Morbimortality consequences of use and misuse of psychoactive medicines in Portugal.

AIMS: To characterize the morbidity and mortality consequences of psychoactive medicines use and misuse in Portugal.

METHODS

Retrospective multisource database study to estimate the risk of psychoactive medicine-related deaths, emergency department admissions, serious poisoning calls and serious adverse drug reaction reports, including combination with alcohol and illicit drugs.

RESULTS

Most intentional exposures to psychoactive medicines involving combinations (n = 5973; 70.2%), antidepressants (n = 5441; 67.1%) or any prescription opioid (n = 355; 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] = 1.12; confidence interval [95% CI): 1.10-1.14), antidepressants (RR = 1.04; 95% CI: 1.02-1.05) and alcohol and/or illicit drugs (RR = 1.18; 95% CI: 1.15-1.21). Among 6737 psychoactive medicine-related 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 = 9.03; 95% CI: 3.71-21.94), antidepressants (RR = 3.20; 95% CI: 2.28-4.49), and alcohol and/or illicit drugs (RR = 1.88; 95% CI: 1.36-2.61). Emergency department admission caused by misuse of a psychoactive medicine (n = 5826) were more likely to involve benzodiazepines/z-drugs (RR = 2.40; 95% CI: 2.30-2.51) or antidepressants (RR = 1.86; 95% CI: 1.80-1.93).

CONCLUSIONS

Psychoactive medicine misuse in Portugal frequently occurs alongside polysubstance use and is associated with substantial health risks. Public health strategies should prioritize addressing high-risk 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.