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1.
Reg Anesth Pain Med ; 48(1): 37-43, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36202619

RESUMO

IMPORTANCE: The COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts. OBJECTIVE: To summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada. EVIDENCE REVIEW: We searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results. FINDINGS: Among 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each. INTERPRETATION: Significant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves. PROSPERO REGISTRATION NUMBER: CRD42021236464.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos/epidemiologia , Analgésicos Opioides/efeitos adversos , Antagonistas de Entorpecentes/uso terapêutico , Overdose de Opiáceos/diagnóstico , Overdose de Opiáceos/epidemiologia , Pandemias , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle
2.
JAMA Netw Open ; 5(11): e2241174, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36350649

RESUMO

Importance: In 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations. Objective: To compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs). Design, Setting, and Participants: In this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island. Interventions: Distribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach). Main Outcomes and Measures: Witnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates. Results: A total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo. Conclusions and Relevance: In this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.


Assuntos
Overdose de Drogas , Drogas Ilícitas , Overdose de Opiáceos , Humanos , Naloxona/uso terapêutico , Rhode Island/epidemiologia , Disparidades nos Níveis de Saúde , Overdose de Drogas/epidemiologia , Atenção à Saúde
5.
Harm Reduct J ; 19(1): 125, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397146

RESUMO

BACKGROUND: Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. METHODS: Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. RESULTS: Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20-2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08-1.91), binge drug use (AOR 1.36; 95% CI 1.08-1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00-2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52-0.98) and being in a relationship (AOR 0.30; 95% CI 0.23-0.39). CONCLUSION: We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.


Assuntos
Overdose de Drogas , Abuso de Substâncias por Via Intravenosa , Masculino , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estudos Prospectivos , Overdose de Drogas/epidemiologia , Canadá/epidemiologia , Trabalho Sexual
7.
BMC Public Health ; 22(1): 2121, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401244

RESUMO

BACKGROUND: Illicit drug poisoning (overdose) continues to be an important public health problem with overdose-related deaths currently recorded at an unprecedented level. Understanding the geographic variations in fatal overdose mortality is necessary to avoid disproportionate risk resulting from service access inequity. METHODS: We estimated the odds of fatal overdose per event from all cases captured by the overdose surveillance system in British Columbia (2015 - 2018), using both conventional logistic regression and Generalized Additive Models (GAM). The results of GAM were mapped to identify spatial-temporal trends in the risk of fatal overdose. RESULTS: We found that the odds of fatal overdose were about 30% higher in rural areas than in large urban centers, with some regions reporting odds 50% higher than others. Temporal variations in fatal overdose revealed an increasing trend over the entire province. However, the increase occurred earlier and faster in the Interior and Northern regions. CONCLUSION: Rural areas were disproportionately affected by fatal overdose; lack of access to harm reduction services may partly explain the elevated risk in these areas.


Assuntos
Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Drogas Ilícitas , Humanos , Colúmbia Britânica/epidemiologia , Overdose de Drogas/epidemiologia , Saúde Pública
8.
Harm Reduct J ; 19(1): 126, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401299

RESUMO

BACKGROUND: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. METHODS: Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. RESULTS: Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). CONCLUSIONS: We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.


Assuntos
COVID-19 , Overdose de Drogas , Masculino , Humanos , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Estudos Transversais , Canadá/epidemiologia , Overdose de Drogas/epidemiologia
9.
Pharmacol Res Perspect ; 10(6): e01033, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36404650

RESUMO

Opioid use and associated morbidity and mortality have increased in several countries during the past 20 years. We performed a study whose objective was to assess the frequency and causes of opioid-related emergency division (ED) visits in an adult tertiary Swiss University Hospital over 9 weeks in 2018. We primarily assessed opioid-related adverse drug reactions (ADR), secondary overdose, misuse, abuse, and insufficient pain relief. Current opioid use was identified in 1037 (8.3%) of the 12 470 included ED visits. In 64 opioid users, an ADR was identified as a contributing cause of the ED visit, representing 6.2% of opioid users, and 0.5% of the total ED visits. Moreover, we identified an overdose in 16 opioid users, misuse or abuse in 19 opioid users, and compatible withdrawal symptoms in 7 opioid users. After pooling all these events, we conclude that the ED visits could be related to opioid use in 10.2% of opioid users. Finally, in 201 opioid users, insufficient pain relief (pain not responding to the current pharmacological treatment) was identified as a contributing cause of ED visits. In these cases, other factors than simply pharmacological nonresponse may have been involved. In the context of an ever-increasing opioid use to better control chronic pain situations, these results should reinforce emergency network epidemiological surveillance studies at a national level.


