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Opiate overdose

Maura Sammon, Alveena Dawood, Scott Beaudoin, Richard A Harrigan
BACKGROUND: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions. CASE REPORT: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose...
October 7, 2016: Journal of Emergency Medicine
James Dodington, Pina Violano, Carl R Baum, Kirsten Bechtel
Significant breakthroughs in the field of injury prevention and childhood safety have occurred during the past half-century. For example, the Poison Prevention Packaging Act of 1970 and the institution of child passenger safety laws are responsible for a significant reduction in injuries among children and adolescents. This review will focus on the following three topics because of their significant contribution to pediatric injury morbidity, especially among adolescents, and their promise for further effective prevention research...
September 27, 2016: Pediatric Research
Joanne Neale, Julia Bradford, John Strang
BACKGROUND AND AIMS: The time available to act is a crucial factor affecting the likely success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to i. construct a proto-typology of non-fatal opiate overdose onset and ii. assess the implications for overdose management and prevention of fatalities. METHODS: Re-analysis of a subset of data from a large qualitative study of non-fatal opiate overdose conducted 1997-1999...
August 20, 2016: Addiction
Élise Roy, Nelson Arruda, Karine Bertrand, Magali Dufour, Émélie Laverdière, Didier Jutras-Aswad, Michel Perreault, Djamal Berbiche, Julie Bruneau
BACKGROUND: There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected. METHODS: This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015...
September 1, 2016: Drug and Alcohol Dependence
P B Persson
No abstract text is available yet for this article.
August 2016: Acta Physiologica
Amanda K Gatewood, Michael J Van Wert, Andrew P Andrada, Pamela J Surkan
AIMS: To identify perceived barriers to the prescription of naloxone to third-party contacts of opiate users. DESIGN: Qualitative descriptive study. SETTING: Two academic hospitals in Baltimore, MD, USA. PARTICIPANTS: Thirty medical providers, including both physicians and medical students. MEASUREMENTS: Qualitative; in-depth interviews and focus groups analyzed using line-by-line, focused, and axial coding based on methods adapted from grounded theory...
October 2016: Addictive Behaviors
Vivian D Hope, Katelyn J Cullen, Josie Smith, Lucy Jessop, John Parry, Fortune Ncube
The recent, and rapid, emergence of injection of the short-acting stimulant mephedrone (4-methylmethcathione) has resulted in concerns about increased infection risks among people who inject drugs (PWID). Data from the bio-behavioural surveillance of PWID in the United Kingdom were analysed to examine the impact of mephedrone injection on infections among PWID. During the year preceding the survey, 8.0% of PWID (163/2,047) had injected mephedrone. In multivariable analyses, those injecting mephedrone were younger, less likely to have injected opiates, and more likely to have injected cocaine or amphetamines, used needle/syringe programmes or sexual health clinics, been recruited in Wales and Northern Ireland or shared needles/syringes...
May 12, 2016: Euro Surveillance: Bulletin Européen sur les Maladies Transmissibles, European Communicable Disease Bulletin
Redonna K Chandler, Matthew S Finger, David Farabee, Robert P Schwartz, Timothy Condon, Laura J Dunlap, Gary A Zarkin, Kathryn McCollister, Ryan D McDonald, Eugene Laska, David Bennett, Sharon M Kelly, Maureen Hillhouse, Shannon G Mitchell, Kevin E O'Grady, Joshua D Lee
BACKGROUND: Among the nearly 750,000 inmates in U.S. jails, 12% report using opioids regularly, 8% report use in the month prior to their offense, and 4% report use at the time of their offense. Although ample evidence exists that medications effectively treat Opiate Use Disorder (OUD) in the community, strong evidence is lacking in jail settings. The general lack of medications for OUD in jail settings may place persons suffering from OUD at high risk for relapse to drug use and overdose following release from jail...
May 2016: Contemporary Clinical Trials
Philip Krieter, Nora Chiang, Shwe Gyaw, Phil Skolnick, Roger Crystal, Fintan Keegan, Julie Aker, Melissa Beck, Jennifer Harris
Parenteral naloxone has been approved to treat opiate overdose for over 4 decades. Intranasal naloxone, administered "off label" using improvised devices, has been widely used by both first responders and the lay public to treat overdose. However, these improvised devices require training for effective use, and the recommended volumes (2 to 4 mL) exceed those considered optimum for intranasal administration. The present study compared the pharmacokinetic properties of intranasal naloxone (2 to 8 mg) delivered in low volumes (0...
