Poisoning and drug overdose
| Poisoning and drug overdose |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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.
References
1 D Ives, T. J., Chelminski, P. R., Hammett-Stabler, C. A., Malone, R. M., Perhac, J. S., Potisek, N. M. & et al. (2006). Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Services Research, 6, 46.
2 Washington State Department of Health. Health of Washington State. (2007). Poisoning & Drug Overdose chapter in Injury and Violence Section. Retrieved on January 10, 2008 from http://www.doh.wa.gov/hws/IV2007.shtm.
3 Paulozzi, L., Budnitz, D. S., & Xi.Y. (2006). Increasing deaths from opioid analgesics in the United States. Pharmacoepideniology and Drug Safety, 15(9), 618-27.
4 North Carolina; Utah; Maine; New Mexico; and Clark County, Nevada.
5 Drug Enforcement Administration. U.S. Department of Justice. Automation of Reports and Consolidated Orders System. Retail Drug Summary. Retrieved from www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html. Approximate number of doses is available. The use and abuse of prescription-type opiates in Washington State. The Alcohol and Drug Abuse Institute, University of Washington, Seattle. Retrieved on April 24, 2007, from http://depts.washington.edu/adai/pubs/arb/PrescriptionOpiates_March30_2007.pdf.
6 Franklin, G. M., Mai, J., Wickizer, T., Turner, J. A., Fulton-Kehoe, D. & Grant, L. (2005). Opioid dosing trends and mortality in Washington State workers’ compensation, 1996-2002. American Journal of Industrial Medicine, 48(2), 91-9.
7 Wells, K.B., Roland, S. & Burnam, A. (2005). National survey of alcohol, drug, and mental health problems. Health-care for Communities. (2000-2001). ICPSR version. Los Angeles: University of California, Los Angeles, Health Services Research Center [producer]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor] (2005).
8 Motheral, B., Cox, E., Mager, D., Henderson, R. & Martinez, R. (2002). Prescription drug atlas. Table 3.1 Retrieved on April 20, 2007, from www.expressscripts.com/ourcompany/news/outcomesresearch/prescriptiondrugatlas/.
9 Ballantyne, J. C. (2007). Opioid analgesia: perspectives on right use and utility. Pain Physician, 10, 479-491.
10 Marks, C. E. & Goldring, R. M. (1973). Chronic hypercapnia during methadone maintenance. The American Review of Respiratory Disease, 108, 1088-1093.
11 Substance Abuse and Mental Health Services Administration. (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings. Office of Applied Studies: Rockville, MD. Retrieved February 12, 2007, from http://www.oas.samhsa.gov/p0000016.htm#2k5.
Centers for Information & Dedicated to Help
- Big Brothers Big Sisters of America
- Communities That Care Community Planning System
- Drug Policy Alliance, New Mexico’s 911 Good Samaritan law
- Life Skills Training Program
- National Center for Injury Prevention and Control, Poisoning fact sheet
- National Youth Violence Prevention Center, Substance Abuse Prevention - Program Evaluations, Best Practices and Model Programs
- Preventing Prescription Drug Abuse
- Project Alert
- Signs and symptoms of drug addiction
- Strengthening Families Program
- Substance Abuse in Brief Fact Sheet – Pain Management without Psychological Dependence: A Guide for Healthcare Providers
- Western Center for the Application of Prevention Technologies
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