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JAMA Psychiatry Nov 2023Determining the association between drug use and suicide is complicated but can help to inform targeted suicide prevention strategies.
IMPORTANCE
Determining the association between drug use and suicide is complicated but can help to inform targeted suicide prevention strategies.
OBJECTIVE
To examine the substances prevalent in poisoning- and nonpoisoning-related suicides in Australia.
DESIGN, SETTING, AND PARTICIPANTS
This was a multiple-year, cross-sectional study of suicides from July 2013 to October 2019 in Australia with toxicology data available in a national coronial database. The cause of death was classified as poisoning related if any type of poisoning was determined by the coroner to contribute to the cause of death. Prevalence ratios (PRs) were calculated to compare substance detection in poisoning- vs nonpoisoning-related suicides. Data were analyzed from October 2021 to April 2023.
EXPOSURES
All substances detected in decedents at the time of death according to toxicology reports were recorded.
MAIN OUTCOME(S) AND MEASURE(S)
The most common individual substances and substance classes were identified. From these, blood concentrations of substances of interest were analyzed, and the most commonly occurring combinations of substance classes were listed.
RESULTS
Toxicology was performed on 13 664 suicide decedents (median [IQR] age, 44 [31-57] years; 10 350 male [76%]). From these, 3397 (25%) were poisoning-related suicides (median [IQR] age, 50 [38-63] years; 2124 male [63%]). The remainder were classified as nonpoisoning-related suicides (median [IQR] age, 42 [29-55] years; 8226 male [80%]). PRs for common medicine classes being detected in poisoning-related suicides compared with nonpoisoning-related suicides were as follows: antidepressants (PR, 1.63; 95% CI, 1.54-1.73), benzodiazepines (PR, 2.01; 95% CI, 1.90-2.13), nonopioid analgesics/anti-inflammatory drugs (PR, 1.88; 95% CI, 1.78-2.00), and opioids (PR, 2.72; 95% CI, 2.58-2.87). Alcohol (as ethanol ≥0.03 g/100 mL) was almost equally prevalent in poisoning- and nonpoisoning-related deaths (PR, 1.07; 95% CI, 1.01-1.14), whereas amphetamines (PR, 0.68; 95% CI, 0.61-0.77) and cannabinoids (PR, 0.67; 95% CI, 0.60-0.74) were detected more often in nonpoisoning-related suicides. Combinations of multiple sedative agents in poisoning-related suicides were common.
CONCLUSIONS AND RELEVANCE
Both poisoning- and nonpoisoning-related suicide deaths featured a high prevalence of psychotropic medicines or potential intoxication, which suggests the association of suicide with poor mental health and substance misuse. Findings suggest that substances with a high involvement in poisoning-related suicides should be prescribed cautiously, including antidepressants that are toxic in overdose, sedatives, opioids, and potentially lethal combinations.
Topics: Humans; Male; Adult; Middle Aged; Suicide; Cross-Sectional Studies; Coroners and Medical Examiners; Drug Overdose; Antidepressive Agents; Ethanol; Analgesics, Opioid; Poisoning
PubMed: 37494023
DOI: 10.1001/jamapsychiatry.2023.2289 -
The American Journal of Emergency... Dec 2023A 48-year-old male intentionally ingested "gopher killer" containing strychnine as a, suicide attempt. He rapidly developed generalized muscle spasms with opisthotonos...
A 48-year-old male intentionally ingested "gopher killer" containing strychnine as a, suicide attempt. He rapidly developed generalized muscle spasms with opisthotonos followed by cardiovascular collapse. He was resuscitated, treated with 24 h of, neuromuscular paralysis, and was discharged on hospital day 10 without sequelae. A blood strychnine concentration obtained five hours post ingestion was 2.2 mg/L. Strychnine poisoning is exceedingly rare in the modern United States and this report contains a video recording of the classic exam findings.
Topics: Male; Humans; United States; Middle Aged; Strychnine; Spasm; Suicide, Attempted; Disease Progression; Poisoning
PubMed: 37805370
DOI: 10.1016/j.ajem.2023.09.055 -
Practical Neurology May 2024A 64-year-old man had progressive unsteadiness over several years, with tingling in his feet. He was a longstanding bodybuilding enthusiast. Clinical assessment and...
A 64-year-old man had progressive unsteadiness over several years, with tingling in his feet. He was a longstanding bodybuilding enthusiast. Clinical assessment and neurophysiology confirmed a cerebellar ataxia and axonal peripheral neuropathy. His serum mercury concentration was significantly raised. We diagnosed chronic mercury toxicity secondary to excessive tuna consumption. We advised him to stop eating tuna and prescribed dimercaptosuccinic acid, after which his serum mercury concentrations subsequently fell. This case report highlights the importance of considering dietary and nutritional causes of neurological disease. We also discuss the mechanisms, diagnosis and treatment of mercury toxicity.
