title: Drug-caused deaths in Australian medical practitioners and health-care professionals.
abstract: There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent.
  
  
  
  Retrospective cohort study.
  
  
  
  The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner.
  
  
  
  A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians).
  
  
  
  χ2tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm.
  
  
  
  Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI) = 42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI = 92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI = 33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ2(7)= 237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases.
  
  
  
  Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.
authors.affiliation: Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pilgrim
authors.affiliation: Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.
authors.forename: Rhyse
authors.initials: R
authors.lastname: Dorward
authors.affiliation: Department of Forensic Medicine, Monash University, Southbank, VIC, Australia.|Victorian Institute of Forensic Medicine, Southbank, VIC, Australia.
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Drummer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000401:mortality*; D055815:Young Adult
keywords: Drug abuse; drug-caused impairment; fatality; health-care professional; intentional self-harm; medical practitioner; suicide