Trends in acute drug poisoning in the Hospital del Mar (Barcelona), and the relative impact of prosereme, Spain's drug review program

Studies conducted in Spain during the 1970s found psychotropic drugs to be involved in a high number of acute poisoning episodes; barbiturates and fixed-dose combinations were often implicated. Such findings were thought to support the need for a comprehensive review of the country's supply of drugs. In 1983 the Spanish health authorities launched Prosereme (Programa Selective de Revision de Medicamentos, Drug Selective Review Program) to review the marketed drugs in terms of safety and efficacy. The primary goal of the present study was to evaluate trends in episodes of acute drug poisoning in the Hospital del Mar (Barcelona, Spain), and the relative impact on such trends of Prosereme, During the seven years of study, 1,275 acute drug (medicine) poisoning episodes (DPE) were registered, of which 70.7% involved one drug alone, 17.8% two drugs and 11.5% one drug plus another agent. The rate of DPE per 1,000 visits to the Emergency Department decreased from 5.73 in 1983 to 1.79 in 1989. Whereas at the beginning of the period 75.5% of DPEs involved only one drug containing a single active principle, this figure raised to over ninety-five percent in the last three years; although rates of DPEs involving one drug with one active principle declined more markedly, all (negative) trends were statistically significant. Overall, psychotropic drugs were implicated in 63.8% of episodes; barbiturates were involved in 13.1% of episodes involving a psychotropic drug and 8.3% of all DPEs. The annual average decline in rates was -0.26 for benzodiazepines, -0.17 for barbiturates, -0.03 for antidepressants and -0.03 for stimulants (p < 0.05 in all instances). Barbiturates were implicated in 22% of all DPEs in 1983 but in only 1% in 1989 (p, 0.05); the corresponding figures for benzodiazepines are 43.7% and 61.5% (p = 0.001). Figures for the two main indicators of the relative impact of Prosereme upon this sample (namely, psychotropic drugs in association, and metamizol in association with another substance) were already low at the beginning of the study period, and they achieved null values by the end of it. The results support that the decline in DPEs involving barbiturates and other psychotropic drugs in association started before Prosereme was launched and, therefore, suggest that the impact of the program on acute drug poisoning was limited. To assess the impact of pharmaceutical policies on specific health outcomes, the search for 'sensitive clinical targets' must continue.