Fatal injuries while under the influence of psychoactive drugs: a cross-sectional exploratory study in England

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.BACKGROUND: Studies of drug-related mortality rarely describe fatal injuries due to psychoactive drug intoxication (FIUI). The main aim of this study was to determine the nature, extent and pattern of FIUI. METHODS: This observational study covered the period January 1999 to December 2001. Data were provided by members of a study panel of coroners in England using a standard protocol. Sources of data for this study included autopsy protocols, death certificates, hospital records, police reports, toxicology reports and inquest transcripts. Inclusion criteria for this were (i) the mention of one or more psychoactive substances as contributing to fatality; and (ii) the presence of a Controlled Drug at post mortem. RESULTS: A total of 3,803 drug-related deaths of persons aged 16-64 years were reported by the study panel during the three-year period. The study panel accounted for 86% of drug-related deaths in England in this period. There were 147 FIUI cases (119 males, 28 females), giving a proportionate mortality ratio of approximately 4%. The majority of FIUI cases (84%) were aged 16-44 years, with a median age at death of 33 years (Quartile deviation = 7). Fifty-six percent of FIUI occurred in urban areas of England. The population of the study jurisdictions aged 16-64 years contributed 49,545,766 person-years (py) to the study, giving an annual crude rate of 3/1,000,000 person-years (py). Rates for male and females were 4.9 and 1.1/1,000,000 py respectively, giving a male/female rate ratio of 4.5 (95%CI = 2.9-6.8). The rates of intentional and unintentional FIUI were 2 and 1/1,000,000 py respectively. The leading mechanism for intentional FIUI was suffocation while the predominant mechanisms in unintentional FIUI were road traffic accidents and falls. There is a significant difference in the pattern of drug-specific risk between FIUI and fatal poisoning. Risks of intentional FIUI are elevated among Black and Minority Ethnic groups. CONCLUSION: There are differences in the nature, extent and pattern of intentional and unintentional FIUI that should necessitate targeted prevention strategies. Also, there is an opportunity for cross-discipline collaboration between injury prevention specialists and substance abuse/mental health specialists.Peer reviewedFinal Published versio

Lessons from biomass planning at national and regional level in the EU

Abstract in Undetermined Action plans are an important tool for meeting the EU renewable energy targets. Planning of biomass at national level has recently shifted from biomass action plans to renewable energy action plans; the latter still assigning special attention to biomass. A number of regions have also developed or are developing biomass plans. However, even though such plans are to assist the delivery of bioenergy development, the processes leading to successful implementation are not well documented. Little is known of the roles and function of these plans. This paper examines factors underlying plans and draws lessons from the planning processes that appear to support successful bioenergy development. The work presents views of actors involved in biomass planning in eleven countries and nine regions in Europe with an analytical framework employed to condense and present interview content. The analysis shows that while planning processes at both national and regional levels have encountered barriers – most of them common to policy implementation in general, but some specific to bioenergy policy – the national level appears to have better dealt with such barriers. Stakeholder commitment, continuity of policy, and flexibility of planning guidelines and processes were found as some of the keys to successful implementation. While biomass plans were demonstrated to serve several roles, approaches looking beyond energy use are still limited. The work concludes that coordination of planning between jurisdictional levels needs to be strengthened and regional stimuli recognized at higher levels in order for biomass policy and planning to better achieve goals