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1.
Forensic Sci Int ; 306: 110093, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31816483

RESUMO

Studies on the mortalities of drug abusers in China are scarce. This study explores the deaths of methamphetamine, opioid, and ketamine abusers in Shanghai (2004-2017) and Wuhan (2005-2017). Chi-square/Fisher's exact tests were used to compare the differences in terms of region, gender, age, cause of death, and the method used in the last drug abuse. Poisson regression models were used to estimate the rate ratios ("RRs") and annual percentage changes ("APCs"). 314 heroin, 43 methamphetamine, and 4 ketamine abusers were included. Furthermore, simultaneously, 6 abusers used heroin and methamphetamine, and 7 abusers used methamphetamine and ketamine. Heroin-related deaths have declined in Shanghai (APC, -16.1; 95 % CI, -18.4 to -11.3) and Wuhan (APC, -16.0; 95 % CI, -18.9 to -10.6), whereas methamphetamine-related deaths have increased in Wuhan (APC, 12.8; 95 % CI, 0.0 to 29.2). On the whole, in the two cities, males were more frequently observed than females in heroin-related deaths (4.4, 230/52). However, the gender ratios for methamphetamine- (1.8, 34/19) and ketamine-related deaths (1.2, 6/5) were close to one. In view of the mortality rates of the drug abusers in most Chinese cities were still unclear, it is thus important to improve mortality surveillance of the drug abusers at the national level.


Assuntos
Analgésicos Opioides/envenenamento , Ketamina/envenenamento , Metanfetamina/envenenamento , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adolescente , Adulto , Distribuição por Idade , Analgésicos Opioides/efeitos adversos , Intoxicação por Monóxido de Carbono/mortalidade , China/epidemiologia , Feminino , Heroína/efeitos adversos , Heroína/envenenamento , Humanos , /envenenamento , Ketamina/efeitos adversos , Masculino , Metanfetamina/efeitos adversos , Pessoa de Meia-Idade , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Adulto Jovem
2.
Am J Forensic Med Pathol ; 40(4): 329-335, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31688050

RESUMO

Forensic pathologists are requested to select matrices alternative to blood in cases of toxicological interest in which blood is not available for different reasons. We evaluated morphine concentrations in blood, bile, and liver samples in 52 cases of heroin overdoses, relating them to each other, to understand the information that could be derived from their analysis. Gas chromatography/mass spectrometry analysis was performed for all the samples positive on screening for opiates. Shapiro-Wilk test, nonparametric Mann-Whitney test, linear regression analysis, and Bland-Altman test were used for analysis. Linear regression demonstrated that there was not a statistically significant association in morphine concentrations between blood and bile and blood and liver. Mean liver/blood ratio was 2.76, varying from 0.131 to 13.379, and bile/blood ratio was 28.79, varying from 0.28 to 559.16. According to these results, bile analysis is a "screening test"; biliary or hepatic concentration of morphine cannot provide information on hematic concentration at the time of death, having no forensic value taken individually.


Assuntos
Bile/química , Overdose de Drogas , Heroína/envenenamento , Fígado/química , Morfina/análise , Adolescente , Adulto , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Dependência de Heroína , Humanos , Modelos Lineares , Masculino , Detecção do Abuso de Substâncias , Adulto Jovem
4.
Am J Public Health ; 109(7): 1022-1024, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31095410

RESUMO

OBJECTIVES: To describe changes in suspected heroin overdose emergency department (ED) visits. Methods. We analyzed quarterly and yearly changes in heroin overdoses during 2017-2018 by using data from 23 states and jurisdictions (including the District of Columbia) funded by the Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance program. The analyses included the Pearson χ 2 test to detect significant changes. Results. Both sexes, all age groups, and some states exhibited increases from quarter 1 (Q1) 2017 to Q2 2017 and significant decreases in both quarters from Q3 2017 to Q1 2018 in heroin overdose ED visits. Overall, there was a significant yearly decline of 21.5% in heroin overdose ED visits. Three states had significant yearly increases (Illinois, Indiana, and Utah), and 9 states (Kentucky, Maryland, Massachusetts, New Hampshire, Ohio, Pennsylvania, Rhode Island, West Virginia, and Wisconsin) and the District of Columbia had significant decreases. Conclusions. We identified decreases in heroin overdose ED visits from 2017 through 2018, but these declines were not consistent among states. Even with the possibility of a stabilization or slowing of this epidemic, it is important that the field of public health and its partners implement strategies to prevent overdoses and target emerging hot spots.


