{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:35:20Z","timestamp":1792254920163,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,17]],"date-time":"2019-07-17T00:00:00Z","timestamp":1563321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brit J Clinical Pharma"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug\u2010associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 444 drug\u2010related deaths and 21,296 overdoses during the study period. FTI and CF were well correlated (Spearman's rho 0.64, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Of the classes of interest, opioids had the highest FTI (40.3 95% confidence interval [CI] 35.2\u201345.4 deaths per 100\u00a0years of use at the defined daily dose or deaths\/DDD\/100\u00a0years) and CF (12.4% 95%CI 11.0\u201313.9). Fentanyl, methadone and morphine had the highest relative fatal toxicity within this class. Tricyclic antidepressants had the highest relative fatal toxicity of all antidepressants (FTI 14.5 95%CI 9.7\u201319.3 deaths\/DDD\/100\u00a0years and CF 7.1% [95%CI 4.8\u20139.3]) and benzodiazepines appeared to be more associated with multiple agent deaths than single. Of the illicit drugs, heroin had the highest CF (26.4%, 95%CI 19.1\u201333.7).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Knowledge of relative lethal toxicity is useful to prescribers and medicines and public health policy makers in restricting access to more toxic drugs and may also assist coroners in determining cause of death.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bcp.14019","type":"journal-article","created":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T10:39:00Z","timestamp":1559903940000},"page":"2098-2107","source":"Crossref","is-referenced-by-count":30,"title":["The relative lethal toxicity of pharmaceutical and illicit substances: A 16\u2010year study of the Greater Newcastle Hunter Area, Australia"],"prefix":"10.1111","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3065-7495","authenticated-orcid":false,"given":"Jonathan","family":"Brett","sequence":"first","affiliation":[{"name":"St. Vincent's Hospital Sydney &amp; New 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K.","family":"Isbister","sequence":"additional","affiliation":[{"name":"School of Medicine and Public Health University of Newcastle  Australia"},{"name":"New South Wales Poison Information Centre &amp; Hunter New England Toxicology Service  Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick A.","family":"Buckley","sequence":"additional","affiliation":[{"name":"Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health The University of Sydney  Australia"},{"name":"New South Wales Poison Information Centre and Royal Prince Alfred Hospital  Sydney 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