Assuntos
Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Transtornos Relacionados ao Uso de Opioides , Humanos , Adulto , Analgésicos Opioides/efeitos adversos , Centros de Atenção Terciária , Serviço Hospitalar de Emergência , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Overdose de Drogas/epidemiologia , Overdose de Drogas/diagnóstico , Overdose de Drogas/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Dor/tratamento farmacológico
10.
JAMA Netw Open ; 5(11): e2243653, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36416821

RESUMO

Importance: Studies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk. Objective: To examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration. Design, Setting, and Participants: In this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022. Exposures: Substance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics. Main Outcomes and Measures: Hazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events. Results: The study identified 6816 people (5980 male [87.7%]; 2820 aged <30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses. Conclusions and Relevance: This cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.


Assuntos
Estimulantes do Sistema Nervoso Central , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Masculino , Humanos , Analgésicos Opioides/efeitos adversos , Estudos de Coortes , Overdose de Drogas/epidemiologia , Overdose de Drogas/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/efeitos adversos
14.
J Public Health Manag Pract ; 28(Suppl 6): S320-S325, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36194800

RESUMO

CONTEXT: For more than a decade, the state of Ohio has been an epicenter of the opioid crisis. Multiple interventions have been deployed to address this crisis and reduce opioid overdoses and overdose deaths in the state. The Hamilton County Addiction Response Coalition (HC ARC) and its strategic, countywide prearrest diversion (LEAD) and deflection (QRT) programs have been at the forefront of this effort in Cincinnati, Ohio. Operating since April 2018, these programs have continued to grow and improve and have been successful in connecting hundreds of citizens to needed treatment and other social services. PROGRAM: HC ARC combats overdoses and overdose deaths by utilizing cross-sector planning and collaboration to operate 2 countywide programs: Quick Response Team (QRT) and Law Enforcement Assisted Diversion (LEAD). IMPLEMENTATION: The QRT and LEAD programs leverage partnerships with law enforcement, public health, addiction and mental health services, reentry services, and trained peer supporters. The QRT emphasizes triage, assessment, and connection to appropriate services for people with recent nonfatal drug overdoses and provides outreach and education in hot spot communities. LEAD provides diversion from the criminal justice system into long-term case management for nonviolent individuals with low-level offenses who also struggle with substance use disorder, mental health, homelessness, and/or poverty. EVALUATION: QRT and LEAD team members routinely track and record client contacts and outcomes using a centralized electronic case management platform. Data are extracted and analyzed by the evaluation team to examine indices of program success and provide ongoing feedback to the QRT and LEAD teams. DISCUSSION: HC ARC has implemented, tested, expanded, and now standardized its prearrest diversion programming. It has built a sustainable model to improve health and health equity for marginalized individuals whose needs intersect across health care, public health, community-based social services, and the criminal-legal system. Collectively, this work offers a guide for implementation and best practices for the following: detailed planning, policy, and procedure development; identification of key leaders and community partners; and methods to evaluate program operations to make data-driven decisions and real-time program adjustments.


Assuntos
Overdose de Drogas , Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Humanos , Aplicação da Lei , Ohio/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
15.
J Public Health Manag Pract ; 28(Suppl 6): S372-S380, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36194809

RESUMO

The Public Health and Safety Team (PHAST) Framework and Toolkit were developed by the CDC Foundation in collaboration with the Centers for Disease Control and Prevention to guide local jurisdictions in strengthening coordination among public health, public safety, and other sectors to address the overdose crisis. The PHAST Framework uses guiding principles, strategies, and tools to help improve multisector engagement, data sharing, and coordinated overdose prevention. To assess its utility and inform its refinement, the initial version of the Toolkit was piloted in York County, Pennsylvania. A follow-up assessment was conducted 1 year after the pilot concluded. Application of the PHAST Framework appeared to have contributed to positive and sustained changes to meeting activities, structure, and attendance, supporting the potential utility of PHAST for advancing local-level multisector overdose prevention efforts. This article describes the basic tenets of PHAST, the pilot process, and findings from the 1-year follow-up assessment.


Assuntos
Overdose de Drogas , Epidemias , Centers for Disease Control and Prevention, U.S. , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Humanos , Disseminação de Informação , Saúde Pública , Estados Unidos
16.
Drug Alcohol Depend ; 240: 109645, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36191532