Assuntos
Overdose de Drogas/epidemiologia , Serviço Hospitalar de Emergência , Dependência de Heroína/epidemiologia , Heroína/envenenamento , Fatores Etários , Overdose de Drogas/diagnóstico , Dependência de Heroína/diagnóstico , Humanos , População Rural/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
6.
Drug Alcohol Depend ; 196: 46-50, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30665151

RESUMO

BACKGROUND: British Columbia is experiencing a public health emergency due to overdoses resulting from consumption of street drugs contaminated with fentanyl. While the risk of overdoses appears to be increasing, the overdose rate and severity of overdose presentations have yet to be quantified. METHODS: Insite is a supervised injection site in Vancouver. Data from Insite's client database from January 2010 to June 2017 were used to calculate overdose rates as well as the proportion of overdoses involving rigidity and naloxone administration over time in order to estimate changes in the risk and severity of overdose resulting from changes in the local drug supply. RESULTS: The overdose rate increased significantly for all drug categories. Heroin used alone or with other drugs continues to be associated with the highest overdose rate. The overdose rate associated with heroin increased from 2.7/1000 visits to 13/1000 visits over the study period, meaning that clients were 4.8 times more likely to overdose in the most recent period as in the baseline period. The proportion of overdose events involving rigidity, a known complication of intravenous fentanyl use, increased significantly from 10.4% to 18.9%. The proportion of overdoses requiring naloxone administration increased significantly from 48.4% to 57.1% and is now similar across all drug categories. CONCLUSIONS: The risk and severity of overdoses at Insite have increased since the emergence of illicit fentanyl. This information derived from supervised injection site data can be used to inform local harm reduction efforts and the response to the overdose emergency.


Assuntos
Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Programas de Troca de Agulhas/tendências , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/terapia , Adolescente , Adulto , Colúmbia Britânica/epidemiologia , Cocaína/administração & dosagem , Cocaína/envenenamento , Overdose de Drogas/diagnóstico , Feminino , Redução do Dano , Heroína/administração & dosagem , Heroína/envenenamento , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/métodos , Saúde Pública/tendências , Fatores de Risco , Problemas Sociais/tendências , Abuso de Substâncias por Via Intravenosa/diagnóstico , Adulto Jovem
7.
J Forensic Sci ; 64(1): 144-148, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29684941

RESUMO

Heroin and fentanyl are the overwhelming and increasing cause of opioid deaths in Milwaukee County, Wisconsin. We reviewed all drug and opioid deaths from 2013 to 2017 to delineate the specific opioid drugs involved and changes in their incidence. From 2013 to 2017, 980 deaths were due to opioids, rising from 184 in 2013 to 337 in 2017. In 2017, opioid deaths exceeded combined non-natural deaths from homicide and suicide. Illicit heroin and fentanyl/analogs caused 84% of opioid deaths and 80% of drug deaths, with no increase in deaths due to oral prescription drugs such as oxycodone and hydrocodone. Any approach to decreasing this dramatic increase in opioid deaths should first focus on interdicting the supply and cheap availability of these illicit opioids. Fentanyl and its analogs represent the most deadly opioids and the greatest threat to human life in our population.


Assuntos
Analgésicos Opioides/envenenamento , Fentanila/envenenamento , Heroína/envenenamento , Transtornos Relacionados ao Uso de Opioides/mortalidade , Analgésicos Opioides/análise , Buprenorfina/análise , Buprenorfina/envenenamento , Médicos Legistas , Fentanila/análise , Heroína/análise , Humanos , Hidrocodona/análise , Hidrocodona/envenenamento , Incidência , Metadona/análise , Metadona/envenenamento , Oxicodona/análise , Oxicodona/envenenamento , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Wisconsin/epidemiologia
8.
J Forensic Sci ; 64(1): 149-153, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29940698

RESUMO

Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is a potent opioid analgesic with no medicinal uses. We report deaths between 2016 and 2017 at the Medical Examiner's Office in Detroit, MI where acetyl fentanyl was found in the decedent's blood and compare them to previously published deaths between 2015 and 2016. The recent cases (cohort B) had a mean acetyl fentanyl concentration of 0.9 ng/mL (range: 0.1-5.3 ng/mL) and an associated higher concentration of fentanyl along with multiple other drugs present. The older cases (cohort A) had higher concentrations of acetyl fentanyl (mean: 8.9 ng/mL; range: 0.28-37 ng/mL) with lower, yet still toxic, concentrations of fentanyl. We conclude that the cause of death in these recent cases was likely multiple drug toxicity with fentanyl and that the consistently observed lower peripheral blood concentrations of acetyl fentanyl are most likely an artifact in the manufacture of the consumed illicit fentanyl.


