You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Poisonings

Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?

 

More background on our blogging team

19 Jun, 15 | by Bridie Scott-Parker

Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!

What excites you about being part of the Injury Prevention social media editorial team?  

Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.

David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide.  This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.

Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.

Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.

Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.

Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.

What are you passionate about?

Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.

David Bui: Passionate about bringing people and ideas together.

Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.

Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).

Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.

Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.

 

I hope you are looking forward to hearing from our bloggers, starting next month!

More background on our new blogging team

18 Jun, 15 | by Bridie Scott-Parker

Today I will share more about our blogging team members.

Blog 2: Explain your injury prevention research and interests.

Sheree Bekker: My research investigates safety promotion and injury prevention policy and practice within community sport in Australia. I have a particular interest in dissemination and social marketing. The overall purpose of my research is to allow people to be safe, as well as feel safe, whilst participating in sport or physical activity.

David Bui: Undertaking a number of different projects currently; my injury prevention research focuses on Hip fracture and Falls Prevention research, working with Neuroscience Research Australia. I am also looking into Social Media and its utility in healthcare and civilian settings, and I believe that it represents a powerful new medium in health promotion and injury prevention.

Angy El-Khatib: I am interested in integrating public health approaches with athletic training practice. Athletic training has traditionally focused on the individual but may be able to maximize the effectiveness of prevention efforts by using population-level approaches to improve health and wellness.

Klara Johansson: I am not currently doing research on injury/safety. But I am interested in social difference in injury risk – and also how perceived risk of injuries affects people’s daily lives, mobility, fears and physical activity; and how perceived and real injury risks interrelate with each other and with gender and socioeconomics. Main focus on adolescent safety; real and perceived. Also interested in open data and availability/accessibility of injury statistics globally.

Joseph Magoola: My research interests center around prevention of injury, especially through generation of data for evidence-based decision making and policy action. I am also interested in the use of media to disseminate research findings and for advocacy.

Julian Santaella-Tenorio: At the moment I conduct research on policy evaluation, specifically on policies that impact injury-related outcomes. I am interested in looking at substance use policies and firearm-related legislation and their effects on the health of populations.

Tomorrow: Learn about their passions!

Medical marijuana laws associated with decreased fatal opioid overdoses in the US

8 Sep, 14 | by gtung

Really interesting paper published by Bachhuber and colleagues recently in JAMA Internal Medicine looking at the association between medical marijuana laws and opioid analgesic overdose in US states from 1999-2010.

http://archinte.jamanetwork.com/article.aspx?articleid=1898878

They found an association between states with medical marijuana laws and decreased fatal opioid overdoses. To be exact, a 24.8% decrease in fatal opioid overdoses in medical marijuana states compared to nonmedical marijuana states. The authors were careful to point out that their analysis did not highlight a potential mechanism of action but they did discuss the potential that the use of medical marijuana to manage pain by those patients that might have otherwise used some or more opioids may have contributed to the decreased overdoses.

The findings from this study are especially interesting given the continued rise of opioid overdose deaths and the ongoing experiment with both medical and recreational marijuana in the United States. Additional research needs to be done in this area including all of the potential impacts (good and bad) of recreational marijuana in what seems inevitably to be the increasing number of states to legalize it.

The next frontier in protecting children from recreational marijuana in Colorado

3 Feb, 14 | by gtung

The U.S. state of Colorado operationalized the legalization of recreational marijuana at the beginning of this year.  You can now walk into one of 34 marijuana dispensaries in the state and buy a diversity of marijuana products that range from just buds (which you smoke) to all kinds of edible products.  The options go far beyond the pot brownies and cookies that typically first come to mind.  There are marijuana infused juices, gummy candies, lollipops, and the list goes on and on.

