Skip to main content
Log in

Changes in Fatalities Due to Overdose of Anxiolytic and Sedative Drugs in the UK (1983–1999)

  • Original Research Article
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

Objective: To establish the frequency with which anxiolytic and sedative drugs result in fatal poisonings and to examine longitudinal changes in poisoning deaths.

Method: The number of fatal poisonings between 1983 and 1999 in England, Scotland and Wales due to a single anxiolytic or sedative drug was obtained from the Department of Health in the UK. This was divided by the number of prescriptions for these drugs in England and Scotland to derive a fatal toxicity index (FTI) of deaths per million prescriptions.

Results: Chloral hydrate, clomethiazole, barbiturates, and related sedatives had much higher FTIs than benzodiazepines, buspirone, zolpidem and zopiclone. There has been a substantial reduction in the annual number of deaths from sedative drug poisoning between 1983 and 1999. This has been due to a sustained reduction in prescriptions for high toxicity drugs and more recently a major reduction in temazepam deaths that coincided with the withdrawal of gelatin capsule formulations.

Conclusion: Deaths would be expected to be further reduced if there were reduced prescriptions of high toxicity drugs — and the continuing need for short-acting barbiturates, clomethiazole and chloral hydrate should be questioned.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Buckley NA, Whyte IM, Dawson AH, et al. Correlations between prescriptions and drugs taken in self-poisoning: implications for prescribers and drug regulation. Med J Aust 1995; 162(4): 194–7

    PubMed  CAS  Google Scholar 

  2. Crome P. The toxicity of drugs used for suicide. Acta Psychiatr Scand Suppl 1993; 371: 33–7

    Article  PubMed  CAS  Google Scholar 

  3. King LA, Moffat AC. Hypnotics and sedatives: an index of fatal toxicity. Lancet 1981; I(8216): 387–8

    Article  Google Scholar 

  4. Serfaty M, Masterton G. Fatal poisonings attributed to benzodiazepines in Britain during the 1980s. Br J Psychiatry 1993; 163: 386–93

    Article  PubMed  CAS  Google Scholar 

  5. Buckley NA, McManus PR. Can the fatal toxicity of antidepressant drugs be predicted with pharmacological and toxicological data? Drug Saf 1998; 18(5): 369–81

    Article  PubMed  CAS  Google Scholar 

  6. King LA, Moffat AC. A possible index of fatal drug toxicity in humans. Med Sci Law 1983; 23(3): 193–8

    PubMed  CAS  Google Scholar 

  7. Office of National Statistics. Deaths from poisoning by solid or liquid substances: accidental, suicidal and undetermined whether accidentally taken or purposely inflicted, 1983–1999. London: HMSO, 2001

  8. Jackson GWL. Drug-related deaths in Scotland in 2000 [online]. Available from URL: http://www.gro-scotland.gov.uk/grosweb/grosweb.nsf/pages/00ddeaths [Accessed 2002 Dec 12]

    Google Scholar 

  9. Buckley NA, McManus PR. Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. BMJ 2002; 325: 1332–3

    Article  PubMed  Google Scholar 

  10. Lentner C. Geigy scientific tables. Vol. 2. Introduction to statistics: statistical tables. Mathematical formulae. 8th ed. Basle: Ciba Geigy Ltd, 1984

    Google Scholar 

  11. Ellenhorn MJ. Medical toxicology: diagnosis and treatment of human poisoning. 2nd ed. Baltimore (MD): Williams & Wilkins, 1998

    Google Scholar 

  12. Michel K, Waeber V, Valach L, et al. A comparison of the drugs taken in fatal and nonfatal self-poisoning. Acta Psychiatr Scand 1994; 90(3): 184–9

    Article  PubMed  CAS  Google Scholar 

  13. Marzuk PM, Tardiff K, Leon AC. Increase in fatal suicidal poisonings and suffocations in the year Final Exit was published: a national study. Am J Psychiatry 1994; 151(12): 1813–4

    PubMed  CAS  Google Scholar 

  14. Naik P, Lawton J. Pharmacological management of alcohol withdrawal. Br J Hosp Med 1993; 50(5): 265–9

    PubMed  CAS  Google Scholar 

  15. Robertson JR, Roberts JJ, Black H, et al. Management of drug abuse. Lancet 1987; II(8553): 284–5

    Article  Google Scholar 

  16. Ekeberg O, Ellingsen O, Jacobsen D. Mortality and causes of death in a 10-year follow-up of patients treated for self-poisonings in Oslo. Suicide Life Threat Behav 1994; 24(4): 398–405

    PubMed  CAS  Google Scholar 

  17. Madden JS. Alcohol and depression. Br J Hosp Med 1993; 50(5): 261–4

    PubMed  CAS  Google Scholar 

  18. Buckley NA, McManus PR. The fatal toxicity index (FTI) of anxiolytic and sedative drugs in the UK (1983-1999) [abstract]. J Toxicol Clin Toxicol 2002; 40(3): 344

    Article  Google Scholar 

  19. Gunnell D, Middleton N, Whitley E, et al. Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999. Br J Psychiatry 2003; 182: 164–70

    Article  PubMed  Google Scholar 

  20. Gunnell D, Wehner H, Frankel S. Sex differences in suicide trends in England and Wales. Lancet 1999; 353(9152): 556–7

    Article  PubMed  CAS  Google Scholar 

  21. Buckley NA, Dawson AH, Whyte IM, et al. Relative toxicity of benzodiazepines in overdose. BMJ 1995; 310(6974): 219–21

    Article  PubMed  CAS  Google Scholar 

  22. Buckley NA, Whyte IM, Dawson AH, et al. Self-poisoning in Newcastle, 1987-1992. Med J Aust 1995; 162(4): 190–3

    PubMed  CAS  Google Scholar 

  23. Dwyer PS, Jones IF. Fatal self-poisoning in the UK and the paracetamol/dextropropoxyphene combination. Hum Toxicol 1984; 3Suppl.: 145S–74S

    Article  PubMed  Google Scholar 

  24. Crompton B. Misuse of benzodiazepines: voluntary ban on prescribing is effective. BMJ 1994; 308(6945): 1709

    Article  PubMed  CAS  Google Scholar 

  25. Innes CF, Cotter JC, Davies P, et al. Misuse of temazepam. BMJ 1992; 305(6857): 832–3

    Article  PubMed  CAS  Google Scholar 

  26. Grahame-Smith DG. Misuse of temazepam [letter]. BMJ 1991; 302(6786): 1210

    Article  PubMed  CAS  Google Scholar 

  27. Hatzitolios AI, Sion ML, Eleftheriadis NP, et al. Parasuicidal poisoning treated in a Greek medical ward: epidemiology and clinical experience. Hum Exp Toxicol 2001; 20(12): 611–7

    Article  PubMed  CAS  Google Scholar 

  28. Feeney GF, Gibbs HH. Digit loss following misuse of temazepam. Med J Aust 2002; 176(8): 380

    PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Zoe Uren of the Office for National Statistics, Graham Jackson of the General Register Office for Scotland, Bill Gold of ISD, Primary Care Information Unit, Scotland, and Andy Savva of the Statistics Division of the Department of Health, England for supplying the data on which this analysis is based.

The authors have no conflicts of interest directly relevant to the content of this study. No sources of funding were used to assist in the preparation of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicholas A. Buckley.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buckley, N.A., McManus, P.R. Changes in Fatalities Due to Overdose of Anxiolytic and Sedative Drugs in the UK (1983–1999). Drug-Safety 27, 135–141 (2004). https://doi.org/10.2165/00002018-200427020-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002018-200427020-00004

Keywords

Navigation