Assuntos
Analgésicos Opioides/sangue , Analgésicos Opioides/envenenamento , Fentanila/análogos & derivados , /envenenamento , Transtornos Relacionados ao Uso de Opioides/mortalidade , Adulto , Benzodiazepinas/sangue , Benzodiazepinas/envenenamento , Depressores do Sistema Nervoso Central/sangue , Cromatografia Líquida , Cocaína/sangue , Cocaína/envenenamento , Estudos de Coortes , Grupos de Populações Continentais/estatística & dados numéricos , Médicos Legistas , Overdose de Drogas/sangue , Overdose de Drogas/mortalidade , Etanol/sangue , Feminino , Fentanila/sangue , Fentanila/envenenamento , Heroína/sangue , Heroína/envenenamento , Humanos , Masculino , Espectrometria de Massas , Michigan/epidemiologia , Transtornos Relacionados ao Uso de Opioides/sangue , População Urbana
9.
MMWR Morb Mortal Wkly Rep ; 67(50): 1384-1387, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30571673

RESUMO

The opioid epidemic has resulted in a threefold increase in drug overdose deaths in the United States during 1999-2015 (1). Whereas American Indians/Alaska Natives (AI/AN) have experienced larger increases in drug overdose mortality than have other racial/ethnic groups in the United States (2), little is known about the regional impact of opioids in tribal and urban AI/AN communities. To address this data gap, death records from the Washington State Center for Health Statistics, corrected for misclassification of AI/AN race, were examined to identify trends and disparities in drug, opioid-involved, and heroin-involved overdose mortality rates for AI/AN and non-Hispanic whites (whites) in Washington. Although AI/AN and whites had similar overdose mortality rates during 1999-2001, subsequent overdose rates among AI/AN increased at a faster rate than did those among whites. During 2013-2015, mortality rates among AI/AN were 2.7 and 4.1 times higher than rates among whites for total drug and opioid-involved overdoses and heroin-involved overdoses, respectively. Washington death certificates that were not corrected for misclassification of AI/AN race underestimated drug overdose mortality rates among AI/AN by approximately 40%. National statistics on the opioid epidemic, which report that overdose mortality rates are significantly higher among whites than among AI/AN, are not reflective of regional prevalences, disparities, and trends. Comprehensive efforts to address the opioid epidemic in AI/AN communities rely on strong partnerships between tribal governments and local, state, and federal entities. Additional measures are needed for community-based surveillance, treatment, and prevention to effectively respond to the epidemic across diverse tribal and urban AI/AN communities.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Analgésicos Opioides/envenenamento , Overdose de Drogas/etnologia , Overdose de Drogas/mortalidade , Heroína/envenenamento , Índios Norte-Americanos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Washington/epidemiologia
10.
Drug Alcohol Depend ; 193: 169-176, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30384325

RESUMO

BACKGROUND: We are at a unique moment in United States (US) history as heroin overdose rates are higher than at any time in recent memory. Based on prior research and the developmental risks faced by young adults (ages 18-25), we examine the trends and correlates of perceived access to heroin among this group over a 15-year period. METHODS: We analyzed national trend data from the National Survey on Drug Use and Health (2002-2016) on young adults' (N = 247,679; ages 18-25) perceived access to heroin. We conducted logistic regression analyses with survey year specified as an independent variable and heroin access specified as the dependent variable while controlling for sociodemographic factors. RESULTS: A majority of respondents reported that it would be difficult or impossible to obtain heroin, if desired. Young adult reports that it would be "probably impossible" to access heroin increased significantly from 31% in 2002 to 41% in 2016. The upward trend in the perceived lack of access was most robust among African Americans and Hispanics as well as those reporting no past-year substance use or drug/criminal justice system involvement. CONCLUSIONS: In the midst of a very serious opioid epidemic, the present study found that most young adults in the US consider that it would be "probably impossible" to obtain heroin. This trend was observed across young adulthood and across gender, racial/ethnic, and family income differences. However, we found that these trends are largely driven by those at relatively low risk of drug misuse and deviant behaviors generally.