October 2016: Journal of Clinical Pharmacology
Viktor Arelin, Julius J Schmidt, Nathalie Kayser, W Nikolaus Kühn-Velten, Hendrik Suhling, Gabriele Eden, Jan T Kielstein
The synthetic opioid methadone hydrochloride has a low molecular weight of 346 D, a high volume of distribution (4 - 7 L/kg), and is lipophilic. It is used as an analgesic and for the maintenance treatment of opiate dependence. In drug addicts, methadone is frequently involved in mixed intoxications that can lead to death. Here we present the case of a drug addict in whom a high cut-off dialysis membrane together with extended dialysis was used in the setting of suspected overdose and acute kidney injury. Although the observed dialyzer plasma clearance (31...
June 2016: Clinical Nephrology
Rebecca McDonald, John Strang
BACKGROUND AND AIMS: Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take-home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take-home naloxone, with two specific aims: (1) to study the impact of take-home naloxone distribution on overdose-related mortality; and (2) to assess the safety of take-home naloxone in terms of adverse events...
July 2016: Addiction
Kevin F Boehnke, Evangelos Litinas, Daniel J Clauw
UNLABELLED: Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015...
June 2016: Journal of Pain: Official Journal of the American Pain Society
Glenn Burns, Rebecca T DeRienz, Daniel D Baker, Marcel Casavant, Henry A Spiller
BACKGROUND: There has been a significant spike in fentanyl-related deaths from illicit fentanyl supplied via the heroin trade. Past fentanyl access was primarily oral or dermal via prescription fentanyl patch diversion. One factor potentially driving this increase in fatalities is the change in route of administration. Rapid intravenous (IV) fentanyl can produce chest wall rigidity. We evaluated post-mortem fentanyl and norfentanyl concentrations in a recent surge of lethal fentanyl intoxications...
June 2016: Clinical Toxicology
Franklin King, Nicholas A Morris, Jeremy D Schmahmann
INTRODUCTION: Delayed posthypoxic leukoencephalopathy (DPHL) may result from a variety of hypoxic insults, including respiratory depression from an opiate overdose. The underlying pathophysiological mechanism of DPHL remains uncertain. We describe a patient with a typical case of DPHL who responded clinically to antioxidant treatment. METHODS: Clinical, serological, and radiographic investigations were undertaken in the evaluation of the patient. RESULTS: A 63-year-old man developed altered mental status 10 days following recovery from an opiate overdose and aspiration pneumonia that required intubation...
September 2015: Case Reports in Neurology
Kimberly A Dion
PROBLEM: Death by overdose has been steadily increasing since 1992 and has become a public health epidemic. With the rise of prescription pain medications for nonmedical use and the highest use of illicit substances by those ages 18-25, the need for action is imperative. PURPOSE: The aim of the study was to determine whether an educational intervention had an effect on nursing students' knowledge and skills regarding administration of intranasal naloxone for opioid overdose...
January 2016: Journal of Addictions Nursing
Suzanne Nielsen, Marie Claire Van Hout
There is growing evidence that expanded supply of take-home naloxone to prevent opioid overdose deaths is needed. Potential routes for expansion of naloxone provision include through community pharmacies. The aim of this scoping review is to establish what is known about community pharmacy supply of naloxone, in light of unique challenges and opportunities present in pharmacy settings. A scoping review methodology was employed using the six stage iterative process advocated by Arksey and O'Malley (2005) and Levac et al...
February 15, 2016: International Journal on Drug Policy
Paul T Wertlake, Michael D Henson
Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive...
2016: Journal of Pain Research
Katherine McLean
BACKGROUND: Applying the "risk environment" approach proposed by Rhodes (2002, 2009), this study considers the diverse contextual factors contributing to drug overdose in a deindustrialized region of the United States. The Monongahela Valley of Pennsylvania, once a global center of steel production, has suffered a mass exodus of jobs, residents, and businesses since a national manufacturing crisis erupted in the early 1980s; more recently, it has seen a dramatic uptick in accidental drug poisoning deaths...
March 2016: International Journal on Drug Policy
Joseph M Reardon, Katherine J Harmon, Genevieve C Schult, Catherine A Staton, Anna E Waller
BACKGROUND: Although fatal opioid poisonings tripled from 1999 to 2008, data describing nonfatal poisonings are rare. Public health authorities are in need of tools to track opioid poisonings in near real time. METHODS: We determined the utility of ICD-9-CM diagnosis codes for identifying clinically significant opioid poisonings in a state-wide emergency department (ED) surveillance system. We sampled visits from four hospitals from July 2009 to June 2012 with diagnosis codes of 965...
2016: BMC Emergency Medicine
Elizabeth A Samuels, Kristin Dwyer, Michael J Mello, Janette Baird, Adam R Kellogg, Edward Bernstein
OBJECTIVES: Develop and internally validate a survey tool to assess emergency department (ED) physician attitudes, clinical practice, and willingness to perform opiate harm reduction (OHR) interventions and to identify barriers and facilitators in translating willingness to action. METHODS: This study was an anonymous, Web-based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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