Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths Time-Series Study 英文参考文献.docVIP

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Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths Time-Series Study 英文参考文献.doc

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Six-Year Follow-Up of Impact of Co-proxamol Withdrawal in England and Wales on Prescribing and Deaths Time-Series Study 英文参考文献

Six-YearFollow-UpofImpactofCo-proxamolWithdrawal inEnglandandWalesonPrescribingandDeaths:Time- SeriesStudy KeithHawton1*,HelenBergen1,SueSimkin1,ClaudiaWells2,NavneetKapur3,DavidGunnell4 1CentreforSuicideResearch,UniversityofOxfordDepartmentofPsychiatry,WarnefordHospital,Headington,Oxford,UnitedKingdom,2OfficeforNationalStatistics, Government Buildings, Newport, United Kingdom, 3Centre for Suicide Prevention, University of Manchester, Manchester, United Kingdom, 4School of Social and CommunityMedicine,UniversityofBristol,Bristol,UnitedKingdom Abstract Background:Theanalgesicco-proxamol(paracetamol/dextropropoxyphenecombination)hasbeenwidelyinvolvedinfatal poisoning. Concerns about its safety/effectiveness profile and widespread use for suicidal poisoning prompted its withdrawalintheUKin2005,withpartialwithdrawalbetween2005and2007,andfullwithdrawalin2008.Ourobjectivein thisstudywastoassesstheassociationbetweenco-proxamolwithdrawalandprescribinganddeathsinEnglandandWales in2005–2010comparedwith1998–2004,includingestimationofpossiblesubstitutioneffectsbyotheranalgesics. MethodsandFindings:WeobtainedprescribingdatafromtheNHSHealthandSocialCareInformationCentre(England) andPrescribingServicesPartneriaethCydwasanaethauGIGCymru(Wales),andmortalitydatafromtheOfficeforNational Statistics. We carried out aninterrupted time-series analysis of prescribing and deaths(suicide, open verdicts, accidental poisonings)involvingsingleanalgesics.Thereductioninprescribingofco-proxamolfollowingitswithdrawalin2005was accompanied by increases in prescribing of several other analgesics (co-codamol, paracetamol, codeine, co-dydramol, tramadol,oxycodone,andmorphine)during2005–2010comparedwith1998–2004.Thesechangeswereassociatedwith majorreductionsindeathsduetopoisoningwithco-proxamolreceivingverdictsofsuicideandundeterminedcauseof221 deaths(95%CI234to28)perquarter,equatingtoapproximately500fewersuicidedeaths(261%)overthe6years2005– 2010,and225deaths(95%CI238to212)perquarter,equatingto600fewe