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Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in and were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total patients were analyzed. The average age of patients was Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased. Many patients in emergency departments are admitted due to toxic poisoning. According to domestic research, patients admitted to emergency departments due to toxic poisoning represent between 0. Patients with poisoning may have been exposed to the toxic materials voluntarily or involuntarily, and the sources of the substances and reasons for poisonings are diverse. Various social factors can affect poisoning, and the characteristics of poisoning can change over time 2. Excluding patients with chronic addiction, most patients with symptomatic acute toxic poisoning requiring medical care are treated in emergency departments. Thus, it is necessary to understand the characteristics of patients with acute toxic poisoning admitted to emergency departments in order to develop a better approach for treating such patients. Nationwide data on toxic poisoning have not been collected in Korea. Moreover, much of the existing research is limited to singe-center studies. Recently, multi-center studies were carried out, and some reports attempted to standardize data-collection systems 3 , 4. Still, most studies used only data that were limited in scope and scale. However, the need for a regular data collection has increased due to the fact that epidemiologic data, regarding toxic poisoning, requires consistent monitoring. Therefore, the authors hypothesized that the characteristics of poisoning cases would change over time. And an epidemiological study of poisoning cases in the year and was conducted to compare the differences over time, with the ultimate goal of developing data that could potentially help in the treatment of poisoned patients. For this investigation, the year from January 1 to December 31, was set, and the year from January 1 to December 31, was set. Data from patients visiting the emergency department at one of 3 university hospitals in Korea 1 in Gangnam and 1 in Gangbuk, Seoul, and 1 in Gyeonggi-do who were admitted due to toxic poisoning were evaluated. As there are three hospitals affiliated with the one medical center at which the study was conducted, data were collected through a unified protocol from the emergency departments of all three hospitals. Electronic record-keeping at the medical center began in , and thus was chosen as the first year of study, and was chosen for its most recent data. The clinical history, symptoms, and laboratory data were extracted about all patients who visited the emergency department because of toxic poisoning. Data on patients with poisoning due to any category of toxic substance, including caustic agents, irritants, natural plant and animal poisons, chemical agents, and medications were analysed. In , total patients were admitted, and in , total patients were admitted respectively. The epidemiological characteristics of all patients were investigated. Data on gender, age, cause of exposure to toxic material, purchase route, type of toxic material, admission details, and mortality rates were retrospectively investigated using patients' clinical histories. Patients thought to have been poisoned by a single intake of alcohol or by food poisoning were excluded. Statistical analyses. All statistical calculations were performed using SPSS The characteristics of patients admitted in and those admitted in were compared. This research was carried out after receiving approval from the institutional review board of the Korea University Ansan Hospital No. Informed consent was waived by the board. A total of patients including, patients from the and patients from the were included in the analysis. The male-to-female ratio was Most cases of toxic poisoning were due to suicidal committing in both The toxic substances were most often obtained from pharmacies i. Patients visiting the emergency department for acute toxic poisoning represented 0. The proportion of cases accompanied by alcohol consumption did not change significantly from the to the Table 1 General characteristics of the subjects. Of the patients admitted in , 92 were aged in their 30s, 83 in their 20s, and 68 in their 40s. Among the patients admitted in , patients were aged in their 30s, 90 in their 40s, and 88 in their 20s. Rate of emergency department visits for poisoning by age group, and Most admissions in both and occurred during the night rather than during the day Fig. Further, admissions were most common in May and August in , and in April, September, and October in ; however, there were no meaningful differences between the and Fig. Rate of emergency department visits for poisoning by year and visiting time. Rates of emergency department visits for poisoning by month, and In , substances that were the most common cause of poisoning were over-the-counter drugs, acetaminophen and doxylamine, followed by household items and chemical substances. In , although the percentage of poisonings caused by over-the-counter drugs decreased, they remained the most common causative agents, followed by psychiatric drugs Table 2. Table 2 Substances of poisoning. Fifty percent of patients returned to their home in , whereas only Among poisoned patients, 6 and 9 patients died in and , respectively. Lavage was conducted in Additionally, charcoal administration increased in These changes between the 2 yr were all statistically significant Table 3. Among the patients who died in both years, paraquat was the most common toxic