Biochemical, Social and Psychiatric Aspects of Drug Overdoses

Abstract

In Part A investigations have been made into the problem of deliberate drug overdoses, with the intention of setting up a permanent data base for collection of clinical and social information about patients admitted to the West Midlands Regional Poisoning Treatment Centre after drug overdose incidents. This involved the development and use of a computer-coded questionnaire sheet. An analysis of the information collected over 40 months was carried out and confirmed many of the findings of similar reports from other geographical locations. The study probed deeper into the social aspects of the drug over~ dose problem than is usual and the clinical data was collected ina more purposeful fashion and involved more detailed description of symptoms and their associated drug levels in body fluids than previous studies. The study also reinforced the intentional nature of adult drug overdoses and suggested that the behaviour seen might itself be interpreted as a "coping strategy" to enable patients to deal with stressful situations rather than as a "cry for help" as is the view held at present by most workers in the field. It was evident that a high proportion of drug overdose patients took salicylate analgesics and that this proportion tended to be younger and to have bought the drug in large quantity containers. In Part B the metabolism and kinetics of salicylate were investigated in normal human volunteers and in overdosed patients. This involved the development of an improved colourimetric method for estimating salicylic acid in body fluids. The study yielded further evidence of the rate limitation of some of the pathways of salicylate metabolism. Lowering of brain glucose associated with salicylate overdose was observed for the first time in humans, confirming the interference of salicylate with carbohydrate metabolism in the central nervous system previously reported in animals. The study revealed that the ratio of salicylate in the cerebrospinal fluid to that in plasma did not reach the high levels previously reported in infants and this confirmed the difference in metabolic disturbances reported in different age ranges of salicylate overdose patients.