Change in Access to Prescribed Medication following an Episode of Deliberate Self-Poisoning: A Multilevel Approach

Abstract

ObjectivePatients with a history of deliberate self-poisoning (DSP) are prescribed a greater amount of medication than the general public. DSP is the most robust risk factor for repeat episodes of DSP and subsequent death by suicide, and one might therefore expect that access to prescribed medication would be reduced following an episode of DSP. However, it is unclear whether access to prescribed medication changes after an episode of DSP. The objectives of this study were to investigate changes in 1) overall, psychotropic, non-psychotropic and the psychotropic subgroup antidepressant prescribed medication availability in DSP patients following an episode of DSP, 2) prescribing of the medication ingested in the episode, and 3) potential effects of gender, age and repeater status on such change.MethodsThe design was longitudinal. We included 171 patients admitted for DSP between January 2006 and March 2007. Data on patients' prescriptions prior to admission were retrieved from The Norwegian Prescription Database. The outcome measure was the difference between medication load in the year following compared to the year prior to the DSP episode.ResultsThere was a significant increase in total medication load following DSP, including both psychotropic and non-psychotropic medication. Antidepressant medication load remained stable. There was a tendency for access to drugs ingested in the episode to increase following the episode, albeit not significantly. Medication load increased with age across all medication groups irrespective of time period and gender.ConclusionsThe findings show that physicians do not curb prescribing to patients who have recently deliberately self-poisoned. Moreover, they highlight the need for cautious and judicious prescribing for these patients, in combination with psychological and social interventions.

Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial

“…In a Norwegian study of the same population, although with a different design, the researchers were allowed to obtain information about those who did not participate. They found no significant difference according to gender, but a higher age in the non-participation group [ 30 ].…”

“…Third, the findings cannot be generalised as applying to patients with higher risk of further suicidal behaviour, such as patients admitted to psychiatric inpatient care [ 29 ], those with no fixed abode [ 30 ], and DSH patients using violent methods [ 31 – 33 ].…”

Microbial forensics: new breakthroughs and future prospects

“…In high-income countries, the consumption of antidepressant drugs is significantly increasing, with the collateral risks of producing addiction or increasing the risk of self-poisoning (Gjelsvik et al 2014;Löfman et al 2017). In MF, it is important to bear in mind that while some antidepressant drugs (e.g., amitriptyline, doxepin, fluoxetine, imipramine) present stable concentrations, others (e.g., dothiepin, phenelzine, tranylcypromine) are known to be degraded during cadaver putrefaction due to microbial activity (Butzbach 2010;Caddy and Stead 1978;Garcia-Pardo et al 2018;Kwon and Monden et al 2018;Pounder et al 1994;Stevens 1984;Yonemitsu and Pounder 1993).…”

Prescribers aware: a cross-sectional study from New Zealand emergency departments on the substances used in intentional self-poisoning and their sources

“…This risk needs to be balanced with patients' convenience of access to medicines they need for successful pharmacotherapy. 7,8 The aim of this study was to identify the most common substances used in intentional selfpoisoning, and to investigate the sources of these agents. This study was conducted to contribute to drug policy discussions and to inform prescribers and public health agencies of self-poisoning behaviours in New Zealand.…”