Suicide, risque d'overdose élevés quand les toxicomanes quittent l’hôpital. sur Medlineplus d'après un communiqué de Reuters santé mercredi 29 aout 2012
Résumé : D'après étude au royaume uni, les taux de suicides et de décès par overdose ont été plus de 10 fois plus élevé chez les utilisateurs de drogue sortis de l'hôpital depuis moins d'un mois que pour ceux sortis depuis plus d'un an.
«Comme la libération de prison, la sortie de l'hôpital marque le début d'une période bien définie de vulnérabilité accrue pour les patients en soin pour la toxicomanie», écrivent Elizabeth Merrall de l'Unité de biostatistique MRC à Cambridge et ses collègues dans leur rapport.
Leur étude, publiée dans la revue Addiction, est fondée sur les dossiers de près de 70.000 personnes en Ecosse traités pour un certain type de toxicomanie.
En reliant les registres nationaux avec des enregistrements de traitement, les chercheurs ont constaté que les décès par overdose et par suicides sont plus fréquents durant l'hospitalisation - probablement parce que de nombreux patients admis pour ces mêmes problèmes et dont la réanimation a échoué.
Mais même après la sortie les taux restent élevés. Dans les 28 premiers jours, il y avait 21 décès liés aux drogues pour 1000 personnes par an, comparativement à 4,2 pour 1000 habitants par an pour les plus d'un an . Le taux de surdosage a été encore plus faible chez les utilisateurs qui n'avaient jamais été hospitalisés.
Les suicides non liés à la consommation de drogues est passé de 3,9 pour 1.000 personnes par an pour ceux sortis dans les premiers mois à moins d'un pour 1000 habitants par an, pour les après un an.
Référence de l'étude citée"A record-linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996-2006 Elizabeth LC Merrall1,*, Sheila M. Bird1,2, Sharon J. Hutchinson2,3 / 1- MRC Biostatistics Unit, Cambridge 2 -Department of Mathematics & Statistics, Strathclyde University, Glasgow 3 Health Protection Scotland, Glasgow*
MRC Biostatistics Unit Robinson WayCambridge, CB2 0SR Email: Elizabeth.merrall@mrc-bsu.cam.ac.uk
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TEXTE ORIGINAL medline plus (Lien)
Suicide, OD risks high when addicts leave hospital
By Frederik Joelving - 29/08/2012
NEW YORK (Reuters Health) - Drug users just getting out of the hospital have another rough patch in store, according to a new UK report showing elevated death rates among freshly discharged patients.
Rates of suicides and overdose deaths were more than 10 times higher for drug users who had been out of the hospital for less than a month than for those who had been out for at least a year, researchers found.
"Like prison-release, hospital discharge marks the start of a well-defined period of heightened vulnerability for drug-treatment clients," Elizabeth Merrall of the MRC Biostatistics Unit in Cambridge and colleagues write in their report.
Their study, published in the journal Addiction, is based on records from nearly 70,000 people in Scotland who had been treated for some type of substance abuse.
By linking national registers with treatment registrations, the researchers found that overdose deaths and suicides were most common during hospital stays - likely because many patients were admitted for these very problems and resuscitation was unsuccessful.
But even after discharge the rates remained high. In the first 28 days, there were 21 drug-related deaths per 1,000 people per year, compared to 4.2 per 1,000 people a year or more later. The overdose rate was even lower among users who had never been hospitalized.
Suicides unrelated to drug use dropped from 3.9 per 1,000 people per year in the first month to less than one per 1,000 people per year after a year.
It's possible that drug users, particularly those dependent on heroin or prescription opioids, start binging after they get out of the hospital or lose some of their drug tolerance at the hospital, making it easier to overdose, said Dr. Patrick G. O'Connor.
"You do start to lose some tolerance right away," explained O'Connor, an addiction expert at Yale School of Medicine in New Haven, Connecticut, who was not involved in the research. "I think the loss of tolerance is a contributor, but there are probably other factors as well."
It could be, as suggested by the UK researchers, that "hospital contact may simply represent a desperate, sometimes final, call for help."
But a few days at the hospital are not going to fix a life that is threatening to collapse, O'Connor said, adding that many substance abusers may need housing, jobs and psychiatric help.
"For drug users who leave the hospital, we need to be able to provide instantaneous and tight linkages for these patients to at least three services: primary care services, social services and drug treatment services," he told Reuters Health.
While Scotland has a national overdose prevention program and universal healthcare, many people in the U.S. don't even have basic health insurance, "so the approach is even more important in our environment," O'Connor added.
REFERRALS UPON DISCHARGE?
It's estimated that some 3.7 million Americans have used heroin at some point in their lives and in 2008 alone, opioid pain relievers such as Vicodin were involved in 14,800 deaths.
The drug naloxone works as an antidote to heroin and other opioids and is available freely from more than 180 overdose prevention programs across the U.S., according to Eliza Wheeler of the Harm Reduction Coalition, a national drug user advocacy group.
But most hospitals are unlikely to refer drug users to such programs upon discharge, she told Reuters Health. A national overdose program locator can be found at http://hopeandrecovery.org/resources
"There has been some effort to implement those programs in a more clinical setting," Wheeler said, "but it has been a slow process."
SOURCE: http://bit.ly/OxHR8i Addiction, online August 24, 2012.
Reuters Health
