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1.
MMWR Morb Mortal Wkly Rep ; 69(5): 125-129, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027630

RESUMO

Increased prevalence of illicitly manufactured fentanyl and fentanyl analogs has contributed substantially to overdose deaths in the United States (1-3). On October 26, 2015, CDC issued a Health Advisory regarding rapid increases in deaths involving fentanyl. This CDC Health Advisory has been updated twice to address increases in fentanyl and fentanyl analog overdoses and their co-occurrence with nonopioids (4). Deaths involving carfentanil, an analog reportedly 10,000 times more potent than morphine and 100 times more potent than fentanyl, were first reported in Florida, Michigan, and Ohio in 2016 and described in an August 2016 CDC Health Advisory (1,5). Carfentanil is used to rapidly immobilize large animals in veterinary medicine and has no U.S. approved therapeutic use in humans. Carfentanil's street price per dose is likely lower than that of heroin. During 2016 and 2017, an outbreak of carfentanil-involved fatal overdoses in Florida emerged, and the Medical Examiner jurisdiction serving Sarasota, Manatee, and DeSoto counties (the Sarasota area) was the outbreak epicenter. This report describes toxicology profiles, sociodemographic information, and geographic distributions of carfentanil-involved fatal overdoses (carfentanil deaths) in the Sarasota area compared with those in the rest of Florida (i.e., all Florida counties excluding Sarasota area) from January 2016 to December 2017. The Sarasota area accounted for 19.0% of 1,181 statewide carfentanil deaths that occurred during this time and experienced a peak in carfentanil deaths preceding the larger Florida outbreak. The report of a single carfentanil death from August to December 2017 (compared with 73 reported deaths during the same period in 2016) appeared to mark the end of the outbreak in the area. The threat of such rapid, intense fatal overdose outbreaks highlights the need for accelerated reporting, reliable data sharing systems, and novel proactive surveillance to support targeted prevention and response efforts by public health and safety organizations (6).


Assuntos
Surtos de Doenças , Overdose de Drogas/mortalidade , Fentanila/análogos & derivados , Adulto , Feminino , Fentanila/envenenamento , Florida/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade
3.
Toxicol Lett ; 320: 109-112, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778775

RESUMO

BACKGROUND: Since 2016 an increase has been observed in the availability of new synthetic opioids (NSO) in Europe. Cyclopropylfentanyl is a very potent and selective µ-opioid agonist, which was reported for the first time in August 2017 in Europe. METHODS: The case was included in a prospective observational study of patients treated in emergency departments after the intake of novel psychoactive substances (NPS). Clinical features were acquired using a structured questionnaire for physicians. Serum and/or urine samples of ED patients were analyzed using liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) screening methods for NPS. CASE REPORT: Within 10 min after intranasal intake of fentanyl, a 25-year-old male developed nausea, profuse sweating and dyspnoe. Because soon afterwards coma and respiratory insufficiency was noticed, the patient was admitted to hospital. After administration of naloxone (0.8 mg) breathing stabilized. However, the patient displayed recurrent decreases of oxygen saturation for 12 h. The intake of cyclopropylfentanyl was analytically confirmed. CONCLUSION: The constantly growing diversity of NSO still poses a high risk for drug users and can be a challenging task for clinicians and forensic toxicologists. Clinicians treating opioid overdoses should be aware of the potentially long lasting respiratory depression induced by fentanyl analogs.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/diagnóstico , Fentanila/análogos & derivados , Transtornos Relacionados ao Uso de Opioides , Detecção do Abuso de Substâncias/métodos , Administração Intranasal , Adulto , Aerossóis , Analgésicos Opioides/administração & dosagem , Cromatografia Líquida de Alta Pressão , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/fisiopatologia , Fentanila/administração & dosagem , Fentanila/envenenamento , Humanos , Masculino , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Espectrometria de Massas por Ionização por Electrospray , Espectrometria de Massas em Tandem , Resultado do Tratamento
4.
J Forensic Sci ; 65(1): 112-116, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31483504

RESUMO

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.


Assuntos
Analgésicos Opioides/envenenamento , Doenças Cardiovasculares/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/efeitos adversos , Autopsia , Encéfalo/patologia , Edema Encefálico/patologia , Estudos de Casos e Controles , Overdose de Drogas , Feminino , Patologia Legal , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Tamanho do Órgão , Edema Pulmonar/patologia , Estudos Retrospectivos , Distribuição por Sexo , Bexiga Urinária/patologia , Adulto Jovem
6.
J Opioid Manag ; 15(5): 357-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849026

RESUMO

OBJECTIVE: To evaluate current practices in naloxone prescribing upon hospital discharge. DESIGN: Electronic cross-sectional survey. SETTING: Academic medical center. PARTICIPANTS: Inpatient physicians and advanced practice providers. MAIN OUTCOME MEASURES: Respondents completed survey items including current naloxone prescribing practices, barriers to naloxone prescribing, and methods to improve naloxone prescribing. RESULTS: The survey response rate was 51.6 percent. Greater than 90 percent of respondents agreed that naloxone should be prescribed for patients with an active opioid use disorder, history of overdose, and use of greater than 50 morphine milligram equivalents per day. Lack of patient education on proper use of naloxone was the most identified barrier to prescribing. CONCLUSIONS: Providers agree with the Centers for Disease Control and Prevention recommendations to prescribe naloxone to high-risk patients. Certain barriers affect the rate of naloxone prescribing at discharge, including lack of time, patient education, provider training, and concern for increasing riskier behaviors.


