0271.5384/81/040275-08~2.00/0 Copyrtghf 0 Pergamon Press Ltd zyxwvut AGE- AND SEX-RELATED DIFFERENCES IN PATTERNS OF DRUG OVERDOSE AND ABUSE USOA BUSTO,* HOWARD L. KAPLAN? and EDWARD M. SELLERS* *Clinical Pharmacology Program and Womputer Services Addiction Research Foundation, Ontario, Canada Abstract-In a prospective study of 3546 patients with drug overdose and abuse, females outnumbered males in overdose 2: 1 while males predominated in drug abuse 2:l. Half of drug abuse patients and 28% of overdose patients were under 21 years of age. In overdose the highest incidence rates were at ages 19-20 for both males and females (800 and 512 per 100,ooO population, respectively). Relatively high proportions of females and patients over 60 were admitted to hospital. Females and youth of both sexes frequently ingested salicylates, while barbiturates and other sedatives were chosen more commonly by adult males. Benzodiazepines were the most commonly selected drugs among all age groups irrespective of sex. Concurrent ethanol use, especially among males of all ages, was frequently found. In drug abuse, the choice of benzodiazepines, ethanol. barbiturate, non-barbiturate sedatives, salicylates, other analgesics, cannabis and other hallucinogens were related to age. Cannabis and other hallucinogens were more prevalent among the younger age group and the remaining drugs more prevalent among the older. Our data show that drug overdose and abuse is a major health problem among the youth. INTRODUCTION Patients with acute and chronic drug-related prob- lems are frequently seen at Emergency wards [l-3]. The type of problem and the drugs alleged by patients with drug abuse or overdose may differ according to their age and sex [4,5]. For example, females out- number males in overdose nearly 2: 1, and the number of young patients presenting at Emergency with drug related problems has been increasing [4-93. However, there are few precise data on age- and sex-related differences in the selection of drugs for overdose and abuse and on the management of these patients. Moreover, although the importance of drug problems among the zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA yo ung has been largely emphasized, very few systematic studies have been conducted in an entire urban population, and information on the patterns of drug overdose and abuse among these patients is still lacking. In a previously reported study on acute and chronic drug emergencies in Toronto [7] we found that 50”” of the drug abuse and 28% of the drug overdose were in patients under 21 years of age. Females predominated at all ages in drug overdose, but particularly in the younger individuals. Here we report in detail the age- and sex-related differences found in these patients, emphasizing the problem among the young. PATIENTS AND METHODS Between 1 January and 30 June, 1975, nurse research assistants collected data on 3546 patients presenting at the 21 Metropolitan Toronto hospitals with a ‘drug overdose’ or ‘drug abuse’ problem. Patients under 14 were rarely recorded as they are often sent to a special hospital for children, not in- Reprint Requests: Dr E. M. Sellers, Clinical Pharma- cology Program, Addiction Research Foundation, 33 Rus- zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONM sell Street. To ro nto , Ontario, M5S 2A1, Canada. eluded in the survey. Drug overdose was defined as “a single ingestion of a drug in a quantity greater than the maximum recommended prescribed dose or greater than an individual’s usual habit”. Drug abuse was defined as “the chronic ingestion or injection of a quantity of a drug which is greater than the rec- ommended usual dose” and includes illegal sub- stances with no recommended dose. The difference between overdose and abuse is usually that between intentionally self-destructive or parasuicidal behav- iour and accidental overdose in the course of experi- mental drug use. Patients whose sole problem was alcohol intoxication were excluded from the study. Briefly, data collected from the Emergency record in- cluded demographic data, alleged drug(s) including quantity when possible, clinical characteristics of patients, toxicological assays and treatment in Emer- gency. In this paper only allegation of drugs will be considered. Further details on terminology, defini- tions, data collection and standard statistical analyses are given elsewhere [7, lo]. RESULTS There were 3546 cases of drug abuse or drug over- dose presenting at Emergency during the 6 month study. Of these 2723 (77%) were classified as drug overdose and 816 (23%) were drug abuse cases. In 9 patients the type of problem was not recorded. Age and sex distribution Table 1 shows the age and sex distribution of the 3429 patients whose sex and age were recorded. (a) Drug or% erdose. 77% (2644) of patients were cate- gorized as drug overdose. The overall female:male ratio was 2: 1 and the mean age f SD for overdose patients was 30.0 f 12.6 years. Of these patients, 731 (28%) were under 21 years of age, 462 (17%) were under 18 and 228 (9%) were under 16. Females’ mean age was significantly lower than males’ mean age for 275