Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000-2018.
TL;DR: The authors in this article determined the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018, and found that the major harm associated with these drugs is now suicide.
Abstract: Objectives To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. Design, setting Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). Main outcome measures Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. Results We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100 000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100 000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100 000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). Conclusions While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.
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TL;DR: Interest in barbiturates has increased, particularly in their use at the end of life, and clinical indications for prescribing them are now extremely limited.
Abstract: Barbiturates have a narrow therapeutic index, and accidental or deliberate poisoning can cause coma and cardiorespiratory arrest. Barbituraterelated death rates were high in the mid20th century, when barbiturates were still commonly prescribed, but safer alternatives mean that clinical indications for prescribing them are now extremely limited.1 Over the past twenty years, however, interest in barbiturates has increased, particularly in their use at the end of life.2
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References
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TL;DR: The problems of safety which, accompanied by the introduction of a range of psychoactive drugs in the 1950s, brought an end to barbiturate use, except in specific applications, such as the induction of anesthesia and the treatment of certain types of epilepsy.
Abstract: The present work offers an analysis of the historical development of the discovery and use of barbiturates in the field of psychiatry and neurology, a century after their clinical introduction. Beginning with the synthesis of malonylurea by von Baeyer in 1864, and up to the decline of barbiturate therapy in the 1960s, it describes the discovery of the sedative properties of barbital, by von Mering and Fischer (1903), the subsequent synthesis of phenobarbital by this same group (1911), and the gradual clinical incorporation of different barbiturates (butobarbital, amobarbital, secobarbital, pentobarbital, thiopental, etc). We describe the role played in therapy by barbiturates throughout their history: their traditional use as sedative and hypnotic agents, their use with schizophrenic patients in so-called "sleep cures" (Klaesi, Cloetta), the discovery of the antiepileptic properties of phenobarbital (Hauptmann) and their use in the treatment of epilepsy, and the introduction of thiobarbiturates in intravenous anesthesia (Lundy, Waters). We also analyze, from the historical perspective, the problems of safety (phenomena of dependence and death by overdose) which, accompanied by the introduction of a range of psychoactive drugs in the 1950s, brought an end to barbiturate use, except in specific applications, such as the induction of anesthesia and the treatment of certain types of epileptic crisis.
189 citations
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TL;DR: There is now little to justify prescribing barbiturate hypnotics or sedatives for anyone, because patients for whom these drugs are still being prescribed would, in the event of an overdose, be unlikely to be found and admitted to hospital in time owing to their age and social circumstances.
Abstract: Hospital admissions due to acute barbiturate poisoning per million population in England and Wales have decreased since 1965 at about the same rate as NHS prescriptions for barbiturates. Admissions due to poisoning with other drugs have increased, but, largely because the benzodiazepine hypnotics and tranquillisers are much less toxic than the barbiturates that they are replacing, deaths from poisoning with all solids and liquids have decreased. The risk of death from self-poisoning associated with each barbiturate prescription has increased two and a half times since 1961, perhaps partly because greater quantities of barbiturate are being dispensed with each prescription and partly because patients for whom these drugs are still being prescribed would, in the event of an overdose, be unlikely to be found and admitted to hospital in time owing to their age and social circumstances. There is now little to justify prescribing barbiturate hypnotics or sedatives for anyone.
67 citations
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TL;DR: A study of suicide in Brisbane reveals that there was a sharp rise in the incidence of deaths from barbiturate overdosage, which reached a peak in the mid 1960s, and suggests that the fall in suicide rates was due to the better recognition and treatment of depressive illnesses and to the introduction of the safer benzodiazepines in place of barbiturates.
Abstract: A study of suicide in Brisbane between the years 1956 and 1973 reveals that there was a sharp rise in the incidence of deaths from barbiturate overdosage, which reached a peak in the mid 1960s. Since then there has been a steady decline in suicide rates from drug overdose and a smaller fall in the rate of other forms of suicide. The decline in the incidence of deaths from carbon monoxide poisoning since 1967 may be due to the use of non-toxic domestic gas. The frequent association between barbiturate suicides and previous ingestion of alcohol indicates the danger of the practice and the probability that many of the victims had major drinking problems. An examination of suicide deaths and the prescribing of barbiturates, benzodiazepines and antidepressant drugs between 1962 and 1973 suggests that the fall in suicide rates was due to the better recognition and treatment of depressive illnesses and to the introduction of the safer benzodiazepines in place of barbiturates. The study indicates that placing restrictions on non-violent methods of suicide does not necessarily result in an increase in suicides from violence. Language: en
63 citations
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TL;DR: The author concludes that the best prospects for suicide prevention lie in universal prevention strategies, and the assessment of suicidal patients should focus on contemporaneous factors and the needs of the patient, rather than probabilistic notions of suicide risk.
Abstract: It is widely believed that suicide prevention involves the consideration of risk and protective factors and related interventions. Preventative interventions can be classified as "universal" (targeting whole populations), "selective" (targeting higher-risk groups), and "indicated" (protecting individuals). This review explores the range of preventative measures that might be used commensurately with different types of suicide prediction. The author concludes that the best prospects for suicide prevention lie in universal prevention strategies. While risk assessments do generate some information about future suicide, suicide risk categorization results in an unacceptably high false positive rate, misses many fatalities, and therefore, is unable to usefully guide prevention strategies. The assessment of suicidal patients should focus on contemporaneous factors and the needs of the patient, rather than probabilistic notions of suicide risk.
39 citations
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TL;DR: The reasons for veterinary suicides are likely to be multifactorial, including work- and life-related stressors, and individual characteristics, and the need for targeted suicide prevention and intervention for veterinarians is highlighted.
Abstract: BACKGROUND: Whether veterinarians have an elevated suicide rate compared with the general population is controversial. METHODS: Reported cases of suicide among veterinarians and veterinary nurses in Australia over the period 2001 to 2012 were investigated in a retrospective case-series study. RESULTS: The standardised mortality ratio of veterinarians (n = 18) was 1.92 (95% CI 1.14-3.03) and that of veterinary nurses (n = 7) to the general population was 1.24 (95% CI 0.80-1.85). Overdosing on drugs (pentobarbitone) was the main method of suicide in these occupations. CONCLUSION: The reasons for veterinary suicides are likely to be multifactorial, including work- and life-related stressors, and individual characteristics. This research highlights the need for targeted suicide prevention and intervention for veterinarians. Language: en
30 citations
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