BARBITURATES are no longer routinely prescribed in Australia but despite this, since 2000 the population rate of intentional self-harm due to them has increased, to the point that the major harm associated with these drugs is now suicide, according to research published today by the Medical Journal of Australia.
Researchers from UNSW Sydney’s National Drug and Alcohol Research Centre (NDARC), and the University of the Sunshine Coast analysed national data on barbiturate-related hospitalisations, drug treatment episodes, and deaths in order to calculate population rates and average annual percentage change in rates.
“We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods,” wrote the authors, led by Professor Shane Darke from NDARC.
“The barbiturate-related hospitalisation rate declined from 0.56 in 1999‒2000 to 0.14 per 100 000 population in 2017‒18.
“The population rate of barbiturate-related deaths increased from 0.07 in 2000–01 to 0.19 per 100 000 population in 2016–17; the rate of intentional self-harm deaths increased, but not that of accidental deaths.”
Darke and colleagues wrote that almost two-thirds of hospitalisations were linked with deliberate self-harm, “confirming the continued association of barbiturates with suicide”.
“Further, mental health diagnoses (particularly mood disorders) were recorded in nearly three in five hospitalisations, and physical health diagnoses were also common.
“The frequency of epilepsy diagnoses is probably linked with the use of barbiturates to treat some patients with this condition.
“Overall, the burden of disease for people admitted to hospital with barbiturate-related harms was considerable, and attempted suicide was the most frequent reason for their admission.”
Darke and colleagues wrote that barbiturates were widely prescribed in the 20th century as anxiolytics, hypno-sedatives, and anticonvulsants, but were removed from routine care because of high rates of toxicity, dependence, and high levels of poisoning.
“Barbiturates are no longer routinely prescribed for humans, except those with rare indications such as induction anaesthesia and refractory epilepsy; during the period 2001‒2015, the annual number of prescriptions in Australia declined from 50 000 to 27 000,” they wrote.
“While the prescribing and community use of barbiturates has declined, their increased use for intentional self-harm, particularly by people with mental health problems, is worrying.
“Clinicians should be aware of their association with suicide when prescribing these drugs. Access to barbiturates via the internet is a difficult public health and border control problem. Although their use for medically supervised euthanasia is now legal in some Australian states (but not during the period covered by our analysis), restricting access to these high lethality drugs remains important, particularly to people with mental health disorders.
“Whether the availability of medically supervised euthanasia reduces the online purchasing of these drugs will be a question of major public health interest.”
If you or someone you know is having suicidal thoughts, there are people here to help. Please seek out help from one of the below contacts:
- Lifeline | 13 11 14
24-hour Australian crisis counselling service - Suicide Call Back Service | 1300 659 467
24-hour Australian counselling service - beyondblue | 1300 22 4636
24-hour phone support and online chat service and links to resources and apps
- Cate Swannell