{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:20:53Z","timestamp":1783077653079,"version":"3.54.6"},"reference-count":38,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Despite increasing opioid use in Brazil, the national epidemiological profile of opioid-related poisonings remains insufficiently characterized. Objective: To characterize opioid-notified poisonings reported in the Sistema de Informa\u00e7\u00f5es sobre Agravos de Notifica\u00e7\u00e3o (SINAN\u2014Notifiable Diseases Information System), accessed through Departamento de Inform\u00e1tica do Sistema \u00danico de Sa\u00fade (DATASUS\u2014Department of Informatics of the Unified Health System), between 2019 and 2025. Methods: This retrospective descriptive study used secondary national surveillance data from publicly accessible databases. Records of exogenous poisonings related to medications and drugs of abuse were screened, and notifications involving opioid analgesics were identified and standardized. Descriptive analyses were performed for demographic, clinical, and exposure-related variables. Bivariate analyses and multivariable logistic regression, regression models were conducted for selected outcomes. Incidence rates were estimated by year and federative unit, and temporal trends were assessed using generalized linear mixed models. Results: Between 2019 and 2025, 1,127,265 poisonings related to medications and drugs of abuse were reported in Brazil, of which 12,645 involved opioids. The opioids most frequently implicated in notifications were codeine (38.65%), tramadol (33.98%), and morphine (17.86%). Most cases occurred in women (70.3%), in individuals aged 26\u201350 years (47.8%), and in residences (85.6%). Digestive exposure predominated (92.3%), and suicide attempt was the main circumstance (73.5%). Most patients recovered without sequelae (75.1%), whereas 1.6% died due to exogenous intoxication. Co-exposure information was classifiable in 9573 records, most commonly involving opioids and medications. In multivariable analyses, suicide attempts were associated with female sex (aOR = 1.98; 95% CI: 1.68\u20132.34), residence-based exposure (aOR = 8.95; 95% CI: 6.29\u201312.72), and co-exposure (aOR = 2.17; 95% CI: 1.82\u20132.60). Hospitalization was less likely among females (aOR = 0.83; 95% CI: 0.75\u20130.91) and more likely with co-exposure (aOR = 1.14; 95% CI: 1.02\u20131.27). Serious outcomes were associated with older age (aOR = 1.017; 95% CI: 1.009\u20131.026), while residence-based exposure and suicide attempt showed lower odds. A significant increasing temporal trend was identified, with higher reported notification rates observed in the South and Southeast regions. Discussion: The predominance of suicide attempts and residential digestive exposures suggests that the notification profile captured by SINAN\/DATASUS is predominantly shaped by intentional self-poisoning and household medication availability, while still representing a broader toxicovigilance scenario involving abuse, habitual use, adverse reactions, and other exposure contexts. The contrast between the most frequent notification profile and the profile associated with serious outcomes indicates that occurrence and severity may follow different epidemiological patterns. Therefore, these findings should be interpreted as a toxicovigilance signal reflecting multiple exposure contexts rather than as evidence of a single opioid-use pattern. Conclusions: Reported opioid-notified poisonings in Brazil increased over the study period and were predominantly associated with domestic exposure, suicide attempts, and co-exposure to other substances. These findings highlight the clinical and public health relevance of opioid-notified poisonings and support the need for strengthened surveillance, improved reporting quality, and preventive strategies addressing both opioid use and mental health. Limitations: Underreporting, missing data, regional reporting differences, and possible misclassification in SINAN\/DATASUS records; therefore, associations, temporal increases, and projections should be interpreted as exploratory, and hypothesis generating.<\/jats:p>","DOI":"10.3390\/ph19070994","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T16:50:33Z","timestamp":1782924633000},"page":"994","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Emerging Burden of Opioid Poisoning in Brazil, 2019\u20132025: A Nationwide Epidemiological and Toxicovigilance Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3326-2296","authenticated-orcid":false,"given":"Lu\u00edza Siqueira","family":"Lima","sequence":"first","affiliation":[{"name":"Instituto de Pesquisa Pel\u00e9 Pequeno Pr\u00edncipe, Curitiba 80230-020, PR, Brazil"},{"name":"Faculdades Pequeno Pr\u00edncipe, Curitiba 80250-060, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0880-898X","authenticated-orcid":false,"given":"Diancarlos Pereira","family":"de Andrade","sequence":"additional","affiliation":[{"name":"Instituto de Pesquisa Pel\u00e9 Pequeno Pr\u00edncipe, Curitiba 80230-020, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane Serra","family":"Melanda","sequence":"additional","affiliation":[{"name":"Secretaria de Estado da Sa\u00fade do Paran\u00e1, Curitiba 