Review of Deaths Related to Analgesic- and Cough Suppressant-opioids; England and Wales 1996-2002

Schifano, Fabrizio; Zamparutti, G.; Zambello, F.; Oyefeso, Adenekan; Deluca, Paolo; Balestrieri, Matteo; Little, D.; Ghodse, A. Hamid

doi:10.1055/s-2006-949149

Cited by 16 publications

(14 citation statements)

References 27 publications

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“…The instructions probably contributed to the high reliability of the OD item and its ability to consistently distinguish unintentional from intentional ODs, and are consistent with recommendations to carefully distinguish these outcomes in research on opiate abusers (Bohnert et al, 2010). These findings also suggest that unintentional and intentional ODs are indeed distinct events with unique causes and correlates (Heale et al, 2003; Neale, 2000; Pfab et al, 2006), which may extend to fatal unintentional and intentional ODs (Darke, Duflou, & Torok, 2010; Schifano et al, 2006). …”

Section: Discussionmentioning

confidence: 68%

A procedure that differentiates unintentional from intentional overdose in opioid abusers

Britton

Bohnert

Wines

et al. 2012

Addictive Behaviors

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Objective The purpose of this study is to develop a procedure for assessing unintentional overdose (OD) in opiate abusers that differentiates it from intentional OD, and provides reliable information about the incident. Methods A sample of 121 patients in a methadone maintenance program at an urban university hospital completed a baseline assessment. A total of 70 participants completed an identical assessment at least 14 days later. The ability of an OD item to differentiate unintentional OD from intentional OD was tested, as was the test-retest reliability of questions assessing symptoms and treatment of OD. Results The procedure differentiated unintentional OD from intentional OD, and is reliable. Questions assessing symptoms of OD were endorsed in almost every unintentional OD incident, although reliability was affected by loss of consciousness. The reliability of questions assessing emergency treatment and Narcan administration was outstanding. Conclusions Our procedure for assessing OD differentiates unintentional OD from intentional OD. The use of follow-up questions assessing acute treatment for OD is recommended. Items concerning symptoms of OD are not needed to confirm the presence of an OD, but may be used to clarify whether an event was an OD.

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Section: Discussionmentioning

confidence: 68%

A procedure that differentiates unintentional from intentional overdose in opioid abusers

Britton

Bohnert

Wines

et al. 2012

Addictive Behaviors

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“…Antidepressants have been frequently reported as a major means of self‐poisoning over the years [39, 40]. The use of paracetamol was also frequently identified in intentional death victims, with its use for suicidal purposes being a well‐known phenomenon in the UK [22, 41, 42].…”

Section: Discussionmentioning

confidence: 99%

“…In our sample, information on the prescribing of DHC to the deceased was only available for about 45% of cases, therefore it is likely that it was illicitly obtained in over a half of cases. In the UK it seems that DHC, similarly to remaining opiate/opioid analgesics [22], is most likely obtained illicitly from friends/relatives or from the streets [10] rather than from Internet websites. These victims were instead more frequently prescribed with methadone and non‐prescribed hypnotic/sedatives were also more likely identified at post‐mortem.…”

Section: Discussionmentioning

confidence: 99%

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Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007

