Melander A, Henricson K, Stenberg P, Löwenhielm P, Malmvik J, Sternebring B, Kaij L, Bergdahl U
Department of Clinical Pharmacology, University of Lund, Sweden.
Eur J Clin Pharmacol. 1991;41(6):525-9. doi: 10.1007/BF00314979.
In 1978 the third largest Swedish city, Malmö, known to have the highest suicide frequency in the country, was found to have a higher prescription rate (defined daily doses (DDD) per 1,000 inhabitants per day) of anxiolytic-hypnotic drugs (AHD) than the country, the corresponding county, other counties, and other cities, including the largest (Stockholm) and second largest (Göteborg = Gothenburg) cities. Barbiturate prescribing in Malmö was 40% higher than in Stockholm and 90% higher than in Göteborg, and the frequency of suicide due to barbiturates was three-times higher than in Göteborg. A small proportion (2.4% of all AHD-prescribing doctors) of private practitioners wrote a large percentage (24%) of all AHD prescriptions. Prescription surveillance and an information campaign in Malmö were accompanied by a 4-year decrease in AHD prescribing (12%), in AHD abuse (40%), in barbiturate prescribing (45%), and in barbiturate suicides (70%). The total suicide rate was reduced by 25%. There was no corresponding 4-year increase in suicide due to other drugs, or by other means, but after 5 to 7 years there was an increase in suicide by non-pharmacological means. The contribution of benzodiazepines to the frequency of suicide was very small, whereas their contribution to AHD abuse was considerable. In Göteborg, where no corresponding intervention was carried out, there was also a reduction in barbiturate prescribing (34%) and in barbiturate suicides (45%), but in contrast there was a continuous increase both in overall AHD and benzodiazepine prescribing, surpassing Malmö after 5 years. Far from a reduction there was a 7-year increase in the overall frequency of suicide. Apparently, AHD abuse and suicide can be greatly reduced by restricted prescribing of AHD, and this may but need not be accompanied by an increase in suicide by other means. Targeted drug information campaigns may assist in changing prescription patterns and their medical and social impact.
1978年，瑞典第三大城市马尔默被发现其抗焦虑催眠药物（AHD）的处方率（定义为每千名居民每天的限定日剂量（DDD））高于全国、相应郡县、其他郡县以及其他城市，包括最大的城市（斯德哥尔摩）和第二大城市（哥德堡），而马尔默的自杀率在该国也是最高的。马尔默的巴比妥酸盐处方量比斯德哥尔摩高40%，比哥德堡高90%，且巴比妥酸盐导致的自杀频率比哥德堡高三倍。一小部分（占所有开具AHD处方医生的2.4%）私人执业医生开具了所有AHD处方的很大比例（24%）。马尔默开展的处方监测和宣传活动使得AHD处方量在4年内下降了12%，AHD滥用情况下降了40%，巴比妥酸盐处方量下降了45%，巴比妥酸盐自杀事件下降了70%。总自杀率降低了25%。因其他药物或其他方式导致的自杀率在这4年中没有相应上升，但在5至7年后，非药物手段导致的自杀率有所上升。苯二氮䓬类药物对自杀频率的影响非常小，而它们对AHD滥用的影响相当大。在未进行相应干预的哥德堡，巴比妥酸盐处方量也有所下降（34%），巴比妥酸盐自杀事件也有所下降（45%），但与之形成对比的是，总体AHD和苯二氮䓬类药物的处方量持续增加，5年后超过了马尔默。自杀的总体频率非但没有下降，反而在7年内有所上升。显然，通过限制AHD的处方量可以大幅降低AHD滥用和自杀情况，而且这可能会但不一定会伴随着其他方式导致的自杀率上升。有针对性的药物宣传活动可能有助于改变处方模式及其医学和社会影响。
