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Title: The epidemiology and surveillance of drug poisoning mortality in England and Wales
Author: Morgan, Oliver William Colville
ISNI:       0000 0004 2743 3252
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2006
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Drug poisoning causes approximately 2,700 deaths each year in England and Wales. Three drug groups are mainly involved: paracetamol, antidepressants, and opiates and drugs of misuse. Harm reduction initiatives have been introduced to reduce drug poisoning mortality. These include restrictions on paracetamol availability, increased recognition and prescribing of antidepressant drugs and greater availability of methadone treatment for heroin addiction. This study explores the epidemiology of drug poisoning mortality and the impact of harm reduction initiatives between 1993 and 2004. The Office for National Statistics provided data from the Drug Poisoning Mortality Database. To interpret mortality trends, data for hospital admissions, prescriptions, pharmacy drug sales, and the availability of illicit drugs were also used. There was a modest decline in paracetamol poisoning deaths, similar to mortality from non-opioid poisoning. Hospital admissions and sales of paracetamol declined but returned to pre-intervention levels. A small decline in poisoning severity was not clinically significant. Antidepressant poisoning mortality remained stable despite a large increase in the prevalence of treated depression and prescriptions for antidepressant drugs. There was no association between increased antidepressant prescriptions and antidepressant poisoning mortality or suicide. Poisoning risk for individual drugs varied over time, indicating the importance of factors other than drug toxicity. Drug misuse mortality increased sharply in the 1990s, decreased after 2000 and increased again in 2004. This meant the government reduction target was not met. Law enforcement seizures of heroin and methadone rose and fell in line with poisoning mortality rates for these drugs, suggesting that availability is a key determinant of drug misuse mortality. Expansion of methadone prescribing did not appear to have caused more methadone poisoning deaths. Systematic and timely surveillance of drug poisoning mortality is vital for the planning and evaluation of harm reduction initiatives. Interpretation of epidemiological trends requires concurrent use of multiple data sources.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available