A previous blog posting discussed the introduction of child resistant packaging requirements to prevent unintentional marijuana ingestions by young children.  In a nutshell, a group of researchers led by me used the Health Impact Assessment framework to make an evidence-based recommendation to the state to adopt child resistant packaging requirements for all marijuana products.  The state of Colorado ultimately adopted those recommendations.  You can read more about the HIA here…

http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/piper/projects/Documents/HIA%20Final%20Report%208.20.2013.pdf

In ongoing efforts to try to protect children from marijuana, there is now an active debate surrounding potential restrictions on what edibles should be infused with marijuana.  A nice overview of some of the considerations appeared in a New York Times article over the weekend.

http://www.nytimes.com/2014/02/01/us/snacks-laced-with-marijuana-raise-concerns.html?_r=0

This is sure to be an issue in Colorado’s state legislature this year.  There is of course the question of whether marijuana should be legal at all but in Colorado where voters have already decided this issue, one of the many outstanding questions is should certain restrictions be placed on what can be infused with marijuana and if so what should they be?  Are gummy candies somehow worse (inherently more appealing to children) than cookies or brownies?  Should there even be edibles or should there just be pills for those not interested in smoking it?  These are questions that the Colorado State Legislature are sure to have to grapple with and ultimately strike a balance with what the state’s voters have determined is an adult’s decision around recreational marijuana use.

Buprenorphine

20 Nov, 13 | by gtung

There is a very interesting in-depth series in the New York Times on the benefits and dangers of the use of buprenorphine to treat opioid addiction.

http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html

Buprenorphine is a semi-synthetic opioid that has become a major treatment option for those who are addicted and dependent on opioids.  At the same time it has itself become a recreational drug, poisoning risk, and a growing problem for law enforcement.  The NYT series does a very nice job of presenting both sides of the issue; from individuals that attribute buprenorphine with saving their lives to law enforcement officers that are seeing buprenorphine on the streets and in prisons as a recreational drug that carries its own addiction and overdose risks.  Wrapped up in all of this is the fact that buprenorphine is major business for the pharmaceutical companies that manufacture it.  All of this continues to highlight the difficulty in finding effective solutions to address the epidemic of addiction and poisonings related to opioids.

Greg

Preventing Unintentional Ingestion of Marijuana by Children

26 Aug, 13 | by gtung

Editor Note – The following guest blog post is by Jodi Duke, MPH.  Jodi is a PhD student in the Health Systems, Management and Policy Department at the Colorado School of Public Health.  Disclosure – I am a coauthor on Health Impact Assessment discussed in this post. 

A number of states and municipalities in the United States have partially or fully decriminalized marijuana for medical and non-medical purposes.  In 2000 Colorado legalized medical marijuana and in 2012 voters passed Amendment 64 fully legalizing recreational marijuana use to those 21 years and older.

The availability, variety, and appeal of marijuana and marijuana-infused products are expected to expand rapidly – potentially increasing accidental ingestions by children.  Products of interest include infused fruit drinks, candies, and baked goods.  In July 2013, the state of Colorado began developing a comprehensive set of regulations for the retail marijuana industry.  Of the issues being considered, packaging to mitigate unintentional ingestion by children was one.

A team of us, working on behalf of the Children’s Health Advocacy Institute at Children’s Hospital Colorado and the Pediatric Injury Prevention Education and Research Program at the Colorado School of Public Health, conducted a Health Impact Assessment (HIA) focused on packaging of retail marijuana products to reduce unintentional ingestion by children. An HIA is a combination of procedures, methods, and tools used to develop recommendations for decision-makers. It combines available scientific evidence with stakeholder opinions, beliefs, and needs. Our HIA resulted in recommendations as well as a set of model regulatory language. Both were rooted in scientific evidence and were sensitive to the needs of stakeholders (including industry and government).