substances: paraquat poisoning was responsible for 5 of the 6 deaths in and 5 of the 9 deaths in Table 4. Table 3 Disposition comparison of vs Table 4 Characteristics of expired patients in vs Comparing the characteristics of poisoning cases between hospitals revealed that the Gangbuk hospital had a total of 32, Emergency Department patients in , and 47, in The Gangnam hospital had 24, Emergency Department patients in , and 54, in Finally, The Ansan hospital had 36, Emergency Department patients in and 44, in The characteristics of three hospitals are shown in the Table 5. There was no difference in sex or age of poisoning patients among the three hospitals. In , the Gangnam hospital showed a relatively lower rate of poisoning by prescription drugs, with a higher rate of use of over-the-counter drugs. The Gyunggido hospital continued to have the highest rate of accidental exposure among the three hospitals in both years. Table 5 Characteristics of patients by 3 hospitals. In emergency departments, the proportion of patients with toxic poisoning differs depending on which substances are defined as toxic and classification of these toxic materials. Toxic poisoning may be broadly or narrowly defined, and its definition may differ in different countries and societies, and over time 2. In addition, collection and analysis of nationwide data on poisoning plays a key role in informing policies for toxic substances, including the production and sales management of toxic substances as well as, placement of poison control centers and stores of rare antidotes 4 , 5. Therefore, relying on treatment data from other countries is problematic. However, there are no standardized nationwide guidelines for such classifications in Korea 3. Our study focused on determining the changes over time of the characteristics of Korean patients with toxic poisoning who were admitted to emergency departments. Comparative research was conducted on data from patients attending 3 university hospitals in Korea in and in The average age of patients with toxic poisoning increased from Among the patients assessed in , 90 The most common age range for patients with poisoning seemed to increase after a decade from patients in their 20ss to those in their 30ss. In , Song et al. In addition, Lee et al. Kang et al. On the other hand, the mean age of patients with toxic poisoning was In other countries, Burillo-Putze et al. Xiang et al. In Korea, the highest portions of poisoning to toxic substances were found in young and socially active people in their 30s and 40s, and the average age appears to be increasing slightly. In this study, toxic poisoning was more common in women than men during both years. In , the male-to-female ratio was In other data from Korea, Lee et al. Likewise, the proportion of females among poisoning patients was reported to be Park et al. Given that female patients are exposed to toxic substances at a higher rate than male patients, and the main cause of poisoning being consumption of toxic material while committing suicide, this finding is most likely related to the high rate of suicidal attempts among women According to Xiang et al. In contrast to that reported in Korea, Burillo-Putze et al. Most cases of toxic poisoning are due to consumption of toxic substances for committing suicide, while accidental poisoning are the second most common cause. Burillo-Putze et al. Similar rates were reported by Song et al. The proportion of toxic poisoning cases due to prescribed drugs tended to increase over time. In , pharmacies were the most common source of toxic materials followed by other types of stores. However, in , substances most commonly source causing poisoning were hospital prescriptions, followed by over-the-counter drugs. Lee et al. In our study, in both and , patients with toxic poisoning represented 0. Meanwhile, Burillo-Putze et al. In the Korean study by Song et al. These rates are somewhat lower than that reported in the s, in which the proportions were between 3. There was little change in the proportion of toxic poisoning cases that were accompanied by alcohol consumption According to the report by Kang et al. Most cases of toxic poisoning occur during the night rather than during the day, and no temporal change was observed in the present study. In , most patients with toxic poisoning were admitted to emergency departments in May and August, whereas in , most were admitted in April, September, and October; however, this difference was not significant. The most important factor to consider in the treatment of acute toxic poisoning is the causative substance. Decontamination and treatment methods as well as antidotes used are different according to toxic substances. Therefore, access to data on substances commonly associated with toxic poisoning is very important for doctors dealing with patients in emergency departments. The substances most commonly causing poisoning vary depending on the patient's society, for example, the ease of purchase and acquisition of toxic substances; changes over time may also be affected. In our research, over-the-counter drugs and household toxic materials were the most common causative agents in Meanwhile, the percentage of poisonings due to over-the-counter drugs decreased in ; however, these drugs remained the most common causative substances, followed by psychiatric drugs. The subject of psychiatric treatment has traditionally been taboo in Korea. Therefore, the treatment of such conditions has historically been rare. The growing number of patients receiving psychiatric treatment in recent years may have facilitated the acquisition and use of psychiatric drugs, especially antipsychotics. Compared to the , the proportion of discharged patients decreased and the proportion of self-discharged patients increased in the This may be because many poisonings were due to consumption of toxic substances while committing suicide. Although poisoning itself may not be life threatening, the ratio of patients for whom hospital transfers or hospitalization would have been recommended increased because of reattempted suicides. Nevertheless, many patients do not want to be hospitalized, and increased awareness of a doctor's obligation to obtain informed consent is thought to be one of the reasons for the increased rates of self-discharge. Six patients in the and 9 patients in the expired from toxic poisoning. Among them, 5 of 6 patients in and 6 of 9 patients in died due to paraquat poisoning. In Korea, the sale and production of paraquat are forbidden by law since Accordingly, we expect a decrease in mortality due to paraquat poisoning. In terms of treatment, the most remarkable change over time was observed in the procedure of gastric lavage. In , In addition, the administration of charcoal increased significantly in Table 3. Lavage was previously used indiscriminately for gastrointestinal decontamination in cases of acute poisoning. However, it is now thought that the advantages of lavage do not justify the risk of complications, such as aspiration. The study by Benson et al. Even though the rate of unnecessary use of gastric lavage has decreased, the rate is still high according to a domestic study In addition, a recent study in Denmark regarding gastric lavage revealed that the procedure was still overused This study is important as it is the first to report the decrease in use of gastric lavage in Korea, and as such, is in accordance with the international trend. Comparing the characteristics of poisoning cases between hospitals revealed that the Gangnam hospital experienced more cases that involved the consumption of alcohol. The Gangbuk hospital had a higher proportion of poisoning cases out of the total patients admitted to the emergency department. The Gyeonggi-do hospital had more cases of accidental exposure and gastric lavage in comparison to the other hospitals. One of the limitations of this study is that the use of antidotes besides lavage and charcoal was not investigated. Because we focused mainly on temporal changes, not all therapeutic information was verified. However, because antidotes are specific to each toxic substance and the toxic substances were verified, it can be assumed that antidotes were used appropriately in each case. Another limitation of this study is that although it was a multi-center study, data from only three centers were included. Because drug poisoning is affected by time, social factors, and regional factors, national data would be of great interest and allow meaningful regional comparisons. Lastly, this study was initially designed to have a yr interval. However, due to electronic difficulties in data collection, the authors chose to study year and We believe the additional future studies monitoring changes over one or two decades would be greatly beneficial to gain a deeper understanding. In conclusion, this multi-center study compared the characteristics of patients admitted to the emergency department with toxic poisoning in and Among the elements that did not change over time were the facts that suicide was the most common cause of toxic exposure, that alcohol consumption was involved in roughly one out of four cases, and that there were more female than male cases. On the other hand, increases in average poisoning patient age, exposure to psychiatric drugs and a decrease in gastric lavage cases were the most salient features that had changed over time. Understanding the characteristics of patients with acute toxic poisoning is important for providing optimal care. Our study results suggest that it is necessary to continuously collect data of patients admitted to emergency departments with toxic poisoning at multiple centers. Copy and paste a formatted citation from below or use one of the hyperlinks at the bottom to download a file for import into a bibliography manager. Home Archive v. Published online Sep 25, Author information. Author notes. Copyright and License. Received April 12, ; Accepted August 19, Go to:. Poisoning ; Epidemiology ; Emergency Service, Hospital. Study subjects For this investigation, the year from January 1 to December 31, was set, and the year from January 1 to December 31, was set. Study design The clinical history, symptoms, and laboratory data were extracted about all patients who visited the emergency department because of toxic poisoning. Ethics statement This research was carried out after receiving approval from the institutional review board of the Korea University Ansan Hospital No. Table 1 General characteristics of the subjects Click for larger image. Click for larger image. Table 2 Substances of poisoning Click for larger image. Table 3 Disposition comparison of vs Click for larger image. Table 4 Characteristics of expired patients in vs Click for larger image. Table 5 Characteristics of patients by 3 hospitals Click for larger image. Drug intoxication patients in the emergency department. J Korean Soc Emerg Med ;— Comparative analysis of acute drug intoxication between s and s. J Korean Soc Clin Toxicol ;—6. J Korean Soc Clin Toxicol ;— Poisonings in the Nordic countries in a 5-year epidemiological follow-up. Clin Toxicol Phila ;— PubMed CrossRef. Litovitz T. The TESS database: use in product safety assessment. Drug Saf ;— Analysis of self-poisoning patients. A clinical analysis of acute drug intoxication in emergency department setting. National multicentre study of acute intoxication in emergency departments of Spain. Eur J Emerg Med ;— ED visits for drug-related poisoning in the United States, Am J Emerg Med ;— Position paper update: gastric lavage for gastrointestinal decontamination. The clinical investigation of gastric lavage in patiernts with acute poisoning. Adherence to international recommendations for gastric lavage in medical drug poisonings in Denmark Characteristics of patients who visit the emergency department with self-inflicted injury. J Korean Med Sci ;— Epidemiologic characteristics of death by poisoning in in Korea. Crossref 6. PubMed 3. Scopus 9. Web of Science 8. Page Views PDF Downloads 6. Links to. Show all Cited by Crossref. Is Cited by the Following Articles in. Citation successfully copied. 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Buying MDMA pills Ansan

Official websites use. Share sensitive information only on official, secure websites. Contributors: E. Miranda contributed with the study conception, methodology, data acquisition, curation, analysis and interpretation, and writing; and approved the final version. Costa contributed with the data acquisition, analysis and interpretation, and writing; and approved the final version. Piazza contributed with the data acquisition, analysis and interpretation, and writing; and approved the final version. Della Corte contributed with the methodology, data interpretation, and discussion of results; and approved the final version. Ragazzoni contributed with the methodology, data interpretation, and discussion of results; and approved the final version. Barone-Adesi contributed with the methodology, data interpretation, and discussion of results; and approved the final version. Andrade contributed with the data analysis and interpretation, and review; and approved the final version. Osorio-de-Castro contributed with the study conception, methodology, data acquisition, curation, analysis and interpretation, and writing; and approved the final version. This is an open-access article distributed under the terms of the Creative Commons Attribution License. Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it. Los desastres provocan cambios en la morbilidad, mortalidad y en el uso de medicamentos. Los desechos mineros se almacenan en represas y las roturas de dichas represas han causado grandes desastres. Disasters of great magnitude have been increasing in Brazil and, in recent years, mining activity has contributed to the occurrence of two major events: the Mariana and the Brumadinho dam failures, both in the state of Minas Gerais. On November 5, , the collapse resulted in an estimated 34 million m 3 of waste, water, and materials used in its construction, causing socioeconomic and environmental impacts in the Doce River basin. This event directly and indirectly affected at least 13 municipalities. Hundreds of other dams remain at high risk of rupture throughout Brazil 3. Disasters directly related to human action are precipitated by an abrupt event, built on an adverse context 4. The literature shows that the health consequences of disasters of this nature are considerable, including changes in morbidity, mortality, and drug use profile. The use of psychoactive drugs, especially, changes over time because of disasters. This change occurs both in the areas directly affected and in regions close to the site of the event 5 , 6. This type of disaster is also usually associated with major psychological consequences compared to natural disasters with the same level of loss and damage. Events that occur as a result of human performance may subvert the feelings of trust and solidarity, considered essential for community life 7. In events like this, the main indications for these medicines are frequently related to anxiety, depression, and posttraumatic stress 8. Increased drug consumption has been reported to occur after a 3-month lag phase 9 , but this may be fleeting Using drug utilization research DUR to monitor mental health outcomes related to drug consumption in this population may be a useful and ethical tool, since the studies may be replicated without directly approaching the affected population, avoiding the memory of the disaster and its negative consequences Although a previous cross-sectional article studied psychoactive drug consumption in the municipality of Brumadinho 12 , our approach is unprecedented in Brazil, and may be employed as a short- to long-term monitoring strategy after an event 8. We conducted an ecological study with two main data sources to estimate drug consumption, one from the public sector drug purchases from the Minas Gerais State and one from the private sector all dispensing data from retail pharmacies. The assumption was that public purchases and private dispensing could be proxies for drug consumption 1 and could show differences in the profile before and after the November disaster. Among them, we identified those located on the banks of the Doce River that held private pharmacy retail outlets. We considered that the environmental damage that caused the water shortage affected the livelihoods of the population, the generation of electricity, the suspension of industrial production, the interruption of commercial fishing, and damage to agriculture, livestock, and tourism. Psychoactive drugs were selected based on a set of criteria, namely: i guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder 13 ; ii inclusion on the Brazilian List of Essential Medicines Medicines used in mental health care are purchased by Brazilian municipalities. Supply