DO) or drug poisonings --- p.11 / Chapter 1.1.7 --- Drug-related hospitalizations (DRH) --- p.12 / Chapter 1.1.8 --- Other relevant definitions --- p.13 / Chapter 1.2 --- LITERATURE REVIEW --- p.16 / Chapter 1.2.1 --- Adverse drug reactions --- p.16 / Chapter 1.2.2 --- Hospital admission due to ADRs --- p.18 / Chapter 1.2.3 --- Drug-related hospitalizations (DRH) --- p.22 / Chapter 1.2.4 --- Discussion --- p.24 / Chapter 1.3 --- PURPOSE OF THIS STUDY --- p.27 / Chapter CHAPTER 2 --- METHODS --- p.30 / Chapter 2.1 --- BACKGROUND --- p.30 / Chapter 2.2 --- DATA COLLECTION --- p.31 / Chapter 2.2.1 --- The patients --- p.31 / Chapter 2.2.2 --- The drug history --- p.31 / Chapter 2.2.3 --- Patients knowledge of drugs they were taking --- p.33 / Chapter 2.2.4 --- Compliance --- p.33 / Chapter 2.2.5 --- Previous episodes of adverse drug reactions --- p.34 / Chapter 2.2.6 --- Diagnosis and outcome --- p.34 / Chapter 2.2.7 --- Laboratory Results --- p.34 / Chapter 2.2.8 --- Demographic characteristics of the patients --- p.35 / Chapter 2.2.9 --- The data sheet --- p.36 / Chapter 2.3. --- CASE REVIEW (REASSESSMENT) --- p.41 / Chapter 2.4 --- CODING OF DATA --- p.41 / Chapter 2.4.1 --- Coding of general data except diagnoses and drugs --- p.41 / Chapter 2.4.2 --- Coding of diagnoses --- p.42 / Chapter 2.4.3 --- Coding of drugs --- p.42 / Chapter 2.5 --- STATISTICAL ANALYSIS --- p.42 / Chapter CHAPTER 3 --- RESULTS --- p.43 / Chapter 3.1 --- THE PATIENTS --- p.43 / Chapter 3.1.1 --- Age and sex distributions --- p.43 / Chapter 3.1.2 --- Patients' ADL and living environments --- p.47 / Chapter 3.1.3 --- Baseline liver and renal function tests --- p.50 / Chapter 3.1.4 --- Diagnoses --- p.52 / Chapter 3.2 --- DRUG USE PRIOR TO ADMISSION --- p.54 / Chapter 3.2.1 --- Overview --- p.54 / Chapter 3.2.2 --- Consumption patterns for the prescribed drugs --- p.61 / Chapter 3.2.3 --- Sources and durations for the prescribed drugs --- p.69 / Chapter 3.2.4 --- Consumption patterns for self-medications --- p.71 / Chapter 3.2.5 --- Source and duration of the self-medications --- p.73 / Chapter 3.2.6 --- Drug overdose patterns --- p.75 / Chapter 3.3 --- PATIENTS' KNOWLEDGE OF THE EFFECTS AND SIDE-EFFECTS OF DRUGS --- p.74 / Chapter 3.3.1 --- Overview --- p.74 / Chapter 3.3.2 --- Patients' knowledge of the effects of their prescribed drugs --- p.74 / Chapter 3.3.3 --- Patients' knowledge of the side-effects of their prescribed drugs --- p.77 / Chapter 3.4 --- COMPLIANCE --- p.79 / Chapter 3.5 --- DRUG-RELATED HOSPITALIZATIONS (DRH) --- p.82 / Chapter 3.5.1 --- Overview --- p.82 / Chapter 3.5.2 --- Adverse drug reactions (ADRs) --- p.84 / Chapter 3.5.3 --- Outcome of ADRs --- p.98 / Chapter 3.5.4 --- "Therapeutic failures (Non-compliance, Inappropriate dose reduction)" --- p.100 / Chapter 3.5.5 --- Drug overdoses --- p.104 / Chapter CHAPTER 4 --- DISCUSSION --- p.106 / Chapter 4.1 --- ABOUT THE PATIENTS --- p.106 / Chapter 4.2 --- DISEASE PATTERNS AND DRUG CONSUMPTION PATTERNS --- p.107 / Chapter 4.2.1 --- Diagnoses on admission --- p.107 / Chapter 4.2.2 --- Drug consumption patterns --- p.109 / Chapter 4.2.3 --- About the sources and durations of the prescribed drugs --- p.112 / Chapter 4.2.4 --- About the self-medications --- p.113 / Chapter 4.3 --- ABOUT PATIENTS' KNOWLEDGE OF THE DRUGS --- p.114 / Chapter 4.4 --- ABOUT COMPLIANCE --- p.116 / Chapter 4.5 --- ABOUT ADRS AND DRUGS INTERACTIONS --- p.118 / Chapter 4.5.1 --- The incidence of ADRs --- p.118 / Chapter 4.5.2 --- The patterns of ADRs --- p.119 / Chapter 4.5.3 --- The drugs and ADRs --- p.119 / Chapter 4.5.4 --- Self-medications and ADRs --- p.121 / Chapter 4.5.5 --- The risk factors for ADRs --- p.122 / Chapter 4.5.6 --- Drug interactions --- p.125 / Chapter 4.6 --- ABOUT THERAPEUTIC FAILURES --- p.126 / Chapter 4.7 --- ABOUT DRUG OVERDOSES --- p.127 / Chapter 4.8 --- CONCLUSIONS --- p.128 / BIBLIOGRAPHY --- p.130

