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Supervised consumption ensures patients take methadone as prescribed and prevents diversion, however, the influence of supervised consumption on retention is unclear. We examined association between supervised consumption and retention across multiple treatment episodes.Cohort study of persons experiencing ≥1 MMT episodes in primary care (2004-2010), excluding ongoing episodes at the start of follow-up. Length of treatment episodes based on methadone prescriptions, retention classified as no interruption in prescribed methadone lasting7 days. When a patient did not receive a new prescription within seven days after the end of coverage of a prescription, they were considered to have ceased treatment. We evaluated the relationship between supervised consumption and time to discontinuation of treatment using proportional hazards gamma frailty models to account for recurrent MMT episodes. Age, gender, median daily methadone dose, and comorbidities included as potential confounders.6393 patients experienced 19,715 treatment episodes over the six-year follow-up period. A J-shaped relationship was observed; having between 20 and 60% of methadone scripts supervised (compared to20%) associated with reduced time to discontinuation (20-39% HR=0.88, 95% CI 0.81-0.95; 40-59%: HR=0.87, 95% CI 0.81-0.94). Beyond a threshold of 60%, retention reduced (60-79% of scripts: HR=1.28, 95% CI 1.20-1.36;80% of scripts: HR=3.59, 95% CI 3.38-3.81). Median daily dose between 60 and 120mg/per day, and multiple treatment episodes also associated with longer time to discontinuation of treatment.A J-shaped relationship was observed between supervised consumption and retention in treatment. Additionally, patients experiencing multiple treatment episodes tend to stay in treatment for progressively longer periods of time.

Background The increasing use of pregabalin and the presence of pregabalin in poisoning deaths, particularly with opioids, highlight it as a potential drug of abuse. In this study we examined factors associated with pregabalin-positive poisoning deaths (PPPD) between 2013 and 2016 in Ireland. Methods Data were extracted from the National Drug-Related Deaths Index (NDRDI). Analysis included univariate and multivariate logistic regression to estimate unadjusted and adjusted odds ratios (OR) and 95 % confidence intervals (CI) for factors associated with PPPD (primary outcome) by logistic regression models for the total sample and stratified by gender. Results Pregabalin was present on 240 (16 %) toxicology reports of 1489 poisoning deaths; significantly rising from 15 (4.5 %) in 2013 to 94 (26 %) in 2016. Women (AOR 2.69, 95 % CI: 1.95–3.70), opioid misuse (AOR 1.74, 95 % CI: 1.17–2.59), in receipt of treatment for problem drug use (AOR 1.95, 95 % CI: 1.33–2.86) and year of death (2016 vs 2013) (AOR 7.95, 95 % CI: 4.58–13.79) were associated with increased odds of PPPD. Alcohol dependence was associated with reduced odds of PPPD (AOR 0.59, 95 % CI: 0.41–0.85). For men, opioid misuse, in receipt of treatment for problem drug use, and year of death were associated with increased odds of PPPD, while alcohol dependence was associated with reduced odds of PPPD. For women, in receipt of treatment for problem drug use and year of death were associated with increased odds of PPPD. Conclusions Enhanced training to prescribers and treatment providers on the potential risks associated with pregabalin, particularly among people who use drugs, is required.

For the first time in the Republic of Ireland, analysis using coronial data describes all fire-related fatalities occurring during the years 2014–2016. Of the 106 fatalities, the majority of those who died were male (69, 65%) and 55 (52%) were 65 years or older. Most fires took place in private dwellings (97, 92%), in rural locations (58, 55%) and the majority were alone at the time of the fire (73, 69%). Fatal fires occurred more frequently during the night and where known (n = 48), the leading cause of fatal fires was due to smoking materials (12, 25%). Mobility was an issue for 16 people (15%) and 32 people (30%) were known to be smokers. Farmers and agricultural workers were over-represented in the data. Alcohol features prominently with alcohol present on toxicology for 54 (51%) fatalities. A Blood Alcohol Concentration (BAC) of at least 160 mg of alcohol per 100 mL of blood (mg/100 ml) was present in 35 fatalities (33% of all fatalities) and of those, the majority were male and in the 35–59 years age group. The high BAC levels in a significant number of fire fatalities, draws attention to the negative impact of alcohol on fire-related mortality.