Assuntos
Overdose de Drogas , Naloxona , Alta do Paciente , Padrões de Prática Médica , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Overdose de Drogas/prevenção & controle , Humanos , Antagonistas de Entorpecentes
7.
J Opioid Manag ; 15(5): 428-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849033

RESUMO

Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer's knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge. We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.


Assuntos
Analgésicos Opioides , Overdose de Drogas , Fentanila/envenenamento , Naloxona/administração & dosagem , Analgésicos Opioides/envenenamento , Overdose de Drogas/tratamento farmacológico , Heroína , Humanos , Masculino , Pessoa de Meia-Idade
9.
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
10.
MMWR Morb Mortal Wkly Rep ; 68(43): 967-973, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671083

RESUMO

Among the 47,600 opioid-involved overdose deaths in the United States in 2017, 59.8% (28,466) involved synthetic opioids (1). Since 2013, synthetic opioids, particularly illicitly manufactured fentanyl (IMF), including fentanyl analogs, have been fueling the U.S. overdose epidemic (1,2). Although initially mixed with heroin, IMF is increasingly being found in supplies of cocaine, methamphetamine, and counterfeit prescription pills, which increases the number of populations at risk for an opioid-involved overdose (3,4). With the proliferation of IMF, opioid-involved overdose deaths have increased among minority populations including non-Hispanic blacks (blacks) and Hispanics, groups that have historically had low opioid-involved overdose death rates (5). In addition, metropolitan areas have experienced sharp increases in drug and opioid-involved overdose deaths since 2013 (6,7). This study analyzed changes in overdose death rates involving any opioid and synthetic opioids among persons aged ≥18 years during 2015-2017, by age and race/ethnicity across metropolitan areas. Nearly all racial/ethnic groups and age groups experienced increases in opioid-involved and synthetic opioid-involved overdose death rates, particularly blacks aged 45-54 years (from 19.3 to 41.9 per 100,000) and 55-64 years (from 21.8 to 42.7) in large central metro areas and non-Hispanic whites (whites) aged 25-34 years (from 36.9 to 58.3) in large fringe metro areas. Comprehensive and culturally tailored interventions are needed to address the rise in drug overdose deaths in all populations, including prevention strategies that address the risk factors for substance use across each racial/ethnic group, public health messaging to increase awareness about synthetic opioids in the drug supply, expansion of naloxone distribution for overdose reversal, and increased access to medication-assisted treatment.


Assuntos
Analgésicos Opioides/envenenamento , Grupos de Populações Continentais/estatística & dados numéricos , Overdose de Drogas/etnologia , Overdose de Drogas/mortalidade , Grupos Étnicos/estatística & dados numéricos , Medicamentos Sintéticos/envenenamento , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
11.
Nurs Clin North Am ; 54(4): 495-501, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703775

RESUMO

This article offers a brief review geared toward primary care providers of the most critical aspects of the management of opiate use disorder, including screening, brief intervention, and referral to treatment as well as medication-assisted treatment and the alarming trends and dangers of illicitly produced fentanyl.


Assuntos
Analgésicos Opioides/efeitos adversos , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Atenção Primária à Saúde , Overdose de Drogas/tratamento farmacológico , Fentanila/efeitos adversos , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia
12.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688944

RESUMO

Since the late 1970s N-acetylcystein has been used as an antidote after paracetamol intoxication. The treatment is traditionally given as three consecutive infusions for 20 hours and 15 minutes. The total dose given is 300 mg/kg. Half of this amount is given as a bolus during the first 15 minutes of treatment.  This regime has proven very efficient in avoiding liver injury. However, side effects, caused by histamine release, are common (10-15%). Symptoms as flush, urticaria and, in rare cases, bronchospasm, angioedema and circulatory shock typically appear during the bolus dose and may lead to interrupted and inadequate treatment. In addition, the regime is complicated leading to a risk of administration errors. During the last years several publications have described the use of a model with two infusions instead of three. The first and the second infusions are merged and given over four hours. The third infusion and the total dose are left unchanged. This modified regime has been shown to reduce side effects and seems not to increase the risk of liver injury. As of November 1, 2019, the Swedish Poisons Information Centre will change its recommendations to the new two-infusion protocol.