Increased opioid analgesic (OA) prescribing has been associated with increased risk of prescription opioid diversion, misuse, and abuse. States established prescription drug monitoring programs (PDMPs) to collect and analyze electronic records for dispensed controlled substances to reduce prescription drug abuse and diversion. PDMP data can be used by prescribers for tracking patient’s history of controlled substance prescribing to inform clinical decisions. The studies in this dissertation are focused on the less utilized potential of the PDMP data to enhance public health surveillance to monitor OA prescribing and co-prescribing and association with opioid overdose mortality and morbidity. Longitudinal analysis of OA prescribing and evaluation of the effect of recent policies and opioid prescribing guidelines require consensus measures for OA utilization and computational tools for uniform operationalization by researchers and agencies. Statistical macros and computational tools for OA utilization measures were developed and tested with Kentucky PDMP data. A set of covariate measures using mortality and morbidity surveillance data were also developed as proxy measures for prevalence of painful conditions justifying OA utilization, and availability of heroin and medication treatment for opioid use disorder. A series of epidemiological studies used the developed OA measures as outcomes, and adjusted for time-varying socio-demographic and health care utilization covariates in population-averaged statistical models to assess longitudinal trend and pattern changes in OA utilization in Kentucky in recent years. The first study, “Trends and Patterns of OA Prescribing: Regional and Rural-Urban Variations in Kentucky from 2012 to 2015,” shows significant downward trends in rates of residents with OA prescriptions. Despite the significant decline over time, and after accounting for prevalence of injuries and cancer, the rate of dispensed OA prescriptions among residents in Kentucky Appalachian counties remained significantly higher than the rest of the state. The second study, “Population-Level Measures for High-Risk OA Prescribing: Longitudinal Trends and Relationships with Pain-Associated Conditions,” shows significant reduction in high-risk OA prescribing (e.g., high daily dosage, long-term use, concurrent prescriptions for OA and benzodiazepines) from 2012 to 2016, significantly positive associations between high-risk OA prescribing and cancer mortality rates with no substantial change in the association magnitude over time, and declining strengths of positive associations between high-risk OA prescribing and acute traumatic injuries or chronic non-cancer pain over the study period. The third study, “A Reciprocal Association between Longitudinal Trends of Buprenorphine/Naloxone Prescribing and High-Dose OA Prescribing,” indicates a significant reciprocal relationship between high-dose OA prescribing and buprenorphine/ naloxone prescribing, and a clinically meaningful effect of buprenorphine/naloxone prescribing on reducing OA utilization. The results from the studies advanced the understanding of the epidemiology of opioid use and misuse in Kentucky, and identified actionable risk and protective factors that can inform policy, education, and drug overdose prevention interventions. The developed operational definition inventory and computational tools could stimulate further research in Kentucky and comparative studies in other states.