RESUMO

BACKGROUND: In 2014, the Norwegian government funded a large-scale take-home naloxone (THN) program to address high overdose mortality rates. The aims of this study are to describe characteristics among persons trained to receive THN, describe actions taken following THN use at an overdose event and to explore factors associated with naloxone use. METHODS: This was a prospective cohort study of individuals who received THN from 2014 to 2021. Descriptive characteristics were collected at initial training. When returning for refill, participants reported on their previous naloxone use. In a multivariable logistic regression model exploring associations with naloxone use: gender, age, opioid use history, concomitant drug use, injecting, history of experienced or witnessed overdose were included. RESULTS: In total, 3527 individuals were included in this study. There were 958 individuals who returned for refills 2303 times. Most participants were male (63.6%), with a history of opioid use (77.5%). Those who reported naloxone use were more likely to have a history of opioid use (aOR= 4.1; 95% CI=2.77,6.1), were younger (aOR=0.98; 95% CI=0.97,0.99) and had witnessed overdoses (aOR=3.3; 95% CI=1.98,5.34). Among current opioid users, the odds were higher for injectors (aOR=1.57; 95% CI=1.18,2.1). Naloxone use was reported 1282 times. Additional actions such as waking the person and calling the ambulance were frequently reported. Survival was reported in almost all cases (94%). CONCLUSION: People who use drugs are a suitable target group for THN-programs, as they seem to be willing and capable to reverse overdoses effectively. Given their personal risk factors for overdosing, recipients will likely also benefit from overdose prevention education.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Humanos , Masculino , Feminino , Naloxona/uso terapêutico , Analgésicos Opioides/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Estudos Prospectivos , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
17.
Subst Use Misuse ; 57(14): 2142-2145, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36305842

RESUMO

Background: Accidental opioid-involved overdose deaths are increasing nationally in the wake of the COVID-19 pandemic, but it is unclear if this reflects a change in populations most at risk. Objective: To determine whether the demographic characteristics and controlled substance prescription history of accidental opioid-involved drug overdose decedents in 2020 differed from prior years. Methods: We identified accidental opioid-involved overdose decedents using Rhode Island (RI) State Medical Examiner's Office data. Decedents were linked to the RI Prescription Drug Monitoring Program database. We compared demographic characteristics and prescription history by year of death. Results: From 2018 to 2020, 763 RI residents died from accidental opioid-involved overdose in RI. From 2018 to 2019, deaths decreased by 7%, but then increased by 31% from 2019 to 2020. Demographic characteristics were similar by year of death (all p > 0.05). The percentage of decedents with a prior opioid prescription and a prior benzodiazepine prescription declined from 2018 to 2020 (p < 0.01 and p = 0.03). Conclusions: We found that opioid-involved overdose deaths in RI are increasing overall, but without significant changes in demographics. While prior exposure to some controlled substances did decline over time, it is not clear if these changes reflect more responsible prescribing practices, or a more concerning pattern such as patient abandonment or decreased healthcare access. More studies are needed to better describe the current trend of increasing opioid-involved deaths while also pursuing current evidence-based interventions.


Assuntos
COVID-19 , Overdose de Drogas , Overdose de Opiáceos , Humanos , Analgésicos Opioides , Substâncias Controladas , Rhode Island/epidemiologia , Pandemias , Overdose de Drogas/epidemiologia , Prescrições
18.
Clin Toxicol (Phila) ; 60(11): 1220-1226, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36287198

RESUMO

BACKGROUND: Early identification of patients at risk of seizure after acute tramadol overdose is crucial. Yet, current evidence has been inconclusive regarding the factors associated with the seizure. There is a lack of study on the Chinese population and the value of electrocardiogram (ECG) in risk prognostication has not been fully evaluated. OBJECTIVES: We aimed 1) to characterise the clinical presentations of isolated tramadol overdose in Hong Kong; 2) to study the frequency of seizure in such overdose and the factors associated with it using multivariable analysis; and 3) to explore the association between individual ECG parameters and seizure. METHODS: This was a retrospective observational study on consecutive patients reported to the Hong Kong Poison Information Centre for tramadol overdose from 1 January 2008 to 30 November 2020. Duplicate cases or patients with an overdose of other co-ingestants were excluded. Univariate and multivariable logistic regression was performed to identify factors significantly associated with seizures in general and seizures that occurred after emergency department (ED) arrival. RESULTS: We identified 93 patients, including 54 women and 39 men, with a median age of 38 years during the study period. The majority was Chinese (90%) and only five patients had a history of seizure. The seizure occurred in 23 patients. Multivariable analysis showed that sinus tachycardia > 100 beats/min was significantly associated with a higher seizure risk (OR 27.95, 95% CI 2.22-351.84, p = 0.010) and age per 10 years increase was associated with a lower risk (OR 0.61; 95% CI 0.39-0.96, p = 0.033). No reliable predictors of seizure after ED arrival were identified. Many patients had ECG features consistent with sodium channel blockade but none of them was predictive of seizure. CONCLUSIONS: A younger age and sinus tachycardia > 100 beats/min were associated with a higher seizure risk after tramadol overdose but no reliable predictors of seizure after ED arrival were identified. Individual ECG parameters were not predictive of seizure.


Assuntos
Overdose de Drogas , Tramadol , Masculino , Humanos , Feminino , Adulto , Criança , Estudos Retrospectivos , Hong Kong/epidemiologia , Taquicardia Sinusal , Overdose de Drogas/diagnóstico , Overdose de Drogas/epidemiologia , Overdose de Drogas/complicações , Convulsões/induzido quimicamente , Convulsões/epidemiologia , Analgésicos Opioides
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