Review of deaths related to analgesic- and cough suppressant-opioids; England and Wales 1996-2002.

OBJECTIVE: The data on England and Wales voluntarily supplied by Coroners to the National Programme on Substance Abuse Deaths for the August 1996-December 2002 time frame were analyzed. METHODS: All cases in which at least one analgesic- and cough suppressant-opioid other than heroin/morphine, methadone or buprenorphine was identified were extracted from the database. We hypothesized that: a) populations of addicts and non-addicts presented differences in patterns of drugs involved; and b) within the population of addicts and non-addicts, intentional and non-intentional deaths presented different patterns of substance consumption. RESULTS: A total of 2024 deaths related to selected opioids, either alone or in combination, were included in the analysis. Typically, non-addicts were older than 45 and died as a result of intentional poisoning whilst majority of addicts were young, males and victims of accidental deaths. In about 93% of cases the selected opioids were reported in combination with another substance. Most frequently identified narcotics were propoxyphene, codeine and dihydrocodeine. Co-proxamol, Co-codamol and Co-dydramol were typically prescribed for non-addicts, whilst dihydrocodeine was mostly given to addicts. In non-addicts, alcohol was mostly represented in accidental deaths and antidepressants were typically represented in intentional deaths. Conversely, illicit drugs and hypnotics/sedatives were typically reported in addicts' accidental deaths. CONCLUSIONS: 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.

Death rates from ecstasy (MDMA, MDA) and polydrug use in England and Wales 1996-2002.

The present study reports on all deaths related to taking ecstasy (alone, or in a polydrug combination) occurring in England and Wales in the time frame August 1996-April 2002. Data presented here are based on all information recorded in the National Programme on Substance Abuse Deaths (np-SAD) database. The np-SAD regularly receives all information on drug related deaths in addicts and non addicts from coroners. A total of 202 ecstasy-related fatalities occurred in the chosen time-frame, showing a steady increase in the number of deaths each year. The ratio male:female was 4:1 and 3 of 4 victims were younger than 29. In 17% of cases ecstasy was the sole drug implicated in death and in the remaining cases a number of other drugs (mostly alcohol, cocaine, amphetamines and opiates) have been found. According to toxicology results, MDMA accounted for 86% of cases and MDA for 13% of cases; single deaths were associated with MDEA and PMA. This is the largest sample of ecstasy related deaths so far; possible explanations are given for the observed steady increase in ecstasy-related deaths and a tentative 'rationale' for this polypharmacy combination is then proposed.

Fatal antidepressant overdose among drug abusers and non-drug abusers.

OBJECTIVE: This study examined the predictors, extent and pattern of fatal antidepressant overdose (FAO) in all psychoactive drug-related deaths and compared these in drug abusers and non-drug abusers. METHOD: Inquest data on 491 psychoactive drug-related cases in England and Wales were analysed. We examined predictors of FAO relative to other drug-related deaths in drug abusers and non-abusers using logistic regression, and compared the relative fatality of different antidepressant classes using the Proportionate Fatality Index (PFI). RESULTS: The overall FAO prevalence ratio was 10% (male = 7.1%, female = 18.5%). FAO was twice as likely to occur among cases aged 45 years and over than in younger cases (MOR = 2.6, 95% CI = 1.4-4.9), and eight times more likely to occur in cases with no history of drug abuse (MOR = 8.2, 95% CI = 4.0-18.4). Ingestion of prescribed antidepressants is the only common predictor of FAO among drug abusers and non-abusers, and co-ingestion of a combination of antidepressants of two different classes is a potent risk for FAO in the cases studied. CONCLUSION: The results highlight the need to develop appropriate therapeutic strategies for managing treatment-resistant depression.

Methadone-related deaths: data from 18 coroners' jurisdictions in England.

