Exploring coronial determination of intent for poisoning-related deaths in Australia, 2001–2013
Open accessAbstract
BACKGROUND: In countries like the United States and the United Kingdom, systematic variation in the classification of intent in pharmaceutical poisoning deaths have been identified between jurisdictions. This study aimed to explore whether the coronial determination of intent (unintentional, intentional, undetermined) for pharmaceutical-related poisoning deaths may have affected death rates over time and by jurisdiction in Australia. METHODS: A retrospective examination of mortality records in the National Coronial Information System (NCIS) during 1 January 2001 to 31 December 2013 was conducted. The NCIS is a national internet-based data storage and retrieval system for deaths that were notified to a coroner. Pharmaceutical deaths due to unintentional, intentional or undetermined intent were identified using the NCIS classification. Proportions of the different intent classifications and the mortality rates by intent over time were compared between jurisdictions. RESULTS: There were 17,895 pharmaceutical-related poisoning deaths in Australia between 2001 and 2013 that had closed cases in the NCIS. Proportions of deaths classified as unintentional (48.3-66.3%), intentional (24.7-35.9%) and undetermined (6.7-24.7%) varied significantly among Australian jurisdictions. There were significant increases in the rate of classification of unintentional poisoning for some states, and significant increases in intentional poisoning classification in Western Australia, and decreases in New South Wales and Victoria. There was no significant change in classification of undetermined intent. CONCLUSIONS: Significant variation in classifications of intent, both between state jurisdictions and over time, may be the result of regional differences in demographics and increases in prescription drug misuse. However, the inconsistent use of 'undetermined' intent between state jurisdictions suggests coroners may experience varying difficulty in retrospectively ruling on intent in the equivocal circumstances of pharmaceutical poisoning. The widespread use of psychological autopsy may assist coroners to classify intent, while the implementation of new classifications for pharmaceutical poisoning death may overcome some of the inherent difficulty in intent classification and improve the potential for injury surveillance irrespective of intent.
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The widespread use of medical drugs, also due to medical prescriptions, has increased over time, as indicated by a selected study conducted in France.
“The widespread use of these medical drugs, also due to medical prescriptions, has increased over time, as indicated by the selected study conducted in France.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [50]
The Background (page unavailable) reports increasing use and misuse of prescription opioids in Australia, which supports a narrower version of the trend. The paper does not report a study conducted in France or establish that use of medical drugs generally increased over time. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn Australia, an increasing trend of deaths due to intentional consumption of poison was observed, with a significant increase in medical prescription drugs, especially opioids, as in other high-income countries.
“In Australia, according to a recent study [50], an increasing trend of deaths due to intentional consumption of poison was observed, with a significant increase in medical prescription drugs, especially opioids, as in other high-income countries.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [50]
The Discussion reports significant increases in intentional pharmaceutical-poisoning mortality rates across Australia from 2001 to 2013, with decreases in New South Wales and Victoria. The Background links increased prescription-opioid use and misuse specifically to unintentional poisoning; the paper does not establish that opioids drove the increase in intentional deaths or that the same intentional-death trend occurred in other high-income countries. (LLM, conf=0.88)
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References 27 · Cited by 6
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- Authors
- Churruca, K., & Mitchell, R.
- Affiliations
- Macquarie University (AU)
- Corresponding author
- Churruca, Kate
- Venue
- BMC Public Health
- Published
- 2017-08-01
- Volume
- 18
- Issue
- 1
- Pages
- 83-83
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5540196
- OpenAlex
- W2742147716
- Cited by
- 6
- References
- 27
- Citations by year
- 2022: 4 · 2021: 1 · 2019: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Update notices
- erratum (2017-09-22)
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Coronial Information System
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- intent classification, accidental poisoning, intentional poisoning, prescription drug misuse, psychological autopsy, injury surveillance, jurisdictional variation, Australia
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Australia, Cause of Death, Child, Child, Preschool, Coroners and Medical Examiners, Female, Forecasting, Humans, Infant, Infant, Newborn, Male, Middle Aged, Poisoning, Retrospective Studies, Suicide, Young Adult
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