Wednesday, November 9, 2011

Coroner's Report -Canadian Society of Addiction Medicine 2011

Dr. Karla Pederson of the BC Coroner's Office presented their findings on the mortality associated with drug abuse.  Dr. Karla Pederson was quick to say that the Coroner's Office was there for 'fact finding" not "fault finding".  She said , "There is no good news at the Coroner's office. We see the worst of the worst".  The following are some of the notes I took but they really don't do justice to a far reaching and very compelling presentation.
Classify death
5 categories
natural, accident, suicide, homicide, undeterminied

1)RX  Opiate Death
Cases represent person overdosing on opiate medications prescribed to them
Deaths due to opiates 2005 to 2009  - consistent - 67-80 deaths each year
61% accidental
35% sucidial
4% undetermined
gender 50/50
2)Illicit Prescription death
-start as triplicate prescription
they started as legitimate prescription but went to someone else
‘street drugs’ are excluded
pharmacy robberies happen but marjority go back to a prescription pad in doctor's office
90 to 125 deaths due to diverted medication
Primarily male problem
30 -39  principal age
seen in all regions but more in metro areas and sold on the street

Illicit and Rx Opiate deaths - may be on rise
95% are accidental deaths
problem seems more criminal
3) RX Methadone Deaths
Prescription methadone
Overdose deaths where relevant drug was methadone
Methadone precribed to individual for maintenance or for pain
It's recognised that this is harm reduction model and harm reduction patient
Carries are a common theme, but no universal
Also high starting doses, too much initital dose
60% male 40% female
40 - 59
Happening in all regions
85% accidental 9% suicidal

4) Illicit Methadone deaths
Person was not on methadone
Uniformly has to be a carry diversion
40 50 yo population peak

The take home message here was 'a carry can end up anywhere".

The presentation was extremely well conceived and brought together. Dr. Pederson was a remarkable professional and handled the most difficult questions at the end with amazing dexterity. There was concern among the physicians with the direct buying of drugs from other countries and access across borders.  The contrasting message of physicians not treating pain sufficiently or clients complaining that doctors don't give them sufficient methadone replacement medication in a timely fashion was all brought together. Especially concerning was the prescribing of excessive benzodiazepines by physicians other than the methadone doctors and the respiratory failures being ascribed as a 'methadone death'.  Indeed the discussion was one of the best following a presentation and Dr. Pederson did a marvellous job of answering the wide range of questions.  Obviously physicians as well as the coroner's office were especially concerned about death.
"First do no harm" was a concern we all shared.

No comments: