{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T12:48:27Z","timestamp":1761742107520,"version":"build-2065373602"},"reference-count":73,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To characterize the morbidity and mortality consequences of psychoactive medicines use and misuse in Portugal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective multisource database study to estimate the risk of psychoactive medicine\u2010related deaths, emergency department admissions, serious poisoning calls and serious adverse drug reaction reports, including combination with alcohol and illicit drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Most intentional exposures to psychoactive medicines involving combinations (\n                      <jats:italic>n\u2009=<\/jats:italic>\n                      \u00a05973; 70.2%), antidepressants (\n                      <jats:italic>n\u2009=<\/jats:italic>\n                      \u00a05441; 67.1%) or any prescription opioid (\n                      <jats:italic>n\u2009=<\/jats:italic>\n                      \u00a0355; 67.4%) resulted in serious poisonings (i.e., medical assistance advised). The risk of serious poisoning was higher for exposures involving substance combinations (relative risk [RR]\u2009=\u20091.12; confidence interval [95% CI): 1.10\u20131.14), antidepressants (RR\u2009=\u20091.04; 95% CI: 1.02\u20131.05) and alcohol and\/or illicit drugs (RR\u2009=\u20091.18; 95% CI: 1.15\u20131.21). Among 6737 psychoactive medicine\u2010related deaths, 166 (2.5%) were identified where the medicine contributed to the fatal outcome. The risk of contribution to death was higher in cases involving substance combinations (RR\u2009=\u20099.03; 95% CI: 3.71\u201321.94), antidepressants (RR\u2009=\u20093.20; 95% CI: 2.28\u20134.49), and alcohol and\/or illicit drugs (RR\u2009=\u20091.88; 95% CI: 1.36\u20132.61). Emergency department admission caused by misuse of a psychoactive medicine (\n                      <jats:italic>n\u2009=<\/jats:italic>\n                      \u00a05826) were more likely to involve benzodiazepines\/z\u2010drugs (RR\u2009=\u20092.40; 95% CI: 2.30\u20132.51) or antidepressants (RR\u2009=\u20091.86; 95% CI: 1.80\u20131.93).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychoactive medicine misuse in Portugal frequently occurs alongside polysubstance use and is associated with substantial health risks. Public health strategies should prioritize addressing high\u2010risk medicine combinations and therapeutic groups most often found to trigger negative outcomes. This may be achieved by targeted prevention efforts integrated into health system design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70171","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T11:13:54Z","timestamp":1752923634000},"page":"3225-3235","source":"Crossref","is-referenced-by-count":0,"title":["Morbimortality consequences of use and misuse of psychoactive medicines in Portugal"],"prefix":"10.1002","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-4341","authenticated-orcid":false,"given":"Ana","family":"Carmona Ara\u00fajo","sequence":"first","affiliation":[{"name":"iMed.ULisboa \u2010 Research Institute for Medicines, Faculty of Pharmacy University of Lisbon  Lisbon Portugal"},{"name":"Healthcare Data, Data Analytics and Methods Task Force European Medicines Agency  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Pedro","family":"Guerreiro","sequence":"additional","affiliation":[{"name":"Centre for Health Evaluation &amp; Research\/Infosa\u00fade\u2014National Association of Pharmacies (CEFAR\/IS\u2010ANF)  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Bulhosa","sequence":"additional","affiliation":[{"name":"Centre for Health Evaluation &amp; Research\/Infosa\u00fade\u2014National Association of Pharmacies (CEFAR\/IS\u2010ANF)  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3988-1162","authenticated-orcid":false,"given":"Ana Paula","family":"Martins","sequence":"additional","affiliation":[{"name":"Independent expert  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-2514","authenticated-orcid":false,"given":"Filipa","family":"Alves da Costa","sequence":"additional","affiliation":[{"name":"iMed.ULisboa \u2010 Research Institute for Medicines, Faculty of Pharmacy University of Lisbon  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2851-2003","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Goul\u00e3o","sequence":"additional","affiliation":[{"name":"ICAD \u2010 Institute on Addictive Behaviours and Dependencies, P.I.  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14659891.2023.2213325"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2021.2219"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263\u2010016\u20100359\u2010y"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264\u2010020\u201000985\u20106"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010018\u20102550\u20101"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14592"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.10223"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20102667(19)30128\u20108"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1291"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.therap.2018.09.078"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/fcp.12738"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2515\/therapie\/2015010"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.2515\/therapie\/2011045"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000346179"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.2515\/therapie\/2015014"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEJ.0000000000000932"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14408"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14014"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.31647"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.11.018"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2018.1457792"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j760"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.03.002"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2017.01.013"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2314"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13181\u2010012\u20100241\u20103"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0b013e31825b954b"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.13056"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2017.0415"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/164_2018_135"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3532"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010060519"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4426"},{"key":"e_1_2_11_35_1","unstructured":"ACSS. Circular Informativa ACSS n.\u00ba 22\/2014\/DPS\/ACSS \u2010 Agrupador de GDH All Patient Refined DRG 2014.https:\/\/www.acss.min-saude.pt\/\/circulares\/Circular_Normativa\/2014\/Circular_Normativa_22_2014.pdf"},{"key":"e_1_2_11_36_1","unstructured":"MSSO.Medical Dictionary for Regulatory Activtiesn.d.https:\/\/www.meddra.org\/"},{"key":"e_1_2_11_37_1","unstructured":"MedDRA MSSO. n.d.Standardised MedDRA queries https:\/\/www.meddra.org\/standardised-meddra-queries(accessed December 8 2023)."},{"key":"e_1_2_11_38_1","unstructured":"European Medicines Agency.Guideline on good pharmacovigilance practices (GVP) module VI \u2013 management and reporting of adverse reactions to medicinal products (Rev 1). EMA\/873138\/2011 Rev 1* 2014:90."},{"key":"e_1_2_11_39_1","unstructured":"WHO Collaboration Centre for Drug Statistics Methodology.Guidelines for ATC classification and DDD assignment 2023.https:\/\/www.whocc.no\/atc_ddd_index_and_guidelines\/guidelines\/(accessed May 12 2023)."},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s000"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.12.023"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010019\u201002707\u2010z"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.802"},{"key":"e_1_2_11_44_1","unstructured":"Ara\u00fajo AC Fernandes E Ruivo IF Machado C Vaz AF.Preval\u00eancia da Dispensa de Medicamentos em Ambulat\u00f3rio na Popula\u00e7\u00e3o Idosa em Portugal : um Estudo transversal prevalence of outpatient use of medicines by the elderly population in Portugal : A Cross\u2010Sectional Study2023."},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2015.05.001"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.180646"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1515\/sjpain\u20102018\u20100307"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100042\u2010101868"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096\u2010019\u201000915\u20102"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228\u2010018\u201002622\u20109"},{"key":"e_1_2_11_51_1","unstructured":"CartagenaFJPorterLMcManusSStrangJHickmanMReedKPrescribing patterns in dependence forming medicines2017."},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14397"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201033765\u20100"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.2174\/1574886311666160724212407"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2019.07.011"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010022\u201007592\u20104"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2019.20056"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873\u2010019\u20100271\u20100"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.2016.05.120"},{"key":"e_1_2_11_60_1","first-page":"194","article-title":"Operacionaliza\u00e7\u00e3o Para Portugal da Lista EU(7)\u2010PIM Para Identifica\u00e7\u00e3o de Medicamentos Potencialmente Inapropriados nos Idosos operationalisation for Portugal of the EU(7)\u2010PIM list for identification of potentially inappropriate medicines in older adults","volume":"33","author":"Rodrigues DA","year":"2020","journal-title":"Acta Med Port"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102125.2007.03060.x"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2000.tb04758.x"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001270200006"},{"volume-title":"Benzodiazepinas e An\u00e1logos","year":"2017","author":"INFARMED","key":"e_1_2_11_64_1"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.18.4.236"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52638"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.21952"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1080\/20523211.2024.2369319"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci8040073"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.04.023"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.088344"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264\u2010023\u201001302\u20107"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096\u2010023\u201001592\u2010y"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bcp.70171","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T07:20:35Z","timestamp":1761722435000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/bcp.70171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,19]]},"references-count":73,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/bcp.70171"],"URL":"https:\/\/doi.org\/10.1002\/bcp.70171","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"type":"print","value":"0306-5251"},{"type":"electronic","value":"1365-2125"}],"subject":[],"published":{"date-parts":[[2025,7,19]]}}}