Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada
A Cross-Sectional Study
Abstract
Abstract.Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009–2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.
References
2008). Methods of suicide: International suicide patterns derived from the WHO mortality database. Bulletin of the World Health Organization, 86, 726–732.
(2006). Guide de gestion de l'urgence.
. ([Emergency management guide] . Retrieved from http://publications.msss.gouv.qc.ca/msss/document-001172/?&date=ASC2015). Population trends in substances used in deliberate self-poisoning leading to intensive care unit admissions from 2000 to 2010. The Journal of Clinical Psychiatry, 76, e1583–e1589. 10.4088/JCP.14m09568
(2016). Prévention des intoxications volontaires par médicaments accessibles sans ordonnance
([Preventing voluntary OTC drug overdoses] . Montreal, Canada: INSPQ. Retrieved from https://www.inspq.qc.ca/pdf/publications/2117_intoxications_volontaires_medicaments.pdf2018). Exposure to suicide behaviour and individual risk of self-harm: Findings from a nationally representative New Zealand high school survey. The Australian and New Zealand Journal of Psychiatry, 52, 349–356. 10.1177/0004867417710728
(2015). Hospital-treated deliberate self-harm in the western area of Northern Ireland. Crisis, 36, 83–90. 10.1027/0227-5910/a000301
(2014). Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland. BMJ Open, 4, e005557. 10.1136/bmjopen-2014-005557
(2000). Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: Worldwide patterns of use and misuse. Suicide and Life-Threatening Behavior, 30, 313–326.
(2008). Determinants and outcomes of serious attempted suicide: A nationwide study in Finland, 1996-2003. American Journal of Epidemiology, 167, 1155–1163. 10.1093/aje/kwn017
(2007). Self-harm in England: A tale of three cities. Multicentre study of self-harm. Social Psychiatry and Psychiatric Epidemiology, 42, 513–521. 10.1007/s00127-007-0199-7
(2013). Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: Interrupted time series analyses. BMJ, 346, f403. 10.1136/bmj.f403
(1988). Suicide, and other causes of death, following attempted suicide. British Journal of Psychiatry, 152, 359–366. 10.1192/bjp.152.3.359
(2009). Suicide. Lancet, 373, 1372–1381. 10.1016/S0140-6736(09)60372-X
(2016). Stronger, clearer labels for over-the-counter acetaminophen products to further address the risk of liver damage. Retrieved from http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2016/60198a-eng.php#issue-problem
. (2013). Deliberate self-poisoning: Characteristics of patients and impact on the emergency department of a large university hospital. Emergency Medicine Journal, 30, e9. 10.1136/emermed-2011-201033
(2015). Mental disorders and risk of suicide attempt: A national prospective study. Molecular Psychiatry, 20, 718–726. 10.1038/mp.2015.19
(2002). Suicide rate 22 years after parasuicide: Cohort study. BMJ, 325, 1155.
(1988). Attempted suicide in psychiatric outpatients with concurrent physical illness. Psychotherapy and Psychosomatics, 50, 201–206. 10.1159/000288121
(2003). Patient characteristics associated with nonprescription drug use in intentional overdose. Canadian Journal of Psychiatry, 48, 232–236. 10.1177/070674370304800406
(2002). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry, 159, 909–916. 10.1176/appi.ajp.159.6.909
(2015). What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries. PLoS One, 10, e0129062. 10.1371/journal.pone.0129062
(2012). Suicide rates: An overview. Retrieved from http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11696-eng.pdf
(2017). National trends in suicide attempts among adults in the United States. JAMA Psychiatry, 74, 1095–1103. 10.1001/jamapsychiatry.2017.2582.
(2014). Patterns and 14-year trends in mortality among illicit drug users in Finland: The HUUTI study. The International Journal on Drug Policy, 25, 1047–1053. 10.1016/j.drugpo.2014.07.008
(2006). Poisonings with diphenhydramine – a survey of 68 clinical and 55 death cases. Forensic Science International, 161, 189–197. 10.1016/j.forsciint.2006.01.019
(2005). Correlates of suicide in the older adult population in Quebec. Suicide and Life-Threatening Behavior, 35, 91–105. 10.1521/suli.35.1.91.59269
(2016). Correlates of attempted suicide from the emergency room of two general hospitals in Montreal, Canada. Canadian Journal of Psychiatry, 61(7), 382–393. 10.1177/0706743716639054
(1991). Multiple imputation in health-care databases: An overview and some applications. Statistics in Medicine, 10, 585–598.
(2012). Idées suicidaires et tentatives de suicide au Québec
. ([Suicidal ideation and attempted suicide in Quebec] . Retrieved from http://publications.msss.gouv.qc.ca/msss/fichiers/2012/12-202-04F.pdf2016). Suicide and suicidal attempts in the United States: Costs and policy implications. Suicide and Life-Threatening Behavior, 46, 352–362. 10.1111/sltb.12225
(2012). Substances used in completed suicide by overdose in Toronto: An observational study of coroner's data. Canadian Journal of Psychiatry, 57, 184–191. 10.1177/070674371205700308
(2000). Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health, 90, 1885–1891.
(2018a). Leading causes of death, by sex. Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36a-eng.htm
. (2018b). Table 102-0110 – potential years of life lost, by selected causes of death (ICD-10) and sex, population aged 0 to 74, Canada, provinces and territories, annual, CANSIM (database). Retrieved from http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1020110#F4
. (2005). Prescription and over-the-counter medication in deliberate self-poisoning and accidental overdosing – preliminary study. Przeglad Lekarski, 62, 568–571.
(2013). A central storage facility to reduce pesticide suicides – a feasibility study from India. BMC Public Health, 13, 850. 10.1186/1471-2458-13-850
(2016). International Classification of Diseases (5th ed.). Retrieved from http://www.who.int/classifications/icd/en/
. (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry, 3, 646–659. 10.1016/S2215-0366(16)30030-X
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