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Addiction
Original research
Trends in drug poisoning deaths, by sex, in Ireland: a repeated cross-sectional study from 2004 to 2017
  1. Ena Lynn1,2,3,
  2. Gráinne Cousins3,
  3. Suzi Lyons1,
  4. Kathleen E Bennett4
  1. 1 National Health Information Systems, Health Research Board, Dublin 2, Ireland
  2. 2 Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3 School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  4. 4 Data Science Centre, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
  1. Correspondence to Ena Lynn; elynn{at}hrb.ie

Abstract

Objective To examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017.

Design Repeated cross-sectional study.

Setting Drug poisoning deaths in Ireland.

Participants National Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017.

Outcome measures The 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.

Results Increased 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).

Conclusion Drugs 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.

  • clinical pharmacology
  • substance misuse
  • epidemiology
  • health policy
  • public health
  • protocols & guidelines

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-048000

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @EnaCLynn, @pharmacoepircsi

    • Contributors EL, KEB and GC contributed to the concept and design of the study. KEB, EL and SL each had a key role in the acquisition of data. EL undertook the statistical analysis with guidance from KEB and GC. EL was responsible for the writing of the manuscript. KEB, GC and SL provided critical input to drafts of the paper. All authors contributed to the interpretation of data, agree to be accountable for all aspects of the work and approved the final manuscript.

    • Funding KEB is funded by the Health Research Board in Ireland (RL-15-1579). The Health Research Board sponsored academic registration fees for EL but had no role in the design or execution of this study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.