Prevalence and Characteristics Associated with Chronic Noncancer Pain in Suicide Decedents: A National Study

Campbell, Gabrielle; Darke, Shane; Degenhardt, Louisa; Townsend, Harriet; Draper, Brian; Farrell, Michael; Duflou, Johan; Lappin, Julia

doi:10.1111/sltb.12627

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…Related to this was the high rate of chronic pain. This is to be expected in a series of cases using a drug prescribed for moderate to severe pain, but it must be borne in mind that chronic pain is in itself an independent risk factor for suicide [37,38].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of fatal tapentadol‐related toxicity in Australia

Darke

Duflou

Peacock

et al. 2022

Drug and Alcohol Review

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Introduction. Tapentadol is a centrally acting opioid analgesic prescribed for the treatment of moderate to severe pain. The study aimed to determine the characteristics of Australian toxicity deaths related to tapentadol. Methods. All cases in which tapentadol use was coded contributory to death (n = 159) were retrieved from the National Coronial Information System (1 July 2000-31 December 2020). Results. The mean age was 48.5 (18-81) and 56% were female. Documented histories of problems with chronic pain (66%), mental health (60.4%), substance use (44%) and injecting drug use (23.3%) were common. The majority of deaths were deemed unintentional (76.1%) and in 18.9% pre-existing disease was co-contributory. The median peripheral blood tapentadol concentration was 1.00 mg L À1 (0.02-47.00), and the median aortic concentration was 2.05 mg L À1 (0.10-30.00). In all cases, psychoactive drugs other than tapentadol were also detected, most commonly antidepressants (72.3%), opioids (66.7%), hypnosedatives (64.2%) and gabapentinoids (43.4%). Of cases where autopsies were conducted, 27.7% were diagnosed with cardiomegaly and 18.5% with severe coronary artery stenosis. Pulmonary oedema (68.1%), aspiration of vomitus (39.5%) and acute pneumonia (26.9%) were common. Discussion and Conclusions. The typical tapentadol-related toxicity death involved unintentional death in the presence of multiple drugs, although a notable minority were intentional self-harm. Multiple morbidities were common. The identification and characteristics of these cases indicate that the adverse event profile of tapentadol needs to be considered in the setting of polypharmacy.

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Section: Discussionmentioning

confidence: 99%

Characteristics of fatal tapentadol‐related toxicity in Australia

Darke

Duflou

Peacock

et al. 2022

Drug and Alcohol Review

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“…sensitization [38] [39]. They may lead to development of depression [40], anxiety, overuse of opioid analgesics with the risk of dependence and toxicity [41] and increase the risk of suicide [42].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Inpatient Ketamine Subanaesthetic Dose Infusion in Chronic Refractory Pain

Tay¹,

Hollins²,

Teo³

et al. 2021

PST

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Background: Inpatient subanaesthetic ketamine infusion for 5 days may improve pain and reduce oral opioid usage in patients with chronic pain. Objective: This study aims to investigate pain and psychological outcomes of ketamine parenteral infusion (0.1 -0.35 mg/kg/h or maximum 24 mg/hour) for 5 days in patients with chronic refractory pain. The secondary objective is to explore any prognostic pain and psychological factors associated with the successful response to the ketamine treatment. Methodology: A prospective longitudinal study of a small cohort (N = 35) of patients with heterogenous chronic refractory pain conditions was conducted from one week to two months follow-up. Results: Pain Severity was significantly improved from mean 6.5 to 5.

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“…In interpreting this finding it was notable that more than a quarter had antidepressants present in their blood at the time of death, and in recent years ketamine has been prescribed for the treatment of retractile depression. Chronic pain, for which ketamine may also be prescribed, was documented in six cases, and it must be borne in mind that chronic pain is an independent risk factor for suicide [31,32]. Traumatic accidents comprised fewer than 10% of cases.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and circumstances of death related to the self‐administration of ketamine

et al. 2020

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Background and aims Ketamine is used for anaesthesia, sedation and the treatment of mood disorders, but is also widely used for non‐medical purposes. This study aimed to: (1) determine the characteristics and circumstances of all recorded cases of self‐administered ketamine‐related death in Australia, 2000–19 and (2) determine the toxicology and major organ pathology of cases. Design Retrospective study of all Australian cases in which self‐administered ketamine was a mechanism contributory to death, retrieved from the National Coronial Information System. Setting Australia‐wide. Cases Sixty‐eight cases, with a mean age of 35.2 years (standard deviation = 11.5, range = 16–63), 76.5% male. Measurements Information was collected on cause of death, demographics, circumstances of death, toxicology and major organ pathology. Findings Death was attributed to toxicity in 82.3% of cases (accidental, 58.8%; deliberate, 23.5%), suicide by violent means (8.8%) and traumatic accident (8.8%). In six cases the decedent had been prescribed ketamine. In 32.4% the final route of ketamine administration was by injection. The fatal incident predominantly occurred in a private environment (72.1%). Ketamine was present in the blood of 90.1% and other biomarkers in the remainder. The median blood ketamine concentration was 0.2 mg/l (0.02–6.9 mg/l). Other drugs were detected in 95.5% of cases: opioids (59.1%), hypnosedatives (57.6%), psychostimulants (50.0%), alcohol (27.3%), Δ‐9‐tetrahydrocannabinol (18.2%), antidepressants (28.8%) and antipsychotics (9.1%). Pulmonary oedema was present in 82.2% of cases that underwent autopsy and pneumonia in 26.7%. Conclusions The typical case of self‐administered ketamine‐related death in Australia, 2000–19, was a male in his mid‐30s who had used multiple drugs, with the fatal incident most commonly occurring in a private setting. Death due to accidental drug toxicity was the most common manner of death, but suicide was highly prevalent.

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Prevalence and Characteristics Associated with Chronic Noncancer Pain in Suicide Decedents: A National Study

Cited by 13 publications

References 30 publications

Characteristics of fatal tapentadol‐related toxicity in Australia

Characteristics of fatal tapentadol‐related toxicity in Australia

A Prospective Study of Inpatient Ketamine Subanaesthetic Dose Infusion in Chronic Refractory Pain

Characteristics and circumstances of death related to the self‐administration of ketamine

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