80230-140, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3633-6484","authenticated-orcid":false,"given":"Ana Tereza Bittencourt","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Instituto de Pesquisa Pel\u00e9 Pequeno Pr\u00edncipe, Curitiba 80230-020, PR, Brazil"},{"name":"Faculdades Pequeno Pr\u00edncipe, Curitiba 80250-060, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2004-5316","authenticated-orcid":false,"given":"Cl\u00e1udia Sirlene","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Instituto de Pesquisa Pel\u00e9 Pequeno Pr\u00edncipe, Curitiba 80230-020, PR, Brazil"},{"name":"Faculdades Pequeno Pr\u00edncipe, Curitiba 80250-060, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1080\/17441692.2019.1629610","article-title":"Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use","volume":"15","author":"Krawczyk","year":"2020","journal-title":"Glob. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0140-6736(21)02252-2","article-title":"Responding to the Opioid Crisis in North America and Beyond: Recommendations of the Stanford-Lancet Commission","volume":"399","author":"Humphreys","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e730","DOI":"10.1097\/PR9.0000000000000730","article-title":"Latin American Pain Federation position paper on appropriate opioid use in pain management","volume":"4","author":"Garcia","year":"2019","journal-title":"Pain Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13011-021-00348-z","article-title":"Opioid use, regulation, and harms in Brazil: A comprehensive narrative overview of available data and indicators","volume":"16","author":"Maia","year":"2021","journal-title":"Subst. Abuse Treat. Prev. Policy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1089\/jpm.2022.0122","article-title":"Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals","volume":"26","author":"Vahos","year":"2023","journal-title":"J. Palliat. Med."},{"key":"ref_6","unstructured":"WHO (2026, April 20). WHO Updates Guidelines on Opioid Dependence Treatment and Overdose Prevention. Available online: https:\/\/www.who.int\/news\/item\/02-04-2026-who-updates-guidelines-on-opioid-dependence-treatment-and-overdose-prevention."},{"key":"ref_7","unstructured":"WHO (2026, February 11). Opioid Overdose. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/opioid-overdose."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"666","DOI":"10.2105\/AJPH.2018.304341","article-title":"Rising Trends of Prescription Opioid Sales in Contemporary Brazil, 2009\u20132015","volume":"108","author":"Krawczyk","year":"2018","journal-title":"Am. J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e9911326240","DOI":"10.33448\/rsd-v11i3.26240","article-title":"Perfil de dispensa\u00e7\u00e3o de opioides no Brasil entre os anos de 2014 e 2018","volume":"11","author":"Castro","year":"2022","journal-title":"Res. Soc. Dev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20230086","DOI":"10.1515\/sjpain-2023-0086","article-title":"Are we missing the opioid consumption in low- and middle-income countries?","volume":"24","author":"Correia","year":"2024","journal-title":"Scand. J. Pain"},{"key":"ref_11","unstructured":"SINAN (2026, April 20). SINANWEB-Intoxica\u00e7\u00e3o Ex\u00f3gena, Available online: https:\/\/portalsinan.saude.gov.br\/intoxicacao-exogena."},{"key":"ref_12","unstructured":"Minist\u00e9rio da Sa\u00fade (2018). Instru\u00e7\u00f5es Para Preenchimento da Ficha de Investiga\u00e7\u00e3o de Intoxica\u00e7\u00e3o Ex\u00f3gena SINAN: Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o, MS."},{"key":"ref_13","unstructured":"SINAN (2026, March 27). SINANWEB-P\u00e1gina Inicial, Available online: https:\/\/portalsinan.saude.gov.br\/."},{"key":"ref_14","first-page":"e20240885","article-title":"Suicide attempts by poisoning recorded at a toxicological information and assistance center: A cross-sectional study, Fortaleza, 2022","volume":"34","author":"Silva","year":"2025","journal-title":"Epidemiol. Serv. Saude"},{"key":"ref_15","first-page":"e09562025","article-title":"Toxic events in adolescents from 2015 to 2022: Characteristics and factors associated with suicide attempts","volume":"30","author":"Saldanha","year":"2025","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_16","unstructured":"Brasil (2026, April 20). PORTARIA GM\/MS N\u00b0 5.201, DE 15 DE AGOSTO DE 2024-PORTARIA GM\/MS No 5.201, DE 15 DE AGOSTO DE 2024-DOU-Imprensa Nacional, Available online: https:\/\/saude.es.gov.br\/Media\/dant\/PORTARIA%20GM_MS%20N%C2%BA%205.201,%20DE%2015%20DE%20AGOSTO%20DE%202024%20-%20PORTARIA%20GM_MS%20N%C2%BA%205.201,%20DE%2015%20DE%20AGOSTO%20DE%202024%20-%20DOU%20-%20Imprensa%20Nacional.pdf."},{"key":"ref_17","unstructured":"PMPCI (2023). PMPCI: Notifica\u00e7\u00e3o e Investiga\u00e7\u00e3o de Casos Suspeitos de Intoxica\u00e7\u00e3o Ex\u00f3gena Por Drogas de Abuso, Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade (SVS)."