Assuntos
Acetaminofen/envenenamento , Acetilcisteína/administração & dosagem , Antídotos/administração & dosagem , Overdose de Drogas/tratamento farmacológico , Envenenamento/tratamento farmacológico , Acetilcisteína/efeitos adversos , Acetilcisteína/uso terapêutico , Administração Intravenosa , Antídotos/efeitos adversos , Antídotos/uso terapêutico , Humanos , Centros de Controle de Intoxicações , Guias de Prática Clínica como Assunto
15.
Lancet ; 394(10208): 1560-1579, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31657732

RESUMO

We summarise the evidence for medicinal uses of opioids, harms related to the extramedical use of, and dependence on, these drugs, and a wide range of interventions used to address these harms. The Global Burden of Diseases, Injuries, and Risk Factors Study estimated that in 2017, 40·5 million people were dependent on opioids (95% uncertainty interval 34·3-47·9 million) and 109 500 people (105 800-113 600) died from opioid overdose. Opioid agonist treatment (OAT) can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes-eg, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries. Mathematical modelling suggests that scaling up the use of OAT and retaining people in treatment, including in prison, could avert a median of 7·7% of deaths in Kentucky, 10·7% in Kiev, and 25·9% in Tehran over 20 years (compared with no OAT), with the greater effects in Tehran and Kiev being due to reductions in HIV mortality, given the higher prevalence of HIV among people who inject drugs in those settings. Other interventions have varied evidence for effectiveness and patient acceptability, and typically affect a narrower set of outcomes than OAT does. Other effective interventions focus on preventing harm related to opioids. Despite strong evidence for the effectiveness of a range of interventions to improve the health and wellbeing of people who are dependent on opioids, coverage is low, even in high-income countries. Treatment quality might be less than desirable, and considerable harm might be caused to individuals, society, and the economy by the criminalisation of extramedical opioid use and dependence. Alternative policy frameworks are recommended that adopt an approach based on human rights and public health, do not make drug use a criminal behaviour, and seek to reduce drug-related harm at the population level.


Assuntos
Analgésicos Opioides/uso terapêutico , Overdose de Drogas/mortalidade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Analgésicos Opioides/envenenamento , Overdose de Drogas/epidemiologia , Saúde Global , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/terapia , Prevalência , Fatores de Risco
16.
Sud Med Ekspert ; 62(5): 4-8, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626186

RESUMO

The purpose of the work is to study the prevalence of overdose deaths from narcotic drugs and psychotropic substances in Russia, as determined by forensic autopsies, for the period 2003 to 2018. For the study, medical statistics were processed, the percentages for each indication were calculated, and the changes in the percentages for different types of overdose deaths were noted. It was established in forensic autopsies for the period under study, that the percentage of narcotic overdose deaths ranged from 4.2% to 16.6% of the total number of poisonings, while the percentage of overdose deaths from psychotropic substances ranged from 0.7% to 1.3%.


Assuntos
Overdose de Drogas/mortalidade , Entorpecentes/envenenamento , Psicotrópicos/envenenamento , Humanos , Prevalência , Federação Russa/epidemiologia
17.
Sud Med Ekspert ; 62(5): 54-57, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626196

RESUMO

An analysis of fatal drug overdoses in the population of the Crimean Republic between 1993-2017 was conducted. The epidemiological characteristics of these drug overdoses were determined. Deaths from drug overdoses occurs mainly in male population during the most active years of drug use (21-30 years). The most frequent cause of death is opioid drug overdose and combined alcohol-opioid intoxication.


Assuntos
Overdose de Drogas/mortalidade , Psicotrópicos/envenenamento , Analgésicos Opioides/envenenamento , Etanol/envenenamento , Humanos , Masculino , Entorpecentes/envenenamento , Transtornos Relacionados ao Uso de Substâncias , Ucrânia/epidemiologia
20.
Lakartidningen ; 1162019 Oct 01.
Artigo em Sueco | MEDLINE | ID: mdl-31573668

RESUMO

Prilocaine/lidocaine is widely used as local anesthetic in children for cannulation and minor surgical procedures. Usually it is unproblematic but it is important to adhere to recommended dose to avoid serious complications. Excessive amount of prilocaine/lidocaine, large application area, prolonged application time or repeated application can, especially in infants, cause methemoglobinemia with clinical symptoms. In severe cases intensive care and antidote treatment with Methylene blue may be required. We report three infants who were overdosed with prilocaine/lidocaine, two of them due to incorrect use after circumcision and one premature baby where prilocaine/lidocaine was not removed in time. Two of the babies had MetHb levels > 33% and were seriously affected with hypoxia, tachycardia and fatigue. After Methylene blue was given the infants recovered within 15 minutes and MetHb levels returned to normal.


Assuntos
Anestésicos Combinados/efeitos adversos , Anestésicos Locais/efeitos adversos , Combinação Lidocaína e Prilocaína/efeitos adversos , Metemoglobinemia/induzido quimicamente , Gasometria , Overdose de Drogas/complicações , Overdose de Drogas/tratamento farmacológico , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/uso terapêutico , Humanos , Recém-Nascido , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/tratamento farmacológico , Azul de Metileno/administração & dosagem , Azul de Metileno/uso terapêutico
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