(111) Mortality Consequences of Misuse of Psychoactive Prescription Drugs in Portugal – The MisuMedPT Project

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1156

Presenting Author(s)

Ana C. Araujo, PharmD
– INFARMED - National Authority of Medicines and Health Products, I.P., Faculty of Pharmacy, University of Lisbon, Lisbon, Lisboa, Portugal

Co-Author(s)

Carolina Bulhosa
– Data analyst, Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisboa, Lisboa, Portugal
José Guerreiro
– Data analyst, Centre for Health Evaluation and Research, National Association of Pharmacies (CEFAR/Infosaude-ANF), Lisboa, Lisboa, Portugal
João Goulão
– General Director, SICAD - General-Directorate for Intervention on Addictive Behaviours and Dependencies, Lisboa, Lisboa, Portugal
Ana Martins
– Assistant Professor with Habilitation, iMed.ULisboa – Research Institute for Medicines, Faculty of Pharmacy, University of Lisbon, Lisboa, Lisboa, Portugal

Background: Forensic data, together with poison centre and hospital information on medicine-related events, are useful to evaluate the possible health-related consequences of medicines’ misuse. Triangulating data from these sources contributes to enhance knowledge on the possible risks associated to psychoactive medicines’ use and can be useful as part of an active surveillance system for monitoring their misuse.

Objectives: To investigate demographic characteristics, polydrug use and medicines’ role in Portuguese violent or unknown cause deaths, taking into account exposure data on psychoactive medicines.

Methods: Observational study of all medico-legally investigated deaths from 2014 to 2018 involving psychoactive medicines (benzodiazepines, antidepressants, antiepileptics and prescription opioids), included in the database of the National Institute of Legal Medicine and Forensic Sciences (INMLCF). Polydrug use - alcohol or illegal drugs - was also analysed. Using sales data from Health Market Research Portugal, medicine utilisation-based death rates and the relationship between the number of deaths and psychoactive medicines’ exposure were investigated.

Results: The rate of deaths involving at least one psychoactive medicine (N=7653) among all violent or ignored cause deaths, has decreased from 2014 to 2016, but increased in 2017 and 2018, reaching 26.7% in 2018 (17.4 deaths/100,000 inhabitan ts), 71.1% of which unintentional. The number of benzodiazepines involved in fatal cases has decreased, from 1361 in 2014 to 1160 in 2018; prescription opioids (strong and weak) show an opposite trend (64;132 to 151; 218 positive toxicology reports), as well as antidepressants (548 to 710). In 4.8% of studied deaths, the autopsy confirmed the medicine’s contribution to the fatal outcome.
In 20% of deaths there was polydrug use, 14.2% with alcohol (75% males; 28% older than 65 years ) and 4.2% with illegal drugs (N=323, 78% males), of which 48% with cocaine and 58% with cannabis . Diazepam (N=5810; 76%), tramadol (1493; 20%) and alprazolam (1262; 16%) were the active substances more frequently found in psychoactive medicine death cases, both with and without medicines’ contribution. In 2018, midazolam, diazepam, fentanyl and tramadol had the highest utilisation-based death rates (1194, 1028, 865 and 808 deaths/100,000 patients treated). A positive significant relationship between psychoactive medicine deaths and sales data was found (Spearman rs = 0.683; p < 0.001).

Conclusions: Our results, pointing to an increase in deaths involving psychoactive medicines in which 20% also involve other CNS-acting non-medicinal substances , highlight the importance of using medicine-related morbi-mortality data as a tool to monitor medicines’ misuse and increase the safety of their use.