is managed at the state level and distributed to primary health care services at the municipal level. Box 1 shows the 11 medicines selected. The system provided data on monthly municipal purchases of the same 11 medicines listed in Box 1. It enables the monitoring of controlled substances, including medicines such as psychoactive drugs and antimicrobials, in pharmacies and private drugstores. Information from the system includes drug name, dosage form and strength, and quantity dispensed in number of drug packaging units. This system is maintained by the Brazilian Health Regulatory Agency Anvisa, acronym in Portuguese and the data is now publicly available, although at the time the study begun, the data was obtained by the LAI and volume was limited. This classification is used worldwide to compare drug consumption and as a tool for the DUR. The DDD is a unit of measurement of consumption and does not refer to any specific dose-related indication. Descriptive analyses focused on the month period of public and private data, from July to July Mean public and retail consumption were calculated for each municipality and each stratum over the study period. The rationale for the analysis was the comparison of two independent groups with a limited number of observations, which indicates a nonparametric approach Public procurement data were then organized into the same strata. The organization into strata was done to allow for better observation of consumption during the study period. For pharmaceutical retail data, we calculated the number of DDDs for each individual medicine dispensed per month and also calculated number of DDDs for all medicines. For public consumption, we charted monthly purchases of each medicine in the affected municipalities. We assumed the quantity purchased in a given month would cover demand for the subsequent months until the next purchase and divided the quantity purchased by the number of months between purchases. We calculated the number of DDDs for each medicine per month. We added up the totals to produce the total monthly number of DDDs for all 11 medicines. Public and retail consumptions were plotted separately on monthly timelines strata 1, 2, and 3. Total consumption values for each medicine in all municipalities were calculated and the monthly means before and after the event were plotted and linear trends were added solely for visual description. The Mann-Whitney test Wilcoxon rank sum method was used to compare pre- and post-disaster periods The data used in this study came from two different sources, one of which was publicly available Anvisa. All information was unidentified and aggregated. The study was submitted to Institutional Review Board of the Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, and received ethical waiver, in accordance with the exemption rule for non-identified aggregated public data in Brazilian ethical guidelines. The maximum and minimal values show two main aspects: that the lower limit of pharmaceutical retail consumption defined the different strata, and that the maximum limits of public procurement data were high compared with their counterparts in pharmaceutical retail data, in which smaller municipalities Stratum 3 have the lowest private values and the highest public consumption values. The consumption means for pharmaceutical retail data in the period were: As for public consumption, Stratum 2 presented the lowest values, with an average of Figures 1 and 2 show monthly pharmaceutical retail consumption and public purchase consumption, respectively, in each stratum. The non-consecutive 4-month periods used for comparison purposes are highlighted in geometric forms rectangles for the pre-disaster period, squares for the immediate post-disaster period, and rectangles for periods of peak consumption. Three different 4-month periods, one for each stratum, in which the highest post-disaster consumption was visually observed and measured. Clonazepam was the leader in pharmaceutical retail consumption, followed by fluoxetine, diazepam, and amitriptyline. Nortriptyline and midazolam were the least consumed. This balance remained the same for the entire period. However, individual medicines consumption showed apparent distinct linear trends before and after the disaster. Except for midazolam, which showed a downward trend during the entire period, clonazepam, fluoxetine, diazepam, nortriptyline, and amitriptyline showed an upward shift in pharmaceutical retail consumption from December onwards. Fluoxetine showed the largest angular coefficient for the linear trend equation in the post-disaster period, signaling a possible greater increase in consumption compared with the other psychoactive drugs Figure 3. Note: linear trends are given for the entire study period to show decrease or increase. Pre-disaster R 2 : clonazepam 0. Amitriptyline and fluoxetine showed reversed roles in pre- and post-disaster pharmaceutical retail consumption. The smallest fluctuations in consumption were shown in the pre-disaster period by amitriptyline and by fluoxetine in the post-disaster period given by the highest R 2 trend values , whereas the highest fluctuations in consumption given by the lowest R 2 value were shown by fluoxetine in the pre-disaster period and by amitriptyline in the post-disaster period. Figure 3 shows the consumption of individual medicines over time. The main findings showed that, compared to private consumption, the public purchase proxy was much higher in volume, as shown in Table 2. The public supply of psychoactive drugs was high throughout the month study period, as can be seen from the range and mean consumption