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Ukioqatigiit

Læknablaðið - 01.10.2014, Qupperneq 23

Læknablaðið - 01.10.2014, Qupperneq 23
LÆKNAblaðið 2014/100 519 eðlilegt hjá fámennri þjóð. Styrkleikar rannsóknarinnar eru þeir að hún nær til flestra sem fengu lífshættulega fylgikvilla í tengslum við notkun vímuefna í æð og þörfnuðust gjörgæsluinnlagnar en erfitt er að fela slíka neyslu við þær aðstæður og eftirfylgni þeirra var nákvæm. Einnig náði hún til allra niðurstaðna réttarefnafræðilegra rannsókna á dauðsföllum fólks sem vitað er um með tengsl við notk- un vímuefna í æð á rannsóknartímabilinu. Ályktun Um 1% innlagna á gjörgæsludeildir Landspítala er vegna fylgikvilla af neyslu fíkniefna í æð. Þetta er ungur sjúklingahópur sem oftast leggst inn vegna alvarlegra eitrana eða sýkinga og er með mjög skertar lífslíkur miðað við sama aldurshóp, en 35% hans voru látin innan 5 ára. Niðurstöður réttarefnafræðilegra rannsókna leiða í ljós 4,1 andlát/105/ár vegna neyslu vímuefna í æð sem gefur til kynna að umfang vandans sé sambærilegt og á öðrum Norðurlöndum. Áhyggjuefni er hve algengt er að nota uppleyst lyfseðilsskyld lyf sem vímuefni til inngjafar í æð. ENGLISH SUMMARY introduction: Injecting drug abuse is a worldwide problem with serious consequences for the individual and for society. The purpose of this study was to gather information on the most serious complications of injecting drug use from two perspectives, intensive care admissions and forensic toxicology reports. Material and methods: Firstly, intensive care admissions related to injecting drug abuse during a five year period were reviewed for demog- raphics, complications and 5 year survival. Secondly, information from forensic toxicology reports regarding deaths amongst known injecting drug abusers were gathered for the same period. Results: A total of 57 patients with a history of active injecting drug use were admitted to intensive care or approximately 1% of admissions, most often for overdose (52%) or life threatening infections (39%). Median age was 26, males were 66%. The most common substances used were prescription drugs. Hospital mortality was 16% and five year survival 65%. Average time from hospital discharge to death was 916±858 days. during the study period 38 deaths of individuals with a history of injecting drugs were identified by forensic toxicology reports or 4.1/105 population/year (age 15-59). Cause of death was most often overdose (53%), usually from prescription opiates but multiple drug use was common. Discussion: The life expectancy of injecting drug abusers after inten- sive care admission is substantially decreased, with 35% death rate within five years. A widespread use of prescription drugs is of concern. Injecting drug abuse seems to be a similar health problem in magnitude in Iceland as in other Scandinavian countries. key words: injecting drug abuse, ICU admission, prescription drugs, drug addict deaths, long term survival. Correspondence: Kristinn Sigvaldason, krisig@landspitali.is injecting drug abuse: Survival after intensive care admission and forensic toxicology reports at death Kristinn Sigvaldason1, Thoroddur Ingvarsson1, Svava Thordardottir2, Jakob Kristinsson3, Sigurbergur Karason1,3 Heimildir 1. Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 2012; 379: 55-70. 2. Ársskýrsla SÁÁ 2007-2010, saa.is - september 2014. 3. Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. for the 2007 reference group to the UN on HIV and Injecting drug use. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008; 372: 1733-45. 4. Steentoft A, Teige B, Holmgren P, Vuori E, Kristinsson J, Kaa E, et al. Drug addict deaths in the Nordic countries: a study based on medico-legally examined cases in the five Nordic countries in 1991. Forensic Sci Int 1996; 77: 109-18. 5. Steentoft A, Teige B, Ceder G, Vuori E, Kristinsson J, Simonsen KW, et al. Fatal poisoning in drug addicts in the Nordic countries. Forensic Sci Int 2001; 123: 63-9. 6. Steentoft A, Teige B, Holmgren P, Vuori E, Kristinsson J, Hansen AC, Ceder G, et al. Fatal poisoning in Nordic drug addicts in 2002. Forensic Sci Int 2006; 160: 148-56. 7. Wiese Simonsen K, Normann PT, Ceder G, Vuori E, Thordardottir S, Thelander G, et al. Fatal poisoning in drug addicts in the Nordic countries in 2007. Forensic Sci Int 2011; 207: 170-6. 8. Jones L, Pickering L, Sumnall H, McVeigh J, Bellis MA. Optimal provision of needle and syringe programs for injecting drug users: A systematic review. Int J Drug Policy 2010; 21: 335-42. 9. Wiessing L, Klempová D, Hedrich D, Montanari L, Gyarmathy VA. Injecting drug use in Europe: stable or declining. Euro Surveill 2010; 15: 19604. 10. Frischer M, Bloor M, Goldberg D, Clark J, Green S, McKeganey N. Mortality among injecting drug users: a critical reappraisal. J Epidemiol Comm Health 1993; 47: 59-63. 11. Copeland L, Budd J, Robertson JR, Elton RA. Changing patterns in causes of death in a cohort of injecting drug users, 1980-2001. Arch Intern Med 2004; 164: 1214-20. 12. Rannsóknarnefnd samgönguslysa (áður Rannsóknarnefnd umferðaslysa). Banaslys í umferðinni. Skýrslur frá 2003- 2007. ww2.rnu.is 13. Ríkislögreglustjóri. Afbrotatölfræði 2009; 24, tafla 6. Fíkniefni sem lögregla og tollgæsla lagði hald á árið 2004 til 2009. Reykjavík 2009. 14. Kronstand R, Druid H, Holmgren P, Rajs J. A cluster of fentanyl-related deaths among drug addicts in Sweden. Forensic Sci Int 1997; 88: 185-95. 15. Lankenau SE, Teti M, Silva K, Bloom JJ, Harocopos A, Treese M. Patterns of prescription drug misuse among young injection drug users. J Urban Health 2012; 89: 1004- 16. 16. Psychotropic Substances. Statistics for 2007. Report from the International Narcotics Control Board 2008. United Nations 2009: 39. 17. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Apache ii: A severity of disease classification system. Crit Care Med 1985; 13: 818-29. R a n n S Ó k n
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