Assuntos
Analgésicos Opioides/envenenamento , Heroína/envenenamento , Percepção , Adolescente , Adulto , Afro-Americanos , Overdose de Drogas/epidemiologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
11.
J Anal Toxicol ; 42(8): 581-585, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30371840

RESUMO

This case report presents three unrelated children found to have heroin and/or fentanyl in their systems after general unknown systematic toxicological analysis (STA). The first case involves an 11-month-old male found unresponsive at their residence. The scene response suggested a potentially unsafe sleeping condition or a sudden unexplained infant death. The second case is a 14-month-old female found unresponsive after eating soft candies, suggesting that a choking related death may have occurred. The third case is a 12-year-old male found unresponsive in bed and foaming from the mouth. Gum was removed from the child's airway, suggesting another choking related death. The STA included a 14-drug category enzyme linked immunosorbant assay (ELISA) screening in whole blood. Cases 1 and 3 were presumptively positive for fentanyl, while Case 2 was presumptively positive for opiates and fentanyl. Reflex confirmation was performed in blood, urine and gastric contents, by solid-phase extraction (SPE) for 12 opiates including morphine and 6-monoacetylmorphine (6MAM) by gas chromatography-mass spectrometry (GC-MS) and for fentanyl, norfentanyl, and novel analogs, by liquid chromatography tandem mass spectrometry (LC-MS-MS). High concentrations of fentanyl and 6MAM in the gastric contents of Case 1, along with the presence of diacetylmorphine, suggested probable enteral ingestion of heroin and fentanyl, separately or in a combined formulation. Interpretation of the toxicology results could not determine a probable route of exposure to heroin/fentanyl in Case 2, however, the cause of death was clearly related to this drug mixture. In Case 3, the presence of acetylfentanyl suggested an illicit fentanyl exposure. The intention of this case report is to demonstrate the need for a STA approach for all non-trauma postmortem cases regardless of case circumstances, age or suspicion of drug use.


Assuntos
Fentanila/análise , Toxicologia Forense/métodos , Heroína/análise , Autopsia , Criança , Cromatografia Líquida , Evolução Fatal , Feminino , Fentanila/envenenamento , Toxicologia Forense/normas , Cromatografia Gasosa-Espectrometria de Massas , Conteúdo Gastrointestinal/química , Heroína/envenenamento , Humanos , Lactente , Masculino , Espectrometria de Massas em Tandem
12.
Int J Drug Policy ; 59: 94-97, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30075401

RESUMO

BACKGROUND: Despite promising findings of opioid overdose education and naloxone distribution (OEND) programs, overdose continues to be a major cause of mortality. The "cascade of care" is a tool for identifying steps involved in achieving optimal health outcomes. We applied the cascade concept to identify gaps in naloxone use. METHODS: Data came from a cross-sectional survey of 353 individuals aged 18 and older who self-reported lifetime history of heroin use. RESULTS: The sample was majority male (65%) and reported use of heroin (74%) and injection (57%) in the past 6 months. Ninety percent had ever witnessed an overdose and of these 59% were in the prior year. Awareness of naloxone (90%) was high. Of those aware, over two-thirds reported having ever received (e.g. access) (69%) or been trained to use naloxone (60%). Of those who had ever received naloxone (n = 218) over one-third reported possession never (36%) or rarely/sometimes carrying naloxone (38%), while 26% reported always carrying. Nearly half of those who had ever received naloxone reported ever use to reverse an opiate overdose (45%). Among individuals who had ever received naloxone, possession often/always compared to never was associated with being female (RRR = 2.88, 95%CI = 1.31-6.27) and ever used naloxone during an overdose (RRR = 4.68, 95%CI = 2.00-11.0). CONCLUSIONS: This study identifies that consistent possession is a gap in the naloxone cascade. Future research is needed to understand reasons for not always carrying naloxone.


Assuntos
Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/prevenção & controle , Naloxona/administração & dosagem , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/provisão & distribução , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adolescente , Adulto , Idoso , Conscientização , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Heroína/envenenamento , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Forensic Sci Int ; 290: e15-e18, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30017664

RESUMO

Homicide occurs in approximately one in five injury-related deaths among infants in the United States and studies suggest that male caretakers (fathers or mothers' intimate partners) are the perpetrators of the majority of infant homicides. Opioid abuse is common and it is estimated that between 26.4 million and 36 million people abuse opioids worldwide. In this case report, we add to the literature the first reported homicide by intentional heroin administration in a 10-month old infant. Toxicology revealed morphine 1092ng/L, codeine 74ng/mL, and 6-monoacetyl-morphine 359ng/L in cardiac blood. Morphine 803ng/g, codeine 54ng/g in liver tissue, and morphine 181ng/mL was found in vitreous humor. With the prevalence of opioid abuse on the rise accidental opioid ingestions in the pediatric population have increased. However, forensic personnel must recognize the possibility of intentional poisoning in this vulnerable population.