values, although there were drops in public consumption in Governador Valadares and Belo Oriente. The public purchasing data resulted in broad consumption ranges, with repeated values and plateaus, covering the demand of subsequent months until the next purchase This is observed due to the purchasing system in Minas Gerais, in which state and municipal demands need to be grouped together in order to ensure economies of scale in purchases, implying an interval of two to three months between purchases. Before arriving at the final three strata, several municipality were grouped to better determine the municipalities that best fit together, in terms of private consumption and limits. The choice of private consumption was based on the fact that dispensing data is a much more precise consumption proxy than purchase data 11 , and the inferior limit was based on the reasoning that the disaster would unveil the increase and not the decrease in consumption. Furthermore, purchase data was linked to much higher values, not suitable for any limits. Stratum 3 showed a lower private consumption range and high public consumption, whereas Stratum 2 was similar to 3 in private consumption and similar to 1 in public consumption. Figures 1 and 2 show how consumption progressed over time. The literature offers an insight about the possibilities for comparing drug consumption with the occurrence of a disaster: a pre-disaster period, an immediately post-disaster period, and a period, after the event, in which a consumption peak may be observed - and measured 15 , 16 , However, although post-disaster peaks were observed, each study may follow a different pattern or consumption profile and may have employed an external comparison another municipality , which did not occur in the Minas Gerais study. For this study we preferred a comparison between strata. To better determine this possible profile, it was necessary to plot consumption over a month period for each stratum. We also chose to represent the comparison periods of post-disaster peaks from pharmacy retail data by applying the same 4-month periods to public purchases. In Brazil, the public sector is an important source of drug provision and medicines are provided free of charge. However, private expenditure on medicines is very high and The high supply of psychoactive medicines in the public sector may have contributed to dissipate other observable peaks in private consumption. Nevertheless, the statistically significant results showed a diminished capacity for obtaining drugs from pharmaceutical retail in the first few months after the disaster, when there may be obstacles in accessing health services 22 , or lower care-seeking behavior on the part of the population 23 , or even immediate financial impacts resulting from the disaster Municipalities within Stratum 1 included Mariana, where the event took place, possibly the hardest hit municipality, but, on the other hand, also the one in which post-disaster recovery funding was concentrated, thus reducing the medium- to long-term economic impact of the disaster to some degree The significant results in Stratum 3 were much more relevant because, although an increase was observed in pharmaceutical retail, a peak was also observed in public provision. If public provision had met needs, there would not have been a peak in pharmaceutical retail consumption. Thus, the need for psychoactive drugs 15 months after the event has greatly increased in these municipalities. This delayed response, coupled with intense consumption compared with other strata , might be associated to belated economic difficulties as a consequence of the disaster. Data on other disasters show that long-term economic effects were only observed in the less affected municipalities - probably because of a lack of investments and disaster relief efforts According to IBGE averages for gross domestic product GDP per capita and the percentage of the population employed, Stratum 3 aggregates the smallest municipalities with the smallest economies. Strata 1 and 2 average population employment percentage was In all municipalities, the SNGPC-originated pharmaceutical retail data showed that clonazepam was the most consumed psychoactive drug, followed by fluoxetine, diazepam, and amitriptyline. This order did not change with the event and was the same throughout the study period. Clonazepam is the most consumed psychoactive medicine in Brazil and its consumption increased 6-fold from to Notably, it also holds a safer metabolic risk profile than other antidepressants In a study, chronic use of benzodiazepines was high in Brazilian state capitals 28 and Belo Horizonte, capital city of Minas Gerais, had the highest consumption of this class of medicines; diazepam consumption decreased, whereas other benzodiazepines, including clonazepam, showed increased consumption These previous consumption studies corroborate our results and also seem to validate the choice of medicines for this study. Simple linear trends are not the best way to depict variation. However, the very low number of pre-disaster points prevented us from employing a more sophisticated approach Nevertheless, our results are visually powerful, suggesting an apparent reversal of linear trends before and after the event. Apart from midazolam, all psychoactive drugs showed a shift from a decreasing trend before the event to an increasing trend positive angular coefficient after the disaster occurred, signaling a possible increase in consumption. Considering the increases in consumption diagnosed in the cited studies 25 , 26 , 28 , 29 , it is also possible that the trends described are part