This paper examines the methadone-related deaths (MRD) among entire cases of inquest on drug-related cases in 18 coroners' jurisdictions in England which were entered on the National Programme on Substance Abuse Deaths during a six-month period in 1997. In 154 deaths methadone, either prescribed or not prescribed, was reported to be the substance directly implicated in the death of 40 individuals. The MRD between the prescribed and non-prescribed cases were compared in respect to various demographic variables and associated risks. The main findings reported are that the majority of deaths in this sample were in cases where methadone had not been prescribed (72%) and that there was a significant difference in age between the methadone prescribed (median = 22 years) and non-prescribed groups (median = 37 years) (Mann-Whitney U = 57.5, p = 0.01). Also significant differences amongst the two groups in respect of the coroners' verdicts are reported. The authors suggest more stringent controls around the prescription and dispensing of methadone, along with measures to alert the population at risk of the hazards of using methadone in a non-controlled fashion.

Drug abuse-related mortality: a study of teenage addicts over a 20-year period.

BACKGROUND: There is growing concern about increase in illicit drug use and associated fatalities in young people. METHOD: This longitudinal analysis of successive cohorts of addicts in England and Wales aged 15-19 years followed up over a 20-year period covering 1974 to 1993 (1) investigated trends in all-causes mortality; (2) examined teenage-specific mortality, i.e. deaths during ages 15-19 years; (3) determined excess teenage-specific mortality; and (4) identified the main underlying causes of teenage-specific death in this population. The main outcome measures were overall mortality rates, teenage-specific mortality and standardised mortality ratios calculated for four 5-year (period) successive cohorts. RESULTS: Overall mortality rate in the study population (N = 9491) was 4.7/1000 person-years. The median age at death was 23 years (semi interquartile range = 3), with the majority (91.3%) of deaths occurring between ages 15 and 29 years. Excess teenage-specific mortality in the population was 10.7 in males and 21.2 in females (general population = 1), and increase in excess mortality in both sexes was evident in the last 5-year period of study. The majority of deaths (64.3%) resulted from accidental poisoning. Methadone and heroine/morphine accounted for about two-thirds of accidental poisoning deaths, while suicide accounted for 11.4% of teenage-specific deaths. CONCLUSIONS: It is strongly recommended that treatment services should be more responsive to the need for careful prescribing, dispensing and administration of substitute medication to teenage addicts in their care. The development of needs-led, case-sensitive treatment services for young addicts is indicated.

Suicide among drug addicts in the UK.

BACKGROUND: The extent of suicide among addicts in the UK has not been sufficiently examined. AIMS: To examine suicide trends among registered addicts in the UK over a 25-year period. METHOD: We quantified suicide using International Classification of Diseases (ICD) external death codes E950-959, calculated annual age-standardised suicide rates, standardised mortality ratios (SMRs) and described trends in methods of suicide and drug overdose suicides in five successive cohorts of registered addicts. RESULTS: Male and female suicide rates are 69.0 and 44.8 per 100,000 person-years, respectively. There was a consistent decline in suicide rate throughout the 25-year period. Among males, the SMR for suicide declined from 17.2 in 1968-1972 to 4.4 in 1988-1992 (SMR ratio = 3.9, 95% CI = 2.5-6.1); among females it declined from 52.6 to 11.3 in the same period (SMR ratio = 4.7, 95% CI = 1.9-10.8). Drug overdose was the most common method of suicide, accounting for 45% of cases. Significant increase in antidepressant (percentage difference = 23.5%, 95% CI = 15.2-31.8) and methadone (percentage difference = 11.0%, 95% CI = 0.5, 21.5) overdose in 1988-1992 compared with 1968-1972 was reported. CONCLUSIONS: The findings confirm that addicts are still at higher risk of suicide than the general population and that prescribed drugs, notably antidepressants and methadone, influence this heightened risk.

"Saturday night fever": ecstasy related problems in a London accident and emergency department.

