Unintentional Drug Research Articles

Poisoning Mortality in the United States: Comparison of National Mortality Statistics and Poison Control Center Reports

<h2>Abstract</h2> <b>Study objective:</b> To determine whether the distributions of age and poisoning categories for poisoning deaths are similar in death certificates as compiled by the National Center for Health Statistics (NCHS) and US poison control centers as reported by the Toxic Exposure Surveillance System (TESS). <b>Methods:</b> Data from both databases for 1994 were examined. Mortality data from NCHS were identified by applicable E-codes of the <i>International Classification of Diseases–ninth revision (ICD-9).</i> All fatalities described in the TESS report were coded to conform to the <i>ICD-9</i> system. <b>Results:</b> A total of 16,527 poisoning deaths were recorded by NCHS; 766 deaths were reported by TESS. For NCHS and TESS, respectively, the age distribution of unintentional drug poisonings (N=7,823; 155) and unintentional non-drug poisonings (N=1,234; 102) differed (<i>P</i> <.001), whereas those for intentional poisonings (N=5,320; 413) did not differ significantly. In the NCHS and TESS data sets, respectively, the relative distribution of death circumstances differed (<i>P</i> <.001) for unintentional drug poisonings (47% versus 20%), unintentional non-drug poisonings (8% versus 14%), intentional poisonings (32% versus 54%), and unknown or other circumstances (13% versus 12%). The distributions of poisoning circumstances and age categories were dependent on the data source (<i>P</i> <.001). There was no statistical agreement between the data sets in rankings of the 12 most frequent <i>ICD-9</i> codes and toxins associated with poisoning deaths. <b>Conclusion:</b> Deaths reported in TESS represent 5% of the poisoning deaths tabulated by NCHS. Differences observed in the 2 data sets may lead to differing health policies to address poisoning hazards. [Hoppe-Roberts JM, Lloyd LM, Chyka PA. Poisoning mortality in the United States: comparison of national mortality statistics and poison control center reports. <i>Ann Emerg Med.</i> May 2000;35:440-448.]

Cuidando su salud

In large urban areas, Hispanics are often dependent upon local Spanish-language broadcast and print media for news and entertainment. Since 1989, a radio show has provided daily disease prevention and health promotion messages to Hispanics on a Washington, DC area Spanish-language station. Cuidando su Salud (Taking Care of Your Health) lasts 2 minutes and is heard three times a day during news segments. By November 1997, 1543 different individual programs had been produced. Categorized according to Healthy People 2000 guidelines, these programs included 603 on health promotion (including programs on tobacco, alcohol, violence, and mental health), 162 on health protection (including programs on unintentional injuries, food and drug safety, and environmental health), and 733 on preventive services (acquired immune defeciency syndrome, cancer, infectious diseases, maternal and infant health, and policy issues affecting Hispanics). The show has been used successfully to recruit women for preventive health services and cancer clinical trials. Radio should be considered a tool for reaching special populations with health promotion and disease prevention messages. Cancer 1998;83:1805-1808. © 1998 American Cancer Society.

Cause and Manner of Death in Fatalities Involving Methamphetamine

We reviewed a series of deaths in which methamphetamine was detected in the decedent's blood. Analysis of postmortem whole blood was performed by gas chromatography/mass spectrometry with a limit of quantitation of 0.05 mg/L. Methamphetamine was detected in 146 cases; 52 were drug caused, i.e., a death in which the direct toxic effects of the drug caused or contributed to the death, 92 were classified as drug related, i.e., a death in which the drug was demonstrated in the blood, but did not directly cause death. A large proportion of the deaths resulted from homicidal (27%) or suicidal (15%) violence. An examination of methamphetamine concentrations in drug related deaths (n = 92), suggests that the range of concentrations in the recreational abusing population is substantial (0.05-9.30 mg/L) but with a median concentration of 0.42 mg/L, and with 90% of that population having concentrations less than 2.20 mg/L. There was substantial overlap in methamphetamine concentration between drug related deaths and drug caused deaths, although the highest concentrations were seen in the unintentional (accidental or undetermined) drug caused deaths. Methamphetamine related traffic deaths (n = 17) showed patterns of driving behavior consistent with reports elsewhere, and showed blood methamphetamine concentrations ranging from 0.05-2.60 mg/L (median 0.35 mg/L). The data show that most methamphetamine deaths occur with blood concentrations greater than 0.5 mg/L, but can occur with levels as low as 0.05 mg/L, though usually in conjunction with other drugs or significant natural disease. Neither apparently toxic nor therapeutic concentrations should be used in isolation to establish conclusively whether a death was caused by methamphetamine; proper classification of deaths involving methamphetamine requires complete death investigation, including investigation of the scene and circumstances of death, and a complete autopsy.