Our HIA found that US Consumer Product Safety Commission-defined child resistant (CR) packages have been highly effective in reducing accidental ingestions of pharmaceuticals and other products by children and that CR packaging would likely decrease unintentional ingestions of marijuana by children as well.  Our review of the evidence and stakeholder input also supported a recommendation that CR packages be opaque.  Opaque packing reduces the ability to see a product and could help decrease accidental ingestions by limiting the appeal to children. We also recommended that packages be re-closeable.  Many marijuana products (i.e. cookies and brownies) can be consumed at multiple times and re-closeable packing is necessary for unconsumed product.  Our final recommendation was that allowances be made to re-use appropriate packaging consistent with manufacturer recommendations.  Stakeholders had a desire to reduce the environmental impact of CR packages which lead to our recommendation that the state of Colorado should allow for their appropriate re-use.

Colorado’s regulations related to marijuana have not been finalized but draft regulations released by the state have already incorporated the HIA’s recommendations.  A link to our HIA report and recent press coverage in the Denver post is included below.

HIA Report:  http://www.ucdenver.edu/academics/colleges/PublicHealth/research/ResearchProjects/piper/projects/Documents/HIA%20Final%20Report%208.20.2013.pdf

Denver Post:  http://www.denverpost.com/breakingnews/ci_23919309/proper-packaging-could-cut-accidental-pot-ingestions-by

CNS Prescription Drug Abuse

13 Aug, 13 | by gtung

A recent report by the Substance Abuse and Mental Health Services Administration in the United States highlights the fact that prescription drug abuse is not limited to painkillers but extends into other classes of drugs including central nervous systems stimulants.

http://www.samhsa.gov/data/spotlight/spot103-CNS-stimulants-adults.pdf

These stimulants are used to treat conditions such as attention deficit hyperactivity disorder but are increasingly being abused in nonmedical ways including recreational use and as study aids. In 2005, there were an estimated 5,605 emergency department visits among young adults age 18 to 34 related to central nervous system stimulants. 22% of those visits were also alcohol-related. Fast forward to 2011 and an estimated 22,949 emergency department visits among those age 18 to 34 were related to central nervous stimulants with 30% of those being alcohol-related.

There has been a tremendous amount of attention paid to the abuse of prescription painkillers in the United States and justifiably so. According to the US Centers for Disease Control and Prevention, almost 15,000 people died in 2008 from prescription painkillers.

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

The problem of prescription painkiller abuse deserves focused attention but the issue should also be viewed within the context of prescription drug abuse more broadly.

 

Opioid Pain Reliever Overdoses Among U.S. Women

9 Jul, 13 | by gtung

A recent Morbidity and Mortality Weekly Report by the U.S. Centers for Disease Control and Prevention (CDC) highlights the worsening epidemic of deaths due to overdoses of prescription pain relievers among U.S. women.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6226a3.htm?s_cid=mm6226a3_w

The report, which examined data from the National Vital Statistics System and the Drug Abuse Warning Network found that the number of deaths due to prescription opioids among women increased more then five times from 1999 to 2010.  During the same time period the number of deaths among men increased 3.6 times.  More men then women still die from opioid pain reliever overdoses but the numbers are increasing faster for women.

Another important finding of the report is that despite being the number three reason for emergency room visits behind heroine and benzodiazepines, opioid pain relievers were responsible for four times more actual deaths then heroine and cocaine combined.  The 2010 rate of opioid pain reliever poisonings was estimated to be 4.2 per 100,000 women.

The CDC report mentions the use of prescribing guidelines and prescription drug monitoring programs as public health interventions to address the epidemic but failed to recognize that the evidence base for these promising interventions is still evolving.  The report also failed to mention the potential role of overdose education and naloxone distribution programs as part of a comprehensive strategy to address the opioid poisonings, an evidence based approach endorsed by the American Public Health Association.

http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1443

Despite the existence of some promising interventions, the reality is that the epidemic of overdoses from prescription opioids is running rampant and there is a critical need for additional research to identify ways to slow the epidemic and hopefully bring it under control.

Latest from Injury Prevention

Latest from Injury Prevention