STUDY - OVERDOSE CLOAKS SUICIDE ATTEMPT

Researcher Says Data Will Help Hospitals

In the emergency departments of St. Vincent Regional Medical Center
and Espanola Hospital, 47 percent of patients who overdosed on drugs
did so with the intent of killing themselves.

They tended to be women, ages 23 to 35, who combined multiple
substances, such as over-the-counter drugs, alcohol, tranquilizers,
muscle relaxants and antidepressants, to harm themselves, according
to a 14-month state Department of Health study of those two hospitals.

It's unknown how New Mexico's overdose suicide attempts compare with
other emergency departments around the country because such studies
aren't common. However, the fact that more females were treated for
nonfatal intentional overdoses than men corresponds with national trends.

"The only thing that I am finding surprising is the predominance of
prescription drugs," said Health Department researcher Nina Shah. "I
think it's important that that is addressed in terms of prevention
.. and in finding the context for why this is happening."

A great deal of attention for years has been focused on New Mexico's
severe drug problem. Little has been known about people in the state
who survive overdoses, however, so health authorities in 2003 decided
to make it a condition that hospitals must track.

Out of that came this pilot study of the two hospitals, located in
Santa Fe and Rio Arriba counties, which for multiple years have been
among the top 20 in the U.S. for rates of drug-overdose death.

"The first step is just to measure and see what's going on," Shah
said. "We have two years of data and it's very initial."

In all, emergency departments in Santa Fe and Espanola reported 561
overdoses or poisoning cases -- 34 of them repeat patients -- between
July 2004 and last August. Overdoses from alcohol only or poisons,
such as household cleaning solutions, weren't counted.

The study classified 35 percent as unintentional overdoses and 18
percent were of unknown intent.

In general, the typical overdose patient was around age 33, Hispanic
and living in a city. Men were slightly more represented than women.

Roughly half of overdose patients required hospitalization. Three
patients treated in 2004 subsequently died. The busiest seasons were
summer and spring. Death records for the 2005 patients weren't available.

Within a day or two of overdosing, patients often start using drugs
again, other research has shown. That's why it's important for
emergency departments to intervene. "In a locale where the
drug-related burden is severe and long-standing, evidence-based and
innovative strategies are warranted," Shah wrote.

About 7 percent of patients in the study overdosed again. In fact, 13
patients had more than three -- and as many as eight -- overdoses
during the period of the study. Repeat patients were more likely to
be Hispanics who overdosed on such substances as heroin, methadone,
tranquilizers and muscle relaxants, according to the study.

"Part of the gist of this whole thing is for EDs to understand that
they are an important window of opportunity," Shah said. "Coupled
with the finding that drug users are more likely to seek care in the
ED, I think these unique opportunities are important to capitalize on."

Shah said emergency departments should consider making these
interventions routine:

► Distribute customized overdose-prevention literature to
patients prior to their release from the hospital.

► Initiate brief discussions with patients about their drug
problems and their motivations for change.

►Refer patients to drug-treatment programs.

"It's not happening across the board," Shah said, "and I don't think
it has been made a priority in terms of what happens in an ED."

However, the study did not gather information on how many patients
got help in the emergency department for the underlying issues behind
their overdoses.

In future studies, Shah said, she will track whether patients
received overdose-prevention materials and treatment referrals before
leaving the emergency department.

Knowing the characteristics of overdoses in a community will help
guide those efforts. "In Espanola, it was largely young, Hispanic
males overdosing on heroin," Shah said.

Case managers there need to present treatment options and remind
those who overdosed not to mix heroin with alcohol, she said.

The trend was different for Santa Fe. "There's more prescription-drug
overdose in Santa Fe, so there might be a little more focus on that,"
Shah said.

Heroin and cocaine were common factors in unintentional overdoses,
whereas prescription drugs were more common in overdose-suicide
attempts, according to the study.

Dr. Frantz Melio, who heads the emergency department at St. Vincent,
said overdoses are taken seriously and treated on the spot. Crisis
counselors, available 24 hours a day, talk with patients and refer
them for drug treatment or psychiatric services, he said.

"I would absolutely agree that you have to talk to these individuals
soon after the event," Melio said. "We ... do that. Our services at
St. Vincent are actually quite good."

Although Santa Fe's emergency department has distributed literature
about preventing opiate overdoses, it has no literature specific to
prescription-drug overdoses, Melio said.

Nothing about the findings surprised Melio, who notes that
nonprescription drugs can be as lethal as prescription drugs -- and
can cause lasting liver damage. Depressed people wanting to hurt
themselves often reach for what's in the medicine cabinet.

He observed another distinction between overdose patients: "Patients
aren't doing cocaine and heroin to kill themselves. They're doing
that to get high."

The complicated aspect of the study was determining whether a patient
made a suicide attempt or simply a suicide gesture. Shah said
defining intent among drug users can be ambiguous.

"I'm trying to figure out a way to describe it more as a spectrum of
intent," she said. "It could be a true suicide. It could be a cry for
help. It could be indifference to what happens. And it could be a
true accident."

With patients often using multiple substances, interactions between
drugs can cause adverse reactions. Also, taking too much medication
to speed up the effect is a classic problem with a drug like
methadone -- a prescription drug used in the treatment of heroin
addicts -- because it's slow-acting, Shah added.

Espanola Hospital did not respond to multiple requests for comment.