Poisoning and drug overdose: Difference between revisions
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* About 90% of the incidents occurred in a home. | * About 90% of the incidents occurred in a home. | ||
* 52% of the incidents occurred to a child under | * 52% of the incidents occurred to a child under six years. | ||
six years. | |||
* The majority of all exposure calls (83%) were handled without transfer to a health care facility. | * The majority of all exposure calls (83%) were handled without transfer to a health care facility. | ||
* 94% percent of exposure calls to children ages six or under were handled without transfer to a health care facility. | * 94% percent of exposure calls to children ages six or under were handled without transfer to a health care facility. | ||
Revision as of 22:06, 11 January 2009
| Poisoning and drug overdose |
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The damaging physiologic effects of ingestion, inhalation, or other exposure to a broad range of chemicals, including pesticides, heavy metals, gases/vapors, drugs, and a variety of common household substances, such as bleach and ammonia. Included are accidental overdoses of drugs, a wrong drug given or taken in error, and a drug taken inadvertently.
Opiate use and misuse appear to be driving the increase in poisoning deaths. Alcohol and other drug abuse are also important public health issues with enormous impacts on many types of injury and violence.
Legitimate medical treatment with opiates
Pain is very common. About 24% of U. S. adults reported moderate to extreme pain in the past month.7 In 2005, about 19% of the 50 million United States adults who used Express Scripts, a large commercial pharmacy benefit program, received a prescription for opiates.8
Chronic opiate use is linked to the development of tolerance to its analgesic or pain relieving effect.9 Tolerance is defined as a decrease in a drug’s effect over time so that larger doses are required to achieve the same effect. Chronic opiate use also may be associated with hyperalgesia, an increase in abnormal pain sensitivity.9 In an attempt to maintain pain relief, the combination of tolerance and hyperalgesia may lead to rampant dose escalation.9
Respiratory depression, a decrease in the rate or depth of a patient’s breathing, is one of the side effects or risks of opiate use. Opiate poisoning deaths are often due to respiratory failure from respiratory depression. As with pain relief, tolerance to respiratory depression develops with chronic opiate use. However, research suggests that tolerance to respiratory depression is incomplete and may develop more slowly than tolerance to the pain relieving effect.10
Other risk factors for unintentional opiate-related poisoning include:
- Concurrent use of other central nervous system depressants like benzodiazepines and sedative-hypnotics.
- The existence of other medical conditions associated with compromised respiratory function such as chronic obstructive pulmonary disease, congestive heart failure, and sleep apnea.
Misuse of Prescription Opiates
In addition to legitimately prescribed opiates, prescription opiates can be obtained in various other ways:
- From a friend or relative with a prescription.
- Obtained from emergency rooms through fraudulent drug-seeking means.
- Purchased on the street or from the Internet.
- Stolen from pharmacies.
During treatment for chronic pain, prescription opiates can be misused by taking more than the prescribed dose or by combining opiates with illicit drugs or alcohol. Nationally, the U. S. Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network tracks drug-related emergency department visits. These visits relate to both misuse and abuse of drugs. For prescription drugs, the definition of ‘non-medical’ use includes:
- Taking more than the prescribed dose of a prescription drug.
- Taking a drug prescribed for another individual.
- Deliberate poisoning with a drug by another person.
- Documented misuse or abuse of a prescription drug.
Opiates accounted for about one-third of all non-medical prescription drug use visits, making them the most frequently reported drugs. In 2006 in King and Snohomish counties, there were 3,529 reports of prescription opiate emergency department visits. The visits were identified as:
- Drug abuse (54%).
- Adverse reaction (18%).
- Accidental overmedication (18%).
Childhood Poisoning
While the highest death rates occur among adults, the majority of reports are for non-fatal poison exposures to children under six years.
- About 90% of the incidents occurred in a home.
- 52% of the incidents occurred to a child under six years.
- The majority of all exposure calls (83%) were handled without transfer to a health care facility.
- 94% percent of exposure calls to children ages six or under were handled without transfer to a health care facility.
The most common substances involved in possible exposures are medications. For example, the top three includes analgesics, topical preparations, and cold and cough preparations. Other common exposures include personal care products, and cosmetics.
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