Involvement of Alcohol in Fatal Self-Poisoning with Medicinal Products in the United Kingdom

  • P. S. Dwyer
  • I. F. Jones
Chapter
Part of the Medicolegal Library book series (MEDICOLEGAL, volume 6)

Abstract

Analgesic drugs appear to be involved to an increasing extent in self-poisoning [1–4]. Dextropropoxyphene (DPP) finds frequent mention in this group of drugs, generally being ingested in the form of its combination product with paracetamol [4, 5]. Barbiturates alone accounted for the majority of fatal self-poisoning in England and Wales during the period 1959–1974 [6] but recent reports have suggested that the combination (DPP/paracetamol) now accounts for more deaths than barbiturate overdosage [7]. An increasing and reportedly extensive involvement of the combination suggested that an investigation of the population involved in such fatal episodes was required. The results of such an investigation in Scotland have been published recently [8]. The present study extends the previous report and examines involvement of all analgesics in fatal self-poisoning in England. The study relies on establishing the involvement of implicated drugs by examining coroners’ files of unnatural deaths. If the mortality of a particular population (such as drug addicts) or the mortality caused by a particular agent in overdose is under study, direct investigations at the offices of the agencies involved in such deaths are necessary. Identification of a single cause of death for a population or of a causative agent may lead the investigator to omit cases when death has been attributed erroneously to other causes if an indirect method of identifying such cases is used. Thus the thoroughness of enquiries by medicolegal agencies and the variation in approach between them can be established by such studies as that presented here. Moreover the accuracy of official statistics can be assessed by direct studies such as this.

Keywords

Medicinal Product Analgesic Drug Case Investigation Blood Alcohol Level Paracetamol Overdosage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Download to read the full chapter text

References

  1. 1.
    Anonymous (1981) Analgesic poisoning. Lancet II: 1120–1121Google Scholar
  2. 2.
    Prescott LF (1982) Analgesic overdosage–an overview of the problem. Contemporary Topics in Pain Management. Royal Society of Medicine International Congress and Symposium Series No. 52, pp 21–28Google Scholar
  3. 3.
    Prescott LF (1976) Prevention of hepatic necrosis following paracetamol overdosage. Health Bull 36: 204–212Google Scholar
  4. 4.
    Young RJ, Lawson AAH, Distalgesic poisoning–cause for concern. Br Med J I: 1045–1047Google Scholar
  5. 5.
    Whittington RM (1977) Dextropropoxyphene (Distalgesic) overdosage in the West Midlands. Br Med J II: 172–173CrossRefGoogle Scholar
  6. 6.
    Johns MW (1977) Self-poisoning with barbiturates in England and Wales during the period 1959–1974. Br Med J I: 1128–1130CrossRefGoogle Scholar
  7. 7.
    Whittington RM, Barclay AD (1981) The epidemiology of dextropropoxyphene ( Distalgesic) overdose fatalities in Birmingham and the West Midlands. J Clin Hosp Pharm 6: 251–257Google Scholar
  8. 8.
    Dwyer PS, Jones IF (1982) An investigation into self-poisoning with analgesic drugs in Scotland. XIIth Congress of the International Academy of Forensic and Social Medicine, Vienna, 17–22 May 1982, pp 779–784Google Scholar
  9. 9.
    Patel AR, Roy M, Wilson GM (1972) Self-poisoning and alcohol. Lancet I: 1099–1102CrossRefGoogle Scholar
  10. 10.
    Ovenstone IMK (1973) Spectrum of suicidal behaviours in Edinburgh. Br J Prey Soc Med 27: 25–35Google Scholar
  11. 11.
    Seager CP, Flood RA (1965) Suicide in Bristol. Br J Psychiatry 2: 919–932CrossRefGoogle Scholar
  12. 12.
    Kessel N (1965) Self-poisoning. Br Med J 2: 1265–1270, 1336–1340Google Scholar
  13. 13.
    Dwyer PS, Jones IF (1980) Distalgesic poisoning–cause for concern. Br Med J II: 60–61CrossRefGoogle Scholar
  14. 14.
    Goldfinger R, Ahmed KS, Pitchumoni CS, Weseley SA (1978) Concomitant alcohol and drug abuse enhancing acetaminophen toxicity. Am J Gastroenterol 70: 385–388Google Scholar
  15. 15.
    Wright N, Prescott LF (1973) Potentiation by previous drug therapy of hepatotoxicity following paracetamol overdosage. Scott Med J 18: 56–58Google Scholar
  16. 16.
    The Coroners’ Rules 1953 (S.!. No.205 1953), London HMSOGoogle Scholar
  17. 17.
    The Coroners’ Amendment Rules 1980 (S. I. 557), London HMSOGoogle Scholar
  18. 18.
    Central and Scottish Health Service Councils (1968) Hospital treatment of acute poisoning. London HMSO.Google Scholar
  19. 19.
    Fraser DM, Lawson AAH (1975) Causes of death from acute poisoning in West Fife occurring inside and outside hospital. Health Bull 33: 1Google Scholar
  20. 20.
    Finkle BS, Caplan YH, Garriott JC, Monforte JR, Shaw RF, Sonsalla PK (1981) Propoxyphene in postmortem toxicology, 1976–1978. J Forensic Sci 16: 739Google Scholar
  21. 21.
    Finkle BS, McCloskey KL, Kiplinger GF, Bennett OF (1983) A national assessment of propoxyphene in postmortem medicolegal investigation, 1972–1975. J Forensic Sci 21: 706–742Google Scholar
  22. 22.
    Anonymous (1983) Drug Ther Bull 21: 17–19Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1986

Authors and Affiliations

  • P. S. Dwyer
  • I. F. Jones

There are no affiliations available

Personalised recommendations