Trends in drug poisoning deaths, by sex, in Ireland: a repeated cross-sectional study from 2004 to 2017

Abstract

ObjectiveTo examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017.DesignRepeated cross-sectional study.SettingDrug poisoning deaths in Ireland.ParticipantsNational Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017.Outcome measuresThe primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) ≥2 CNS depressants and (3) specific drugs/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004–2017), change points over time and average annual percentage changes (AAPCs) with 95% CI.ResultsIncreased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100 000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100 000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving ≥2 CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95% CI 2.2 to 13.6), benzodiazepines (7.2%, 95% CI 2.9 to 11.6), antidepressants (6.1%, 95% CI 2.4 to 10.0) and prescription opioids (3.5%, 95% CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95% CI 0.2 to 8.3), benzodiazepines (3.3%, 95% CI 0.1 to 6.5) and prescription opioids (3.0%, 95% CI 0.7 to 5.3).ConclusionDrugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.

The impact of the Celtic Tiger and Great Recession on drug consumption

“…While Windle's (2018) hypothesis has been partly supported by other observations (Cusack, 2009;Lally, 2010Lally, , 2011Lynn et al, 2021) the lack of specificity in Gardaı ŕecorded drug offence data limits more sophisticated analyses and fails to differentiate between drugs used [2]. Furthermore, recorded crime data is simply an indication of the number of offences known to An Garda Sı ´och ana, and the offences the Gardaı ´choose to record, so may more accurately be framed as "records of decisions" rather than true reflection of possession (Bottomley and Pease, 1994, p. 169;Windle et al, 2022), if such an outcome is even possible.…”

Consensus recommendations for opioid agonist treatment following the introduction of emergency clinical guidelines in Ireland during the COVID-19 pandemic: A national Delphi study

“…An assessment of the impact of increased take-away doses is required in Europe, as the EMCDDA recently reported concern regarding diversion and misuse of OAT medications in Europe, evidenced by an increase in the demand for specialized treatment related to the misuse of OAT medications, and the number of deaths associated with these medications over the past 10 years ( EMCDDA, 2021 ). For example, the most recent analysis of drug-poisoning deaths in Ireland identified an increase in drug poisoning deaths involving methadone between 2004 and 2017, with 48% of deaths involving methadone occurring in people who were not registered on the national OAT treatment register ( Lynn, Cousins, Lyons, & Bennett, 2021 ).…”

Examining the gender dimension in the non-medical use of over the counter and prescription only medication

“…This is extremely relevant given that physiological differences mean that pharmacological studies skewed towards men may not provide adequate evidence of efficacy, adverse outcomes or risk-benefit ratios for women (Meyer et al, 2019). Relatively few studies examining non-medical use of OTC/POM include comparative samples of women or gender stratification (Lynn et al, 2021) and is especially lacking regarding individuals who do not identify with traditional gender roles. When the focus has been on women, it has been on child-bearing years and connected with child welfare or pregnancy (Brady and Lydiard, 2021).…”

“…While there is an acknowledged shortfall in detailed epidemiological data on gender differences in drug related deaths worldwide, trends indicate that the rate amongst women has risen more steeply than amongst men (Lynn et al, 2021). A systematic review of transnational trends in non-medical use of prescription medications suggests that it is a major problem among women of all age groups worldwide, disputing the myth that the primary correlates are being male and/or younger (Peteet, 2019).…”

“…A systematic review of transnational trends in non-medical use of prescription medications suggests that it is a major problem among women of all age groups worldwide, disputing the myth that the primary correlates are being male and/or younger (Peteet, 2019). A worldwide scoping review indicates a gender difference in the medicines involved, and prescribed opioids and benzodiazepines predominate as causative agents in the death of women (Lynn et al, 2021). There are also higher rates of prescribing amongst women for medication associated with dependency and withdrawal (Goetz et al, 2021; Henricson et al, 1999; Marsden et al, 2019; PHE, 2019; Simoni-Wastila, 2000).…”