Weapons of Mass Destruction Weapons of Mass Destruction

Kassirer JP. — Mon, 11 Feb 2013 00:00:00 GMT

While our national leaders agonize about the threats in the Middle East from missiles, bombs, and automatic weapons that might fall into terrorist hands, they have remained eerily silent about the unlimited access to weapons of mass destruction in our own backyard. In a sickening recapitulation of terror wrought in schools, movie theaters, and malls, our nation grieves for the large number of innocents murdered in a few minutes by a single American gunman. Yet the gun lobby has successfully muzzled political debate about guns, shut down federal research on gun-related injuries, and promoted legislation that prevents physicians from asking patients about gun-related risks. In the last few years, Supreme Court cases resulted in judgments that affirmed the right to keep guns in the home for protection. Recently, a federal appeals court ruled that our citizens even have a constitutional right to carry loaded guns outside their homes. Although legal scholars have questioned the current relevance of the Second Amendment, now that men no longer have to bring their private weapons to join the local militia, the Supreme Court has spoken, and for now we must live with its interpretation.

Opioid Dose and Risk of Road Trauma in Canada A Population-Based Study Opioid Dose and Risk of Road Trauma

Gomes T, Redelmeier DA, Juurlink DN, et al. — Mon, 11 Feb 2013 00:00:00 GMT

Background

Use of opioids may predispose drivers to road trauma, yet the effect of opioid dose on this association is unknown.

Methods

We conducted a population-based nested case-control study of patients aged 18 to 64 years who received at least 1 publicly funded prescription for an opioid from April 1, 2003, through March 31, 2011. Cases were defined as having an emergency department visit related to road trauma. Patients without road trauma served as a control group matched to cases by age, sex, index year, prior road trauma, and a disease risk index. We compared the risk of road trauma among patients treated with doses of opioids ranging from very low to very high (<20 to ≥200 morphine equivalents daily). In a subgroup analysis, we stratified our analysis by driver status.

Results

Among 549 878 eligible adults, we identified 5300 cases with road trauma and matched an equal number of controls. Multivariate adjustment yielded no significant association between escalating opioid dose and odds of road trauma (adjusted odds ratio ranged between 1.00 and 1.09). However, a significant association between opioid dose and road trauma was observed among drivers. Compared with very low opioid doses, drivers prescribed low doses had a 21% increased odds of road trauma (adjusted odds ratio, 1.21 [95% CI, 1.02-1.42]); those prescribed moderate doses, 29% increased odds (1.29 [1.06-1.57]); those prescribed high doses, 42% increased odds (1.42 [1.15-1.76]); and those prescribed very high doses, 23% increased odds (1.23 [1.02-1.49]).

Conclusions

Among drivers prescribed opioids, a significant relationship exists between drug dose and risk of road trauma. This association is distinct and does not appear with passengers, pedestrians, and others injured in road trauma.

JAMA Internal Medicine: Injury Prevention and Control Topic Collection

Weapons of Mass Destruction Weapons of Mass Destruction

Opioid Dose and Risk of Road Trauma in Canada A Population-Based Study Opioid Dose and Risk of Road Trauma