Topics: Humans; Male; Middle Aged; Mercury Poisoning; Mercury; Weight Lifting
PubMed: 38253381
DOI: 10.1136/pn-2023-003827 -
The Veterinary Clinics of North... Apr 2024Range and pasture toxic plants can poison horses. Many of these plants are noxious weeds that can dominate plant populations and replace healthy forages. Poisoning is... (Review)
Review
Range and pasture toxic plants can poison horses. Many of these plants are noxious weeds that can dominate plant populations and replace healthy forages. Poisoning is often difficult to diagnose as the resulting plant-induced disease is similar to other infectious, toxic, and nutritional diseases. Identifying potentially problem plants, and observing what plants horses are eating, is essential in determining the risk of poisoning. If the risk is significant, it can drive management to invest in strategies to avoid exposure, animal disease, and suffering.
Topics: Animals; Horses; Poisons; Horse Diseases; Plants, Toxic
PubMed: 38184454
DOI: 10.1016/j.cveq.2023.12.002 -
Journal of Medical Toxicology :... Jul 2023
Topics: Child; Humans; Poisons; Poison Control Centers; Environmental Health
PubMed: 36988816
DOI: 10.1007/s13181-023-00942-6 -
CMAJ : Canadian Medical Association... Aug 2023
Topics: Humans; Lead; Lead Poisoning; Medicine, Ayurvedic
PubMed: 37553150
DOI: 10.1503/cmaj.230592 -
Wilderness & Environmental Medicine Sep 2023
Topics: Animals; Humans; Ciguatera Poisoning; Fishes; Disease Outbreaks
PubMed: 37230929
DOI: 10.1016/j.wem.2023.04.002 -
JAMA Dec 2023
Topics: Humans; Coma; Intubation, Intratracheal; Poisoning; Acute Disease
PubMed: 38019975
DOI: 10.1001/jama.2023.22462 -
The American Journal of Forensic... Dec 2023In agrarian countries, several pesticides are used on a large scale to preserve grains. However, oftentimes, the very people using it are not aware of their harmful...
In agrarian countries, several pesticides are used on a large scale to preserve grains. However, oftentimes, the very people using it are not aware of their harmful effects. Some pesticides produce toxic gases, which can cause poisoning by inhalation. With no specific antidotes and limited data on the benefit of therapeutic interventions, such poisonings can lead to fatalities. This case report discusses the death of an apparently healthy, 6-year-old boy who presented with multiple episodes of vomiting and loose stools and was declared dead on arrival to the hospital. His other siblings and the parents also experienced similar symptoms but survived. Further investigation revealed that the family lived in a closed, poorly ventilated room adjacent to a granary where their landlord stored grains with pesticides for the purpose of preservation. However, during rainy season, moisture came into contact with the grains and toxic gases were released. The family was exposed to these gases through a small window in the living room, proving fatal to one member of the family. This article suggests that phosphine gas was liberated from an aluminum phosphide pesticide and emphasizes the need for improved knowledge, recognition, prevention, and management in such scenario.
Topics: Male; Humans; Child; Pesticides; Gas Poisoning; Diarrhea; Gases; Poisoning
PubMed: 37438888
DOI: 10.1097/PAF.0000000000000855 -
Health Promotion and Chronic Disease... May 2024The objective of this analysis is to describe patient demographics, the context, characteristics and outcomes of a substance-related poisoning, and the recorded mental...
INTRODUCTION
The objective of this analysis is to describe patient demographics, the context, characteristics and outcomes of a substance-related poisoning, and the recorded mental disorder of people with housing and those experiencing homelessness.
METHODS
Hospitalization data for Canada (except Quebec) from 1 April 2019 to 31 March 2020 were retrieved from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database using ICD-10-CA codes for up to 25 diagnoses for substance-related poisonings, homelessness status and other characteristics relevant to the patient's hospitalization. We compared the characteristics of people experiencing homelessness with those of people who were housed, and their substance-related poisoning hospitalizations, using chi-square, t tests and Fisher exact test.
RESULTS
There was a higher proportion of males, younger individuals and people with recorded mental disorders among people experiencing homelessness hospitalized for a substance-related poisoning than among their housed counterparts. Substance-related poisonings among people experiencing homelessness were more likely to be accidental, involve opioids and stimulants (most frequently fentanyl and its analogues and heroin), result in lengthier hospitalizations and end with leaving the hospital against medical advice.
CONCLUSION
These findings can be used to strengthen strategies and interventions to reduce substance-related harms in priority populations, particularly those experiencing homelessness.
Topics: Humans; Ill-Housed Persons; Male; Female; Hospitalization; Adult; Middle Aged; Canada; Mental Disorders; Substance-Related Disorders; Young Adult; Adolescent; Aged; Poisoning; Age Factors; Sex Factors
PubMed: 38748478
DOI: 10.24095/hpcdp.44.5.02