OBJECTIVES: To report on the extent and nature of acute MDMA (ecstasy) related problems presenting to a large London hospital's accident and emergency (A&E) department. METHOD: The computerised attendance records for all patients attending the A&E department over a 15 month period were retrospectively screened. Potential cases thus identified had their case notes systematically reviewed to confirm the history of MDMA use and to extract other relevant data. RESULTS: Forty eight consecutive MDMA related cases were identified. All were in the 15-30 year age group with the majority presenting in the early hours at weekends and having consumed the drug at a night club. The mean number of tablets consumed was two and almost 40% had taken MDMA before. Polydrug use was common with half of the sample having concurrently taken another illicit substance--most commonly other stimulants (amphetamines and cocaine). A wide range of adverse clinical features was found. The most common symptoms were vague and non-specific such as feeling strange or unwell, however many patients had collapsed or lost consciousness. The most common signs elicited were related to sympathetic overactivity, agitation/disturbed behaviour, and increased temperature. The more serious complications of delirium, seizures, and profound unconsciousness (coma) were commoner when MDMA was used in combination with other substances. CONCLUSIONS: For young adults presenting late at night at weekends and exhibiting symptoms of sympathetic overactivity, disturbed behaviour, and increased temperature ("Saturday night fever") the use of stimulant dance drugs especially MDMA should be suspected. As MDMA use does not appear to occur in isolation, the clinical picture is likely to be complicated by multiple rather than single drug ingestion. This poses increased diagnostic and management challenges for A&E staff who typically represent the front line response to dance drug related problems.

Mortality of drug addicts in the United Kingdom 1967-1993.

BACKGROUND: Mortality in specified clinical populations has often been regarded as a measure of treatment effectiveness. This study examined time trends in mortality of drug addicts in the UK notified to the Home Office over a 27-year period. METHODS: The study was a longitudinal analysis of routine mortality data of a population of newly notified addicts from 1967 to 1993. Altogether, 92 802 addicts were newly notified during the study period, and they accounted for 687 673 person-years of observation. The main outcome measures were age-specific all-causes mortality; drug-related mortality; and age- and sex-specific standardized mortality ratios (SMR) 1967-1993. RESULTS: There were significant differences in death rates between the periods 1967-1976 (19/1000 person-years) and 1984-1993 (10.5/1000 person-years). Excess deaths were significantly higher among the 1967-1976 cohorts than in the 1984-1993 cohorts (SMR ratio = 1.80, 95% CI: 1.64-1.97). The majority of deaths were drug-related, with those aged <45 years more likely to die of a drug-related cause than those older (OR = 6.29, 95% CI: 4.97-7.96). CONCLUSIONS: It appears that service provision has some impact on all-causes mortality among opiate addicts. As services improved, there was a corresponding decline in mortality rates during the study period. Further preventive measures, however, should be devised to reduce drug-related deaths.

Developing a quality of care index for outpatient methadone treatment programmes.

This article describes the development and evaluation of a psychometric instrument for assessing quality of care in outpatient methadone substitution therapy (MST) programmes. The instrument, termed the Quality of Care Index-1 (QCI-1), is a seven-item scale evaluated in two studies. Its psychometric properties are consistently acceptable across both studies. The QCI-1 reveals three distinct quality criteria relevant to the condition of the patients in methadone treatment. These are drug use hygiene, sharing of injecting equipment and partner's drug use status.

Subjective sleep-wake parameters in treatment-seeking opiate addicts.

We investigated subjective sleep parameters and sleep difficulties of opiate addicts undertaking methadone detoxification and identified their sleep profile. Using the St Mary's Sleep Questionnaire, we compared the subjective sleep parameters of 27 consecutively consenting patients (16 males, 11 females) with a mean age of 33 years (S.D. = 7.5) undertaking in-patient methadone detoxification with those of 26 drug-free controls (9 males, 17 females) with a mean age of 35 years (S.D. = 8.0). Our findings reveal that subjective sleep parameters of opiate addicts and controls are quantitatively and qualitatively different. The patients are more likely than controls to report difficulty initiating sleep (OR = 5.42; 95% CI = 1.43, 20.47); difficulty maintaining sleep (OR = 16.50; 95% CI = 3.81, 71.47); inadequate sleep quality (OR = 8.56; 95% CI = 2.04, 35.81); and inadequate sleep quantity (OR = 9.00; 95% CI = 2.49, 32.57).

