A retrospective analysis of pharmaceutical and non-pharmaceutical substance-related coronial deaths in South Australia over 20 years
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(Thesis)
Date
2023
Authors
Stephenson, Lilli Grace
Editors
Advisors
Van Den Heuvel, Corinna
Byard, Roger
Humphries, Melissa
Byard, Roger
Humphries, Melissa
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Thesis
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Abstract
Globally, drug use is a major contributor to disease, illness, injury, and death. In Australia, the National Drug Strategy (2017-2026) provides a framework to reduce the impact of health, social and economic harms associated with drug use. A key measure of the effectiveness of this strategy is the drug-related burden of disease, of which drug-related mortality is an important contributor. Irrespective of the reporting organisation, the rate of drug-related or drug-induced deaths has continued to increase over the last two decades. Importantly, the profile of drug-induced deaths has evolved with the social and economic landscape of the country. While reporting of drug-induced deaths at a national level provides important information about broad past and present trends, it is also necessary to understand the psychosocial and socioeconomic determinants of substance misuse to inform targeted and effective prevention strategies within local populations. The aim of the current research was to demonstrate the significance of findings derived from data retrieved from a national database, the National Coronial Information System, supplemented with detailed personal, geographical, and psychosocial decedent information collected from coronial autopsy reports from Forensic Science SA. A database of 2290 pharmaceutical substance-related deaths and 689 non-pharmaceutical substance-related deaths that occurred in South Australia (SA) between 2000-2019 was created, including approximately 60 variables related to the decedent history, circumstances surrounding the death and toxicology profile. The difficulties associated with interpretation of post-mortem toxicology due to pharmacokinetic, pharmacodynamic and environmental factors were also recognised and discussed. Wider analysis of the whole dataset revealed vastly different trends between pharmaceutical and non-pharmaceutical substance-related deaths, the former having drastically increased over the 20-year period and the latter having significantly decreased. Nearly half of pharmaceutical substance-related deaths were unintentional, in stark contrast to non-pharmaceutical substance-related deaths where more than 90% of cases were suicides. This finding highlights the importance of providing consistent and comprehensive analysis of not only pharmaceutical substance-related deaths, but those involving non-pharmaceutical substances, due to the significant proportion of cases associated with intentional self-harm. Several publications are presented within this thesis which examine specific drugs of interest that were identified during the wider analysis of the whole dataset. For pharmaceutical substance-related deaths, characteristics of deaths involving methadone, tapentadol, insulin and barbiturates were of significant interest. A trend of increasing hesitancy in assigning a classification of manner of death within the coronial system was also identified. To address this, a study was undertaken to compare decedent variables associated with an intent classification of either unintentional or intentional, to reclassify undetermined cases. A classification of unintentional was able to be provisionally applied to more than two thirds of the undetermined cases. For non-pharmaceutical substance-related deaths, carbon monoxide, pesticides, petrol (gasoline), and sodium nitrite exposures were analysed in detail. Due to the scope of this study, it was not possible to analyse all drugs and all decedent variables in greater detail although this provides an important avenue for future work.
School/Discipline
School of Medical Sciences
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, School of Biomedicine, 2024
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