Drug-Related Deaths following Bariatric surgery: Case Series Report

 Drug-Related Deaths following Bariatric surgery: Case Series Report Introduction Bariatric surgery is a highly effective treatment option for obesity. The surgery involves modifying the structure and function of the gastrointestinal system, which results in reduced nutrient absorption. However, these changes can also affect the absorption of medications, leading to subtherapeutic or toxic levels. This report aims to investigate the characteristics of drug-related deaths (DRDs) after bariatric surgery.   Methods This case-series report analyzes cases with a history of bariatric surgery from the National Programme on Substance Use Mortality (NPSUM) database identified through text detection.  Results Ten cases of DRDs with a history of bariatric surgery were identified, with females accounting for 70% of these cases. This is a significant deviation from the typically male-dominated DRD demographic, likely due to the higher prevalence of bariatric surgery among women. All ten cases involved gastric bypass surgery, a procedure performed for over 50 years, known for its effectiveness in treating obesity and comorbidities, low complication rates, and long-term weight loss maintenance. In 90% of cases, antidepressants were identified as the implicated drugs. Indeed, most cases involved patients with a history of mental health disorders who were treated with antidepressants. After bariatric surgery, reduced absorption of antidepressants can result in subtherapeutic doses, potentially increasing suicidal ideation when patients do not experience the expected therapeutic effects. As basic drugs, antidepressants are poorly absorbed following bariatric surgery, potentially leading patients to take higher doses to achieve therapeutic effects. Following death antidepressants undergo post-mortem redistribution, which could lead to detection of them at high levels in PM blood samples. Opioids were implicated in 60% of the cases, with all instances involving oral opioids and none involving injectable forms. Since oral opioids are acidic, this will cause overabsorption after bariatric surgery potentially leading to overdose. Suicidal death was reported in 50% of the cases, which is 2.5 times the NPSUM suicide rate.   

Implicated Drug Class
Percentage (%)

Antidepressants
90

Opioids (Oral)
60

Antipsychotics (Quetiapine)
40

Beta-blockers (Propranolol)
20

Cocaine
20

Gabapentinoids
10

Hypnotics and Sedatives
10 

  Table 1: Implicated Drugs Table for cases of DRDs with a history of bariatric surgery Conclusion Despite the well-known efficacy of bariatric surgery, there is limited literature on drug absorption post-surgery.Further research is essential to understand the effects of bariatric surgery on the absorption of medications and supplements, ensuring patients receive safe and effective doses to reduce the risk of DRDs and improve mental health outcomes.