Attitudes towards the work behaviour of ex-mental patients in Nigeria.

Attitudes towards the work behaviour of ex-mental patients were examined in a random sample of 480 senior federal civil servants in Nigeria. The results revealed: pervasive negative attitudes towards ex-mental patients and their work behaviour; inadequate provision for the needs of ex-mental patients by government; lack of awareness of and/or non-existence of welfare policies for rehabilitating ex-mental patients; and a need for a social welfare policy to cater for ex-mental patients in the workplace.

The need for substance misuse education in health studies curriculum: a case for nursing education.

The sharp increase, in recent years, in the use and misuse of psychoactive substances necessitates greater involvement of non-specialist health care workers in the management of problems associated with substance misuse. The need to expand the health studies curriculum in line with current trends in substance use and misuse is recommended.

Psychological adjustment of Yoruba adolescents as influenced by family type: a research note.

This research examines the influence of family type on the psychological adjustment of Yoruba adolescents. Using a sample of 116 adolescents, 69 males and 47 females, with mean age of 17.8 years of age (S.D. = 1.72), the results reveal that male adolescents from monogamous families experience better psychological adjustment than their polygynous counterparts, whereas no such difference exists in the levels of psychological adjustment of female adolescents from both family types. These findings suggest that (i) sex-role prescription influences psychological adjustment of adolescents in Yoruba societies, and (ii) female children enjoy more protective upbringing in polygynous families than their male counterparts.

PIP: 2 psychologists administered the Psychological Adjustment Scale of the Adolescent Personal Data Inventory to 116 Yoruba adolescents (69 males and 47 females) from middle class families attending a holiday youth camp in Ibadan in Oyo State, Nigeria to test the hypothesis that teenagers from monogamous families are better psychologically adjusted than those from polygynous families. 96 and 26 adolescents lived within a monogamous family and polygynous families, respectively. Males from a monogamous family exhibited better psychological adjustment scores than those form polygynous families (p.01). On the other hand, there was no difference between the scores of females form monogamous family with those of females from polygynous families. Thus the psychologists' hypothesis was partially confirmed. These results indicated that gender tempers the effect of family type on adolescent adjustment. This may have been a result of role prescription in Yoruba societies. Specifically, male children in polygynous families had to take care of themselves, their many siblings, and sometimes even their mother's sisters which placed them under considerable stress. Various conflicts arose in polygynous families which did not exist in monogamous families, e.g., friction among cowives, sibling rivalry, and minimum contact with parents. According to these results, this stressful role for male children tended to protect female adolescents from the stresses. In monogamous families, however, male children were more likely to receive emotional and moral support. Further research is needed to identify other factors that influence adolescent adjustment and how they interact with or moderate the effect of family type.

Smoking and type A Behaviour.

This study examines the relationship between Type A behaviour and smoking. Data were gathered from a random sample of 100 undergraduate male daily smokers, with a mean age of 21.2 years (SD = 2.72), using the Type A Behaviour Scale (Bortner and Rosenman, 1967). Results reveal that Type A smokers are heavier daily consumers of cigarettes than Type B smokers (t = 2.90, p less than 0.01). The observed relationship between smoking and Type A behaviour remains significant even when the influence of aggression in partialled out. The need to further investigate the interplay of genetic and non-genetic predispositions, and smoking in the incidence of coronary heart diseases (CHD) is suggested.

Self-esteem as determined by gender differences among Yoruba adolescents in Ibadan, Nigeria: a research note.

This study investigates the influence of gender differences on the expression of self-esteem among Yoruba adolescents. Using a sample of 120 adolescents, 60 males and 60 females, with a mean age of 16.02 years (S.D. = 1.63), the results reveal that male adolescents express higher self-esteem than female adolescents. This finding is attributed to the differing socialization processes for males and females in Yoruba societies.