Penny Buykx1,2, Paul Dietze13, Alison Ritter4 , Sandy Gifford5, Craig Smith6 and Stephen Burgess7
1 Turning Point Alcohol and Drug Centre
2 National Drug Research Institute, Curtin University
3 Monash Institute of Health Services Research, Monash University
4 National Drug and Alcohol Research Centre
5 School of Health Sciences, Latrobe University
6 Faculty of Education, Deakin University
7 Department of Community Emergency Health & Paramedic Practice, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
Currently, little is known about the treatment pathways and outcomes for people who survive non-fatal medication overdoses.This research was designed to;
- estimate the prevalence of non-fatal medication overdose
- identify the role of depression and attempted suicide in non-fatal medication overdose (including exploration of the treatment experiences and social circumstances of overdose survivors)
- document how overdose is currently managed in the acute health care system.
To address these objectives, four main forms of data collection were used. These included:
- an audit of St Vincent’s Emergency Department Patient Administration System
- in-depth interviews with medication-overdose survivors
- observations of overdose-management practices within the context of the wider operations of the Emergency Department
- interviews with professionals from other hospitals.
There were over 400 medication overdose presentations to St Vincent’s Emergency Department during the 12-month data collection period. Females aged in their mid-30s who had ingested benzodiazepines, presented most frequently. The rate of presentation was relatively consistent across months of the year and days of the week, but appeared to peak in the late evening. Most medication overdoses appeared to involve some degree of suicidal ideation associated with depression and/or anxiety. However, only a small number were unambiguous suicide attempts. Most medication overdose survivors received some form of psychosocial assessment and/or referral prior to discharge from the Emergency Department.
The sample generally received treatment in a timeframe that accorded with the assessed urgency of the case and the majority were discharged from the Emergency Department within six hours of receiving treatment.
Most of the medication overdoses did not result in admission for further treatment, with the majority discharged directly to home from the Emergency Department.
The practices and processes in place at St Vincent’s appeared to largely correspond to those evident in other hospitals in Melbourne.
Implications for policy and practice
This research highlights the nature and extent of medication-overdose presentations at one major Emergency Department in Melbourne. The issue of medication overdose is significant, as these overdoses are indicative of mental health issues and are a likely risk factor for future self-harming behaviour.
The finding that benzodiazepines predominate among the medications consumed in overdose, and further, that many patients interviewed were prescribed these medications for a prolonged period of time, suggests that the misuse of this class of medications may be especially problematic.
Nonetheless, this research also highlights other medication types involved in overdose.
The system for managing the mental health issues presented by overdose events appears to be adequate, especially when compared with some practices documented overseas.
Future research in this area should focus on working with the prescribers of medication to ensure that their patients are adequately monitored, particularly those at risk of self harm. Further, the effectiveness of the psychosocial assessment and referral processes provided to medication-overdose patients prior to their discharge from the Emergency Department needs to be better understood.
About the researcher
Associate Professor Paul Dietze has achieved a strong profile in research related to the epidemiology of alcohol and other drugs. He worked in this field for over 10 years during which time he has established surveillance systems, as well as conducted specific research projects that break new ground in the epidemiology of heroin overdose in particular. Paul has been involved in the development and implementation of a variety of intervention initiatives including the Direct Response to Overdose (DROP) project. He co-convenes the Victorian Injecting Drug Harm Reduction Network with the Victorian Department of Human Services through which research findings on injecting drug use are disseminated to the alcohol and drug field.
Associate Professor Wendy Loxley of the National Drug Research Institute, Curtin University, for her helpful advice on the project and review of drafts, and to Dr Andrew Dent, Director, Emergency Department, St Vincent’s Hospital for his support of the project.