1 ABSTRACT Background The annual drug overdose rates have been increasing exponentially since the 90's worldwide. Toxicological information centre (TIC) represents a valuable source of information for evaluating the trends in the drug poisonings in Czech Republic. Aim of the study The purpose was to analyze the number and trends in the calls concerning poisonings due to central nervous system (CNS) affecting drugs, identify the reasons of medication errors caused by laymen, frequency and consequences of these errors across all age groups and also to analyze the numbers, causes, symptoms and severity of the paracetamol intoxications. Methods During the reference period the data from the enquiries were extracted from the TIC electronic database, discharge reports from the hospital were studied or phone call follow-ups with the patients were carried out to be able to evaluate the outcome of the poisonings. Results In the years 1997-2002 the number of calls caused by poisoning with tricyclic antidepressants and barbiturates decreased (by 366.7 % and 340,0 %, respectively) whereas the calls due to selective serotonin reuptake inhibitors and benzodiazepines overdose increased (by 1347.4 % and 359.8 %). The 0-5 years old children are at the highest risk of experiencing medication errors or accidental poisonings...

The selective serotonin reuptake inhibitors appear to have a much wider margin of safety than most other classes of antidepressants. Although there is limited experience with acute overdoses of fluoxetine alone, few serious adverse effects have been reported. There has been almost no experience, however, with significant fluoxetine overdoses in children. This report describes the accidental ingestion of as much as 43 mg/kg of fluoxetine by a 4-year-old child. In this case, serum blood levels of the drug and its major metabolite were consistent with a large ingestion and are among the highest reported in the medical literature. Toxic effects were relatively mild and consisted of a brief spell of unresponsiveness, sinus tachycardia, and moderate psychomotor agitation and dyskinesia. Supportive care was provided and the child recovered completely.

This study explores the experiences of people who have lost loved ones due to socially stigmatized deaths. Drawing from eight individual interviews, the author argues that the stigma associated with death due to drug overdose, suicide, substance abuse, or murder can cause traumatic or prolonged grief and can complicate the way the bereaved talk about grief as a part of their healing process. With the mortality rate in the U.S. rising, there is an epidemic of disenfranchised grief affecting millions of bereaved individuals. Using Coordinated Management of Meaning and Communication Privacy Management theories, the author uncovers strategies the traumatically bereaved employ to manage interactions and relationships with others. A qualitative analysis of participant interviews revealed that social stigma, whether experienced or anticipated, affects the way the bereaved communicate and can cause self-silencing. Findings indicate a need for safe, supportive, and non-judgmental spaces for the traumatically bereaved to share their stories.

No description available.

: Methamphetamine-related deaths have been rising along with those involving synthetic opioids, mostly fentanyl and fentanyl analogs (FAs). However, the extent to which methamphetamine involvement in deaths differs from those changes occurring in synthetic opioid involvement is unknown.: To determine the patterns and temporal changes in methamphetamine-related deaths with and without other drug involvement.: Data from all methamphetamine-related deaths in West Virginia from 2013 to 2018 were analyzed. Quasi-Poisson regression analyses over time were conducted to compare the rates of change in death counts among methamphetamine and fentanyl//FA subgroups.: A total of 815 methamphetamine-related deaths were analyzed; 572 (70.2%) were male and 527 (64.7%) involved an opioid. The proportion of methamphetamine only deaths stayed relatively flat over time although the actual numbers of deaths increased. Combined fentanyl/FAs and methamphetamine were involved in 337 deaths (41.3%) and constituted the largest increase from 2013 to 2018. The modeling of monthly death counts in 2017-2018 found that the average number of deaths involving fentanyl without methamphetamine significantly declined (rate of change -0.025, < .001), while concomitant fentanyl with methamphetamine and methamphetamine only death counts increased significantly (rate of change 0.056 and 0.057, respectively, < .001).: Fentanyl and FAs played an increasingly significant role in methamphetamine-related deaths. The accelerating number of deaths involving fentanyl/FAs and methamphetamine indicates the importance of stimulants and opioids in unintentional deaths. Comprehensive surveillance efforts should continue to track substance use patterns to ensure that appropriate prevention programs are undertaken.