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4689","DOI":"10.18310\/2446-4813.2025v11n2.4689","article-title":"Intoxica\u00e7\u00f5es ex\u00f3genas por medicamentos no Brasil: Uma an\u00e1lise espa\u00e7o-temporal entre 2008 e 2022","volume":"11","author":"Vassilievitch","year":"2025","journal-title":"Sa\u00fade Redes"},{"key":"ref_19","first-page":"e20233234","article-title":"Over a third of treatment-seekers from S\u00e3o Paulo\u2019s Crackland report recent use of synthetic cannabinoids","volume":"46","author":"Madruga","year":"2024","journal-title":"Braz. J. Psychiatry"},{"key":"ref_20","first-page":"e20243587","article-title":"The rise of so-called adolescent \u201czombie\u201d behavior: A spotlight on synthetic cannabinoid abuse","volume":"46","author":"Bombana","year":"2024","journal-title":"Braz. J. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100375","DOI":"10.1016\/j.fsir.2024.100375","article-title":"Synthetic illicit opioids in Brazil: Nitazenes arrival","volume":"10","author":"Fabris","year":"2024","journal-title":"Forensic Sci. Int. Rep."},{"key":"ref_22","first-page":"1","article-title":"CDC Clinical Practice Guideline for Prescribing Opioids for Pain-United States, 2022","volume":"71","author":"Dowell","year":"2022","journal-title":"Morb. Mortal. Wkly. Rep. Recomm. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103355","DOI":"10.1016\/j.eclinm.2025.103355","article-title":"Variability in trends of opioid-related hospital utilization among U.S. Adults, 2016\u20132021 check","volume":"86","author":"Chen","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70269","DOI":"10.1002\/pds.70269","article-title":"Epidemiological Profile of Exogenous Intoxications by Self-Medication in Brazil: A Decade of Trends and the Impact of the COVID-19","volume":"34","author":"Pereira","year":"2025","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Coelho, R., Mrejen, M., Falc\u00e3o, L., Rocha, R., and Hone, T. (2025). Racial inequalities in access to healthcare services in Brazil (2019): A decomposition analysis. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-025-13527-6"},{"key":"ref_26","unstructured":"IBGE (2026, May 21). Desigualdades Sociais por Cor ou Ra\u00e7a no Brasil|IBGE, Available online: https:\/\/www.ibge.gov.br\/estatisticas\/sociais\/populacao\/25844-desigualdades-sociais-por-cor-ou-raca.html."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s13181-015-0491-y","article-title":"The Toxicologist as Educator: Addressing Pain Management in the Midst of an Opioid Epidemic","volume":"11","author":"Beauchamp","year":"2015","journal-title":"J. Med. Toxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s13181-021-00844-5","article-title":"The 2021 Core Content of Medical Toxicology","volume":"17","author":"Hendrickson","year":"2021","journal-title":"J. Med. Toxicol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1177\/0706743720931240","article-title":"The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada","volume":"65","author":"Iwajomo","year":"2020","journal-title":"Can. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"348","DOI":"10.5334\/pme.1006","article-title":"Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review","volume":"12","author":"Shi","year":"2023","journal-title":"Perspect. Med. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/10550887.2024.2331522","article-title":"Explaining the high mortality among opioid-cocaine co-users compared to opioid-only users. A systematic review","volume":"43","year":"2025","journal-title":"J. Addict. Dis."},{"key":"ref_32","first-page":"395","article-title":"Opioid consumption and prescription in Brazil: Integrative review","volume":"5","author":"Piovezan","year":"2022","journal-title":"Braz. J. Pain"},{"key":"ref_33","first-page":"101167","article-title":"A time-series analysis of the use of opioid medications in a network of Brazilian hospitals, 2009\u20132020","volume":"48","author":"Carvalho","year":"2025","journal-title":"Lancet Reg. Health Am."},{"key":"ref_34","unstructured":"SAR. Minist\u00e9rio da Justi\u00e7a e Seguran\u00e7a P\u00fablica (2026, March 27). Sistema de Alerta R\u00e1pido Sobre Drogas (SAR), Available online: https:\/\/www.gov.br\/mj\/pt-br\/assuntos\/sua-protecao\/politicas-sobre-drogas\/obid\/sistema-de-alerta-rapido-sobre-drogas-sar."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"20956","DOI":"10.56238\/arev7n4-307","article-title":"Dispensa\u00e7\u00e3o ambulatorial de opioides pelo sistema \u00fanico de sa\u00fade no brasil e em minas gerais nos anos de 2018 a 2023: Um estudo ecol\u00f3gico","volume":"7","author":"Costa","year":"2025","journal-title":"ARAC\u00ca"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1007\/s40264-023-01351-y","article-title":"Adverse Drug Reactions to Opioids: A Study in a National Pharmacovigilance Database","volume":"46","author":"Gustafsson","year":"2023","journal-title":"Drug Saf."},{"key":"ref_37","first-page":"100507","article-title":"Reports of rising use of fentanyl in contemporary Brazil is of concern, but a US-like crisis may still be averted","volume":"23","author":"Bastos","year":"2023","journal-title":"Lancet Reg. Health-Am."},{"key":"ref_38","unstructured":"R Core Team (2024). R: A Language and Environment for Statistical Computing, Version 4.3.3, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/994\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:35:02Z","timestamp":1783074902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ph19070994"],"URL":"https:\/\/doi.org\/10.3390\/ph19070994","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]}}}