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2. Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Author

Layne, Kerry, Dargan, Paul, Dines, Alison, Leaper, Craig, Yates, Christopher, Hovda, Knut Erik, Heyerdahl, Fridtjof, Archer, John R.H., Giraudon, Isabelle, Wood, David, Anand, Lukasz, Anseeuw, Kurt, Badaras, Robertas, Bonnici, Jeffrey, Brvar, Miran, Burke, Rachel, Caganova, Blazena, Ceschi, Alessandro, Eyer, Florian, Galicia, Miguel, Geith, Stefanie, Gillebeert, Johan, Grenc, Damjan, Gorozia, Ketevan, Jaffal, Karim, Jürgens, Gesche, Konstari, Jutta, Kutubidze, Soso, Laubner, Gabija, Liakoni, Evangelia, Liechti, Matthias, Liguts, Viesturs, Lyphout, Cathelijne, Mégarbane, Bruno, Miró, Òscar, Moughty, Adrian, Noseda, Roberta, O'Connor, Niall, Paasma, Raido, Perez, Juan Ortega, Perminas, Marius, Persett, Per Sverre, Põld, Kristiina, Puiguriguer, Jordi, Radenkova-Saeva, Julia, Rulisek, Jan, Schmid, Yasmin, Scholz, Irene, Sopirala, Radhika, Stašinskis, Roberts, Surkus, Jonas, Toth, Ibolya, Vallersnes, Odd Martin, Vigorita, Federico, Waldman, Wojciech, Waring, W. Stephen, Zacharov, Sergej, Guy's and St Thomas' Hospital [London], King‘s College London, Hospital Universitari Son Espases, Oslo University Hospital [Oslo], European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Observatoire Européen des Drogues et des Toxicomanies, Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Euro-DEN Plus Research Group, and Mégarbane, Bruno

Subjects
medicine.medical_specialty, 030226 pharmacology & pharmacy, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Germany, Medicine, Humans, Pharmacology (medical), In patient, 030212 general & internal medicine, Tramadol, Pharmacology, Coma, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Glasgow Coma Scale, Emergency department, humanities, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Analgesics, Opioid, Europe, Pharmaceutical Preparations, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Emergency medicine, Africa, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, medicine.symptom, Emergencies, business, Emergency Service, Hospital, medicine.drug
Abstract

International audience; Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate

Published
2020

4. Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus.

Author

Layne, Kerry A., Dargan, Paul I., Dines, Alison M., Leaper, Craig, Yates, Christopher, Hovda, Knut Erik, Heyerdahl, Fridtjof, Archer, John R.H., Giraudon, Isabelle, and Wood, David M.

Subjects
TRAMADOL, GLASGOW Coma Scale
Abstract

Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro‐DEN Plus database for the 4‐year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments with a large proportion requiring admission to hospital for ongoing care. [ABSTRACT FROM AUTHOR]

Published
2021
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5. Impact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: a longitudinal study

Author

Barrera, Lena, Leaper, Craig, Pape, Utz J, Majeed, Azeem, Blangiardo, Marta, and Millett, Christopher

Subjects
Adult, Male, Adrenergic beta-Antagonists, Physician's Practice Patterns, Black People, Angiotensin-Converting Enzyme Inhibitors, GENERALIZED ESTIMATING EQUATIONS, Trend analysis, PHYSICIANS, 0807 Library And Information Studies, MANAGEMENT, Humans, Practice Patterns, Physicians', BLOOD-PRESSURE CONTROL, Diuretics, Antihypertensive drugs, PART II, THERAPEUTIC INERTIA, Antihypertensive Agents, African Continental Ancestry Group, Retrospective Studies, Science & Technology, Continental Population Groups, Primary Health Care, Health Policy, BETA-BLOCKERS, Racial Groups, Age Factors, Hypertension guidelines, Middle Aged, Primary care, Calcium Channel Blockers, HEALTH CARE SCIENCES & SERVICES, England, 1117 Public Health And Health Services, Hypertension, Practice Guidelines as Topic, Health Policy & Services, Female, CLINICAL-PRACTICE GUIDELINES, HEALTH, Guideline Adherence, Life Sciences & Biomedicine, Antihypertensive prescribing, Research Article
Abstract

Background In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. Methods A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. Results From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p

Published
2014

7. Impact of ethnic-specific guidelines for antihypertensive prescribing in primary care in England: a longitudinal study.

Author

Barrera, Lena, Leaper, Craig, Pape, Utz J., Azeem Majeed, Blangiardo, Marta, and Millett, Christopher

Subjects
*GUIDELINES, *ANTIHYPERTENSIVE agents, *DRUG prescribing, *PRIMARY care, *LONGITUDINAL method, *LOGISTIC model (Demography)
Abstract

Background In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. Methods A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. Results From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger nonblack patients (OR 0.16, 95% CI 0.12 - 0.21) and older non-black patients (OR 0.49, 95% CI 0.37 - 0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19 - 1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17 - 1.91) but not in older nonblack patients (OR 0.58, 95% CI 0.46 - 0.74). Conclusion The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups. [ABSTRACT FROM AUTHOR]

Published
2014
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