Drug Poisoning in Older Patients

Children under 6 years of age are involved in the majority of poisonings. However, the elderly are more likely to require hospitalisation and to die from poisonings compared with younger individuals. Drugs play an important role in the poisoning exposures of older patients. Analgesics, cardiovascular medications, theophylline preparations and antidepressants and other psychotropic medications are most commonly implicated in drug poisoning fatalities in elderly Americans. Careful review of information which characterises drug poisonings in the elderly is essential to the development of effective preventative strategies. Most poison centre calls for elderly patients involve accidental exposures. The ingestion of extra doses of medications because of forgetfulness, mistaken identity of medications, incorrect route of administration, and improper storage of medications are among the the primary reasons for unintentional drug poisonings in older patients. A model for injury control composed of 3 phases can be applied to poison exposures in the elderly: activities in the pre-event phase focus on prevention; it should occur; the post-event phase is directed at appropriate management to reduce the consequence of injury from poison exposure once it occurs. The general management of drug poisonings is similar in older and younger patients. However, management in the elderly is complicated by difficulties in the diagnosis of drug poisoning, pharmacokinetic and pharmacodynamic changes associated with aging, increased incidence of chronic illness, and increased medication with the potential for clinically significant drug interactions. Aggressive initial treatment is imperative because the elderly are generally more susceptible to the toxic effects of drugs.

China white epidemic: An eastern united states emergency department experience

The purpose of this study was to isolate significant clinical or demographic findings concerning overdose patients treated during a China White (3-methyl fentanyl) epidemic and compare them with data for all unintentional narcotic overdose patients during a 24-month period. We reviewed charts from 85,246 patient visits to our emergency department during the 24-month period of January 1987 through December 1988 to study this narcotic epidemic. Data from the Allegheny County Coroner's Office pertaining to unintentional drug overdose deaths that occurred during this same period also were reviewed. The first outbreak of narcotic overdoses in the eastern United States involving China White occurred in Allegheny County, Pennsylvania, in 1988. Patients were included if they met the criteria of a suspected unintentional narcotic overdose, but excluded if they were not given naloxone. Emergency physicians became suspicious of China White use after an unusual increase in narcotic overdoses presenting to the ED coupled with "routine drug of abuse" screens negative for opiates despite dramatic patient responses to naloxone. In most of the cases in which specific testing was done, there were positive indicators of fentanyl derivatives. Investigations found China White present in street drugs and paraphernalia. A cluster was defined as a time period with a statistically significant increase in overdoses over the expected number for an interval of equal length. Although there were no significant clinical differences in case presentation during the 24-month period, there was a statistically significant 13-fold increase in overdoses during the September through November 1988 cluster (mean, 13 vs 0.95 per month, P less than .001 by Wilcoxon rank-sum test). A dramatic increase in unintentional drug overdose deaths occurred in the county during this cluster. A total of 18 fentanyl-positive unintentional drug overdose deaths, predominantly male (89%) and black (56%), with an age range of 19 to 44 years (mean, 34.9 years), were reported by the county coroner (13 during the cluster). Narcotic overdoses and unintentional drug overdose deaths declined sharply with confiscation of a clandestine China White laboratory. China White was responsible for a dramatic rise in unintentional drug overdose deaths in Allegheny County in 1988. There were no significant clinical differences between China White overdose survivors and other unintentional narcotic overdose victims. Overdoses responsive to naloxone with inconsistent routine toxicologic screens may be due to a fentanyl analogue.

Recent trends in fatal poisoning by opiates in the United States.

Deaths in the United States classified as unintentional poisoning by drugs and medicaments fell from 14.7 per million population in 1975 to 8.8 in 1978, a 40 per cent decrease. Seventy-three per cent of this drop attributable to a reduction in deaths coded to opiates and intravenous narcotism. These two categories accounted for 38 per cent of all unintentional drug deaths in 1975 but only 15 per cent in 1978. There was no simultaneous increase in other drug-related deaths, including suicides, to account for the reduction in deaths coded to opiates. The highest mortality rates and the greatest variation in mortality during 1970-78 occurred in 20-29 year old non-White males. Racial and sex differences in opiate poisoning mortality, notable early in the decade, were greatly reduced by 1978 due to a relatively larger decline in mortality of males and non-Whites. Time trends in mortality from opiate poisoning appear to coincide with variations in the amount of heroin smuggled into the country.