Simkin S, Hawton K, Sutton L, Gunnell D, Bennewith O, Kapur N
University of Oxford Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX.
QJM. 2005 Mar;98(3):159-70. doi: 10.1093/qjmed/hci026.
Restricting means for suicide is a key element in suicide prevention strategies of all countries where these have been introduced. Preventing deaths from analgesic overdoses is highlighted in the National Suicide Prevention Strategy for England. The problem of self-poisoning with the prescription-only drug co-proxamol (dextropropoxyphene plus paracetamol) has received attention in several countries. We have conducted a review of the international literature related to possible strategies to tackle this problem. In England and Wales in 1997-1999, 18% of drug-related suicides involved co-proxamol; these constituted 5% of all suicides. Death usually results from the toxic effects of dextropropoxyphene on respiration or cardiac function. Death from co-proxamol overdose may occur rapidly, the lethal dose can be relatively low, and the effects are potentiated by alcohol and other CNS depressants. The majority of co-proxamol overdose deaths occur before hospital treatment can be received. The risk can extend to others in the household of the person for whom the drug is prescribed. While there is limited evidence that educational strategies have been effective in reducing deaths from co-proxamol poisoning, initiatives in Scandinavia, Australia and the UK to restrict availability of co-proxamol have produced promising results. Given the paucity of evidence for superior therapeutic efficacy of co-proxamol over other less toxic analgesics, there are good reasons to question whether it should continue to be prescribed.
在所有已实施自杀预防策略的国家中，限制自杀手段是这些策略的关键要素。英国的《国家自杀预防战略》强调了预防因过量服用镇痛药导致的死亡。仅凭处方才能获取的药物复方丙氧氨酚（右丙氧芬加对乙酰氨基酚）的自我中毒问题在多个国家受到关注。我们对与解决这一问题的可能策略相关的国际文献进行了综述。在1997年至1999年的英格兰和威尔士，18%的与药物相关的自杀事件涉及复方丙氧氨酚；这些事件占所有自杀事件的5%。死亡通常是由右丙氧芬对呼吸或心脏功能的毒性作用导致的。过量服用复方丙氧氨酚导致的死亡可能迅速发生，致死剂量可能相对较低，并且酒精和其他中枢神经系统抑制剂会增强其效果。大多数复方丙氧氨酚过量致死事件发生在能够接受医院治疗之前。风险可能会延伸到开具该药物的人的家庭中的其他人。虽然仅有有限的证据表明教育策略在减少复方丙氧氨酚中毒死亡方面有效，但斯堪的纳维亚、澳大利亚和英国限制复方丙氧氨酚获取的举措已产生了令人鼓舞的结果。鉴于缺乏证据表明复方丙氧氨酚比其他毒性较小的镇痛药具有更优的治疗效果，有充分理由质疑是否应继续开具该药物的处方。
