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- Fugelstad, A., et al.
(författare)
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Methadone maintenance treatment : the balance between life-saving treatment and fatal poisonings
- 2007
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 102:3, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To determine the total mortality related to the Stockholm methadone programme during the period 1988-2000, both the mortality related to the treatment and fatal methadone intoxications in the Stockholm area during the same period. Methods: The study comprised all individuals (n = 848) who had been in contact with the methadone programme in Stockholm during the study period, including those patients who had been discharged from treatment and those opiate users who had applied for but not received methadone treatment. All deaths that had been the subject of medico-legal examination at the Department of Forensic Medicine in Stockholm where methadone was found in blood or urine were also analysed during the same period. Results: The mortality was lower among those opiate users who remained in maintenance treatment and 91% of the deceased individuals had died due to natural causes, in most cases related to HIV or hepatitis C, acquired before admission to the programme. Those who had been discharged from methadone treatment had a 20 times higher risk of dying from unnatural causes compared to the patients who remained in treatment. The majority died due to heroin injections ('overdoses'). Eighty-nine cases of fatal methadone intoxication were found, but in only two of these cases was there evidence of leakage from maintenance treatment. Conclusion: The 'high threshold programme' is safe as long as the patients remain in treatment and there are very few deaths due to leakage from the programme. However, there is a high mortality among those discharged from the programme and only a minority of the heroin users in Stockholm had applied for treatment.
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- Stenbacka, M., et al.
(författare)
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Self-poisoning across ages in men and women : Risk for suicide and accidental overdoses
- 2017
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Ingår i: Suicidology Online. - Campobasso, Italy. - 2078-5488. ; 8:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- Self-poisoning with licit or illicit opioids, alcohol or other prescribed drugs affects mostly young people, but also older patients are at risk for self-poisoning and suicide. This study investigates suicide methods and drugs involved in 2342 Swedish patients and compares different age categories regarding drug use and causes of death included suicide. All consecutive patients who had been treated for self-poisoning at the emergency department at the Karolinska University Hospital, from 1994 to 2000 were followed up until year 2006 for mortality. Of the whole cohort of 2342 (943 men and 1299 women) at an average age of 38.74 years at admission, 122 (5.2%) had committed suicide during the follow-up period. Standard mortality ratio (SMR) was highest (SMR=70.89) in patients older than 55 years, followed by the youngest age category (15-35 years) (SMR=61.95). Poisoning as suicide method was most common in the younger age categories, while violent methods in older ages. The drugs involved in the suicide cases were predominantly prescribed or illicit opioids in the youngest ages, while alcohol and medications were most common in the elderly. Patients presented to emergency department due to self-poisoning are at high risk for subsequent suicide in comparison with the general population. Women had significantly lower suicide rate, but no differences between men and women were found concerning type of suicide methods. Patients at emergency department due to poisoning should be offered treatment and follow-up for both drug abuse but also for psychiatric problems in order to prevent repetitive overdoses, suicides and other deaths.
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- Davstad, I, et al.
(författare)
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Patterns of illicit drug use and retention in a methadone program: a longitudinal study
- 2007
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Ingår i: Journal of opioid management. - : Weston Medical Publishing. - 1551-7489. ; 3:1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to analyze illicit drug use of participants in a methadone treatment program in relation to methadone dose, counseling, and retention.Methods: This was a longitudinal study of a cohort of 204 heroin-dependent subjects admitted for the first time to a methadone program in Stockholm. The patients were admitted between 1995 and mid-2000 and were followed until December 2000 or discharge. Up to June 11, 1998, individual psychosocial counseling was provided; after this date individual counseling was replaced with group counseling. Clinical data were collected from patient records and from a laboratory database. Rates of drugpositive urine analyses during different time periods were measured.Results: The mean observation time was 2.5 years for all patients. The one-year retention rate was 84 percent, and the two-year rate was 65 percent, with no major differences between the two counseling groups. Almost all patients relapsed to illicit drug use. Discharged patients had a significantly higher rate of positive urine samples (21 percent versus 9 percent) than patients who remained in treatment. Also, low methadone dose and younger age predicted discharge from treatment.Conclusion: The frequent urine monitoring showed that illicit drug use was rather common, even in a program with structured psychosocial interventions, although it was lower than in other studies. This testing policy can be used for early identification of patients at risk for drop-out or discharge who should be offered complementary interventions.
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- Jansson, B., et al.
(författare)
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A small fraction of patients with repetitive injuries account for a large proportion of medical costs
- 2004
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 14:2, s. 161-167
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach. METHODS: Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive. RESULTS: During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries. CONCLUSION: These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.
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