Assuntos
Heroína/envenenamento , Homicídio , Entorpecentes/envenenamento , Codeína/análise , Feminino , Humanos , Lactente , Fígado/química , Morfina/análise , Derivados da Morfina/análise , Corpo Vítreo/química
14.
Forensic Sci Int ; 290: 121-128, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30015276

RESUMO

BACKGROUND: In heroin-related deaths, it is often of interest to determine the approximate time span between intake of heroin and death, and to decide whether heroin or other opioids have been administered. In some autopsy cases, peripheral blood cannot be sampled due to decomposition, injuries or burns. The aim of the present study was to investigate whether measurements of heroin metabolites in matrices other than peripheral blood can be used to differentiate between rapid and delayed heroin deaths, and if morphine/codeine ratios measured in other matrices can separate heroin from codeine intakes. METHODS: In this study, we included 51 forensic autopsy cases where morphine was detected in peripheral blood. Samples were collected from peripheral and cardiac blood, pericardial fluid, psoas and lateral vastus muscles, vitreous humor and urine. The opioid analysis included 6-acetylmorphine (6-AM), morphine, morphine-3-glucuronide (M3G), morphine-6-glucuronide (M6G) and codeine. Urine was only used for qualitative detection of 6-AM. 45 heroin-intake cases were divided into rapid deaths (n=24), based on the detection of 6-AM in blood, or delayed deaths (n=21), where 6-AM was detected in at least one other matrix but not in blood. An additional 6 cases were classified as codeine-intake cases, based on a morphine/codeine ratio below unity (<1) in peripheral blood, without detecting 6-AM in any matrix. RESULTS: The median morphine concentrations were significantly higher in the rapid compared with the delayed heroin deaths in all matrices (p=0.004 for vitreous humor and p<0.001 for the other matrices). In the rapid heroin deaths, the M3G/morphine concentration ratios were significantly lower than in the delayed deaths both in peripheral and cardiac blood (p<0.001), as well as in pericardial fluid (p<0.001) and vitreous humor (p=0.006), but not in muscle. The morphine/codeine ratios measured in cardiac blood, pericardial fluid and the two muscle samples resembled the ratios in peripheral blood, although codeine was less often detected in other matrices than peripheral blood. CONCLUSIONS: Measurements of heroin-metabolites in cardiac blood, pericardial fluid and vitreous humor provide information comparable to that of peripheral blood regarding rapid and delayed heroin deaths, e.g. M3G/morphine ratios <2 indicate a rapid death while ratios >3 indicate a delayed death. However, considerable overlap in results from rapid and delayed deaths was observed, and measurements in muscle appeared less useful. Furthermore, matrices other than peripheral blood can be used to investigate morphine/codeine ratios, but vitreous humor seems less suited.


Assuntos
Codeína/análise , Heroína/envenenamento , Derivados da Morfina/análise , Morfina/análise , Mudanças Depois da Morte , Overdose de Drogas , Toxicologia Forense , Dependência de Heroína/mortalidade , Humanos , Músculo Esquelético/química , Líquido Pericárdico/química , Fatores de Tempo , Corpo Vítreo/química
15.
BMC Public Health ; 18(1): 829, 2018 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973179

RESUMO

BACKGROUND: Public injecting of recreational drugs has been documented in a number of cities worldwide and was a key risk factor in a HIV outbreak in Glasgow, Scotland during 2015. We investigated the characteristics and health needs of people involved in this practice and explored stakeholder attitudes to new harm reduction interventions. METHODS: We used a tripartite health needs assessment framework, comprising epidemiological, comparative, and corporate approaches. We undertook an analysis of local and national secondary data sources on drug use; a series of rapid literature reviews; and an engagement exercise with people currently injecting in public places, people in recovery from injecting drug use, and staff from relevant health and social services. RESULTS: Between 400 and 500 individuals are estimated to regularly inject in public places in Glasgow city centre: most experience a combination of profound social vulnerabilities. Priority health needs comprise addictions care; prevention and treatment of blood-borne viruses; other injecting-related infections and injuries; and overdose and drug-related death. Among people with lived experience and staff from relevant health and social care services, there was widespread - though not unanimous - support for the introduction of safer injecting facilities and heroin-assisted treatment services. CONCLUSIONS: The environment and context in which drug consumption occurs is a key determinant of harm, and is inextricably linked to upstream social factors. Public injecting therefore requires a multifaceted response. Though evidence-based interventions exist, their implementation internationally is variable: understanding the attitudes of key stakeholders provides important insights into local facilitators and barriers. Following this study, Glasgow plans to establish the world's first co-located safer injecting facility and heroin-assisted treatment service.