of a greater overall increase in psychoactive drug consumption in the country. However, the contrasting downward trends before the event cast doubt on this explanation. Previous work on disaster-related psychoactive drug consumption has shown a short-term and short-lived increase in prescriptions for sedatives and hypnotics immediately after the event. There was no observable impact on the consumption of antidepressant or antipsychotic three years after the event Following the Sewol Ferry disaster in Ansan, South Korea, the number of prescriptions for antidepressants, anxiolytics, and sedative-hypnotics was compared between a case and a control municipality. This study holds several limitations. The first is the dual source of consumption proxies - pharmaceutical retail and public purchases. Although these two sources are not comparable, they provide a reasonable context for the overall consumption of psychoactive medicines in the affected municipalities. It was necessary to assume a steady plateau for the consumption proxy based on purchasing data - even though they provide accurate volumes of state distribution to municipalities during the months of provision and reflect the predominant public nature of mental health drug provision in Brazilian municipalities On the other hand, municipalities may not only provide drugs purchased and distributed by the states. They can purchase individual medicines according to their municipal lists 14 and this would not be shown by the data. However, the municipalities involved in this study, except for Governador Valadares, are small and may not have sufficient budgetary resources to carry out a specific provision. Public municipal dispensing data was not available. The Brazilian Ministry of Health plans to link and make these data available in the future, but at the time of our study, only the states were sources of information, which was the case of Minas Gerais. Simultaneously, although the SNGPC data were very dense regarding the number of dispensations and retail outlets for each municipality, the dataset was short in width and only available for a limited number of months. This limited the number of data points to 25 only four before the event , suggesting a recognized, albeit conservative dataset analysis 31 , 32 , since the use of interrupted time-series analysis ITS , jointpoint, or autoregressive integrated moving average ARIMA would produce a better fit with a larger number of data points before or after the truncated period 33 , Finally, we were unable to produce age-related consumption data, to make better comparisons with the available national information on psychoactive consumption and with the international literature of drug consumption in disasters. This was the first study, to our knowledge, with a drug consumption approach based on large datasets linking increased psychoactive consumption to a major disaster in Brazil. Technological disasters may have long-term effects on mental health 35 , 36 and future research may clarify other patterns of morbidity we were unable to recognize in this study timeframe. This study innovates by investigating not only pharmaceutical retail and public purchasing profiles in a disaster setting, but also by describing this phenomenon in different municipal strata, possibly linked to economic profile. Although consumption peaks were observed in all three strata, they occurred at different moments, perhaps signaling differences in the ability to cope with the disaster aftermath. The stratum with the smallest and poorest municipalities 3 may have been the one in which this effect was more intense. The information generated by this paper aimed to guide the health system in future disasters and contribute to the rational use of medicines in disaster contexts. It may also guide the sectors involved in social and economic development to focus recovery strategies mainly on the most vulnerable municipalities. As a library, NLM provides access to scientific literature. Cad Saude Publica. Show available content in en pt es. Find articles by Elaine Silva Miranda. Find articles by Marcelo Dell'Aringa. Find articles by Everaldo Alves da Costa. Find articles by Thais Piazza. Find articles by Francesco Della Corte. Find articles by Luca Ragazzoni. Find articles by Francesco Barone-Adesi. Correspondence E. Elaine Silva Miranda : contributed with the study conception, methodology, data acquisition, curation,, analysis and interpretation, and writing, approved the final version. Marcelo Dell'Aringa : contributed with the data acquisition, analysis and interpretation, and writing, approved the final version. Everaldo Alves da Costa : contributed with the data acquisition, analysis and interpretation, and writing, approved the final version. Thais Piazza : contributed with the data acquisition, analysis and interpretation, and writing, approved the final version. Francesco Della Corte : contributed with the methodology, data interpretation, and discussion of results, approved the final version. Luca Ragazzoni : contributed with the methodology, data interpretation, and discussion of results, approved the final version. Francesco Barone-Adesi : contributed with the methodology, data interpretation, and discussion of results, approved the final version. Claudia Garcia Serpa Osorio-de-Castro : contributed with the study conception, methodology, data acquisition, curation, analysis and interpretation, and writing, approved the final version. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Antidepressants selective serotonin reuptake inhibitors. 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Buying MDMA pills Ansan