Zamparutti

Schifano

Corkery

et al. 2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Dihydrocodeine (DHC) is an opioid analgesic sometimes prescribed as an alternative to other medications (e.g. methadone and buprenorphine) for opioid misuse. Its effectiveness is, however, still controversial. • DHC prescription rates seem to be related to levels of DHC fatalities, possibly in relation to levels of disregard of the availability of supervised or interval dispensing of opioids, but no large‐scale analysis of DHC fatalities has been carried out. • We analysed here involvement of DHC in fatalities that occurred between 1997 and 2007 among individuals with a history of opiate/opioid misuse reported to the National Programme on Substance Abuse Deaths (np‐SAD). WHAT THIS STUDY ADDS • DHC, either alone or in combination, was identified in 584 fatalities. Typical cases identified were males in their early thirties. In accidental overdoses, DHC, which had been prescribed to 45% of the victims, was typically identified in combination with other drugs, such as heroin/morphine, methadone and hypnotics/sedatives. Both paracetamol and antidepressants were more typically identified in combination with DHC in suicides. • Opiate/opioid misusers should be educated about risks associated with polydrug intake and prescribers should carefully consider a pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. AIMS Although its effectiveness is somewhat controversial, it appears that dihydrocodeine (DHC) is still prescribed in the UK as an alternative to both methadone and buprenorphine for the treatment of opiate addiction. METHODS Data covering the period 1997–2007 voluntarily supplied by coroners were analysed. All cases pertaining to victims with a clear history of opiate/opioid misuse and in which DHC, either on its own or in combination, was identified at post‐mortem toxicology and/or implicated in death, were extracted from the database. RESULTS Dihydrocodeine, either alone or in combination, was identified in 584 fatalities meeting the selection criteria. In 44% of cases it was directly implicated in the cause of death. These cases represented about 6.8% of all opiate/opioid‐related deaths during this period. Typical DHC cases identified were White males in their early thirties. Accidental deaths (96%) were likely to involve DHC in combination with other psychoactives, mainly heroin/morphine, hypnotics/sedatives and methadone. Both paracetamol and antidepressants were found in proportionately more suicide cases than in accidental overdoses. DHC had been prescribed to the decedent in at least 45% of cases. CONCLUSIONS Opiate/opioid misusers should be educated about risks associated with polydrug intake. More in particular, co‐administration of DHC with heroin, methadone and benzodiazepines may increase the risk of accidental fatal overdose. Prescribers should carefully consider pharmacological intervention alternative to DHC (e.g. methadone, buprenorphine) when managing and treating opiate addiction. Mo...

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“…INCREASING CLINICAL USAGE of opioid analgesics has led to an escalation of accidental death due to opioid respiratory depression (39,66,83). It is unclear which neural loci are responsible for respiratory depression because of the vast complexity of interactions and compensatory responses in the neural networks participating in respiration and responding to opioids (31,58).…”

mentioning

confidence: 99%

Opioid microinjection into raphe magnus modulates cardiorespiratory function in mice and rats

Hellman¹,

Mendelson

Mendez-Duarte³

et al. 2009

American Journal of Physiology-Regulatory, Integrative and Comp

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The raphe magnus (RM) participates in opioid analgesia and contains pain-modulatory neurons with respiration-related discharge. Here, we asked whether RM contributes to respiratory depression, the most prevalent lethal effect of opioids. To investigate whether opioidergic transmission in RM produces respiratory depression, we microinjected a mu-opioid receptor agonist, DAMGO, or morphine into the RM of awake rodents. In mice, opioid microinjection produced sustained decreases in respiratory rate (170 to 120 breaths/min), as well as heart rate (520 to 400 beats/min). Respiratory sinus arrhythmia, indicative of enhanced parasympathetic activity, was prevalent in mice receiving DAMGO microinjection. We performed similar experiments in rats but observed no changes in breathing rate or heart rate. Both rats and mice experienced significantly more episodes of bradypnea, indicative of impaired respiratory drive, after opioid microinjection. During spontaneous arousals, rats showed less tachycardia after opioid microinjection than before microinjection, suggestive of an attenuated sympathetic tone. Thus, activation of opioidergic signaling within RM produces effects beyond analgesia, including the unwanted destabilization of cardiorespiratory function. These adverse effects on homeostasis consequent to opioid microinjection imply a role for RM in regulating the balance of sympathetic and parasympathetic tone.

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Review of Deaths Related to Analgesic- and Cough Suppressant-opioids; England and Wales 1996-2002

Abstract: The present report constitutes the largest available collection of analgesic- and cough suppressant-opioid mortality data in the UK. Users should be educated about risks associated with polydrug misuse.

Cited by 16 publications

References 27 publications

A procedure that differentiates unintentional from intentional overdose in opioid abusers

A procedure that differentiates unintentional from intentional overdose in opioid abusers

Deaths of opiate/opioid misusers involving dihydrocodeine, UK, 1997–2007

Opioid microinjection into raphe magnus modulates cardiorespiratory function in mice and rats

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