Assuntos
Redução do Dano , Determinação de Necessidades de Cuidados de Saúde , Logradouros Públicos , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Heroína/envenenamento , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Escócia/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto Jovem
16.
Clin Toxicol (Phila) ; 56(11): 1135-1142, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29873588

RESUMO

Background: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated. Methods: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics. The number of non-fatal heroin overdose events over the study period were also examined. Results and discussion: There were a total of 3921 heroin-related attendances by paramedics during the study period, including 2455 cases that involved treatment but where the patient was not transported to hospital. There were also 243 heroin-related deaths identified over the study period and 93% (n = 225) of those cases were matched with Ambulance Victoria electronic patient care records. Data linkage revealed 31 heroin-related deaths where there had been a recent presentation with a non-fatal heroin overdose to paramedics; however, none of these deaths were related to that episode of care, including for 11 individuals that were treated on scene by paramedics but not transported to the hospital. Conclusions: This study demonstrated that the treatment of uncomplicated heroin overdose in the out-of-hospital environment was safe in terms of mortality, irrespective of whether or not naloxone had been administered. In all of the non-fatal heroin toxicity cases attended by paramedics, whether or not transported to hospital, death occurred as a result of a subsequent and unrelated heroin overdose.


Assuntos
Assistência Ambulatorial/normas , Overdose de Drogas/tratamento farmacológico , Serviços Médicos de Emergência/normas , Heroína/envenenamento , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Segurança do Paciente/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Vitória , Adulto Jovem
18.
Harm Reduct J ; 15(1): 26, 2018 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769132

RESUMO

BACKGROUND: Internationally, overdose is the primary cause of death among people injecting drugs. However, since 2001, heroin-related overdose deaths in the United States (US) have risen sixfold, paralleled by a rise in the death rate attributed to synthetic opioids, particularly the fentanyls. This paper considers the adaptations some US heroin injectors are making to protect themselves from these risks. METHODS: Between 2015 and 2016, a team of ethnographers collected data through semi-structured interviews and observation captured in field notes and video recording of heroin preparation/consumption. Ninety-one current heroin injectors were interviewed (Baltimore, n = 22; Chicago, n = 24; Massachusetts and New Hampshire, n = 36; San Francisco, n = 9). Experience injecting heroin ranged from < 1-47 years. Eight participants, who were exclusively heroin snorters, were also interviewed. Data were analyzed thematically. RESULTS: Across the study sites, multiple methods of sampling "heroin" were identified, sometimes used in combination, ranging from non-injecting routes (snorting, smoking or tasting a small amount prior to injection) to injecting a partial dose and waiting. Partial injection took different forms: a "slow shot" where the user injected a portion of the solution in the syringe, keeping the needle in the injection site, and continuing or withdrawing the syringe or a "tester shot" where the solution was divided into separate injections. Other techniques included getting feedback from others using heroin of the same batch or observing those with higher tolerance injecting heroin from the same batch before judging how much to inject themselves. Although a minority of those interviewed described using these drug sampling techniques, there is clearly receptivity among some users to protecting themselves by using a variety of methods. CONCLUSIONS: The use of drug sampling as a means of preventing an overdose from injection drug use reduces the quantity absorbed at any one time allowing users to monitor drug strength and titrate their dose accordingly. Given the highly unpredictable potency of the drugs currently being sold as heroin in the US, universal precautions should be adopted more widely. Further research is needed into facilitators and barriers to the uptake of these drug sampling methods.


Assuntos
Heroína/farmacologia , Entorpecentes/farmacologia , Monitoramento de Medicamentos/métodos , Overdose de Drogas/prevenção & controle , Feminino , Redução do Dano , Heroína/administração & dosagem , Heroína/envenenamento , Dependência de Heroína/psicologia , Humanos , Masculino , Entorpecentes/administração & dosagem , Entorpecentes/envenenamento , Abuso de Substâncias por Via Intravenosa/psicologia , Paladar , Estados Unidos
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