Abstract
Cathy Owen ACT Mental Health Services, Department of Psychological Medicine, Gabrielle Cooper, Department of Clinical Pharmacology, and David Le Couteur, Department of Clinical Pharmacology, The Canberra Hospital, Canberra, Australia:
We write to seek any information colleagues may have about home-based charcoal use following overdose. We plan a feasibility trial of home-based charcoal in a number of circumstances. Charcoal is recommended as the only treatment suitable for gut decontamination after overdose [1]. The effectiveness of charcoal is likely to be maximal when given within 1–2 h of ingestion, therefore early administration is probably crucial. Given that there are often delays in administration of charcoal at hospital, any strategy to reduce such delays are warranted. We have found that most subjects in the Australian Capital Territory with overdose have a previous diagnosis of psychiatric illness [2]. Therefore, we are commencing a trial to determine the feasibility of providing activated charcoal to the families with a psychiatric diagnosis. The bags of activated charcoal will be labelled with the Poisons Information Service and Emergency Department telephone numbers. This strategy will form an additional approach to the well-established efforts of harm minimisation in suicidal patients. We would appreciate hearing from colleagues who may be acquainted with this strategy.
In preparation for the feasibility study, we were reminded that psychiatrists by and large have heard the message of safe prescribing in suicidal patients. Prescription figures of selective serotonin re-uptake inhibitors would certainly indicate a swing to low toxicity antidepressant options. Are we, however, as mindful when reviewing the non-psychiatric medications our suicidal patients take? O'Rynn et al. [3] reported the America Association of Poison Control Center's 1995 self-poisoning data. Of 724 deaths, 82% were a result of intentional overdose. However, 99% of individuals who attempted suicide survived, necessitating a broad review of all medications prescribed. Psychotropic medication is not alone in potential lethality. Theophylline and calcium channel blockers may be as important to replace with lower toxicity options when appropriate.
We were struck by this message and thought your readers may be too.