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3.
Ann Otol Rhinol Laryngol ; 129(2): 164-169, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31581795

RESUMO

OBJECTIVE: The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. METHODS: The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. RESULTS: One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. CONCLUSIONS: RM is associated with increased odds of having an OUD.


Assuntos
Descongestionantes Nasais/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/complicações , Rinite/induzido quimicamente , Rinite/complicações , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descongestionantes Nasais/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Adulto Jovem
4.
J Clin Ethics ; 30(4): 356-359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851627

RESUMO

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks. Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Injeções Intravenosas/ética , Transtornos Relacionados ao Uso de Opioides/complicações , Hospitalização , Humanos
5.
J Opioid Manag ; 15(6): 487-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850510

RESUMO

OBJECTIVE: To characterize hedonic eating behaviors such as sugar cravings, food preferences, and appetitive responsiveness for sweet and hyper-palatable foods, and to determine the prevalence of addictive like eating behaviors and food addiction (FA) in individuals receiving medication-assisted treatment (MAT) for opioid use disorder (OUD). DESIGN: Quasi-experimental. SETTING: Outpatient MAT center. PARTICIPANTS: Nonpregnant adult patients undergoing MAT (n = 116) receiving either buprenorphine/naloxone or methadone for at least 6 months. MAIN OUTCOME MEASURES: Hedonic eating, FA, and food craving. RESULTS: Of the aggregate sample, 13.3 percent met criteria for FA. More than onethird of all subjects endorsed consuming larger amounts of highly palatable food than intended, unsuccessful attempts to quit or cut down on eating such foods, and a great deal of time spent on consuming or recovering from consuming such foods. Both medication groups demonstrated greatest cravings for sweets and fast foods followed by carbohydrates and fats (p < 0.001). Similarly, subjects reported "giving in" most frequently to sweets and fast foods followed by carbohydrates then fats (p < 0.001). Greater appetitive responsiveness was noted in the presence of hyper-palatable foods. No group differences were found. Weight change was not associated with addictive like eating, food craving, or appetitive responsiveness. CONCLUSIONS: Individuals receiving MAT exhibit preferences for sweet and fast foods that appear to be influenced by the proximity of such foods. FA was present. Collectively, such eating behaviors and food preferences may pose additional adverse health consequences and associated co-morbidities. This underlies the importance of comprehensive healthcare for patients with OUD, including nutrition education and evaluation of eating behaviors and food preferences.


Assuntos
Comportamento Aditivo/epidemiologia , Comportamento Alimentar , Preferências Alimentares , Transtornos Relacionados ao Uso de Opioides , Adulto , Analgésicos Opioides , Comportamento Aditivo/psicologia , Fissura , Gorduras na Dieta , Ingestão de Alimentos , Fast Foods , Comportamento Alimentar/psicologia , Humanos , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/terapia
6.
PLoS Med ; 16(11): e1002974, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770382

RESUMO

BACKGROUND: Opioid addiction is a major public health threat to healthy life expectancy; however, little is known of long-term mortality for mothers with opioid use in pregnancy. Pregnancy and delivery care are opportunities to improve access to addiction and supportive services. Treating neonatal abstinence syndrome (NAS) as a marker of opioid use during pregnancy, this study reports long-term maternal mortality among mothers with a birth affected by NAS in relation to that of mothers without a NAS-affected birth in 2 high-prevalence jurisdictions, England and Ontario, Canada. METHODS AND FINDINGS: We conducted a population-based study using linked administrative health data to develop parallel cohorts of mother-infant dyads in England and Ontario between 2002 and 2012. The study population comprised 13,577 and 4,966 mothers of infants with NAS and 4,205,675 and 929,985 control mothers in England and Ontario, respectively. Death records captured all-cause maternal mortality after delivery through March 31, 2016, and cause-specific maternal mortality to December 31, 2014. The primary exposure was a live birth of an infant with NAS, and the main outcome was all deaths among mothers following their date of delivery. We modelled the association between NAS and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. All-cause mortality rates, 10-year cumulative incidence risk of death, and crude and age-adjusted hazard ratios were calculated. Estimated crude 10-year mortality based on Kaplan-Meier curves in mothers of infants with NAS was 5.1% (95% CI 4.7%-5.6%) in England and 4.6% (95% CI 3.8%-5.5%) in Ontario versus 0.4% (95% CI 0.41%-0.42%) in England and 0.4% (95% CI 0.38%-0.41%) in Ontario for controls (p < 0.001 for all comparisons). Survival curves showed no clear inflection point or period of heightened risk. The crude hazard ratio for all-cause mortality was 12.1 (95% 11.1-13.2; p < 0.001) in England and 11.4 (9.7-13.4; p < 0.001) in Ontario; age adjustment did not reduce the hazard ratios. The cumulative incidence of death was higher among NAS mothers than controls for almost all causes of death. The majority of deaths were by avoidable causes, defined as those that are preventable, amenable to care, or both. Limitations included lack of direct measures of maternal opioid use, other substance misuse, and treatments or supports received. CONCLUSIONS: In this study, we found that approximately 1 in 20 mothers of infants with NAS died within 10 years of delivery in both England and Canada-a mortality risk 11-12 times higher than for control mothers. Risk of death was not limited to the early postpartum period targeted by most public health programs. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of opioid-using mothers and their children.


Assuntos
Mortalidade Materna/tendências , Adulto , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Mães , Síndrome de Abstinência Neonatal/epidemiologia , Ontário/epidemiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos
7.
J Consult Clin Psychol ; 87(10): 859-871, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556663

RESUMO

OBJECTIVE: Marijuana and nonprescription opioids remain the two most commonly used illicit substances in the United States. They have commonalities, yet the use of both at the same time may have a greater impact on psychological and health outcomes. Research is needed to determine whether dual-use is associated with more negative outcomes than individual substance use. METHOD: We used the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) Wave 1 (W1; N = 43,093), Wave 2 (W2; N = 34,653), and the more recent NESARC-III (N3; N = 36,171) to compare nonuse with use of marijuana, nonprescription opioids, or both. We examined perceived health, pain interference, pain-related medical conditions, psychiatric conditions, and suicidality. RESULTS: Individual use and dual-use were more common in N3 than in W1. W1 dual-use and nonprescription opioid-only use predicted worse outcomes for most variables prospectively and cross-sectionally, including pain interference and poorer general health. Associations between marijuana-only use and outcomes were not as strong; however, marijuana was associated with depression and suicidal ideation. CONCLUSION: Nonprescription opioid use is concerning with dual-use predicting poorer perceived health and pain interference with work 3 years later along with strong relationships to suicidality and psychiatric conditions. Marijuana and nonprescription opioid dual-use is a possible treatment target. Substance interventions may be enhanced by addressing alternative pain care; chronic conditions; and/or psychiatric comorbidity. Differences in outcomes between substance use and nonuse were smaller recently in N3, particularly for marijuana use only. This may be due to increased access decreasing differences between those using and not using these drugs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Uso da Maconha/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Dor/psicologia , Ideação Suicida , Adulto , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Dor/complicações , Estados Unidos
8.
J Consult Clin Psychol ; 87(10): 952-961, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556671

RESUMO

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Medicina do Vício , Buprenorfina/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Atenção Primária à Saúde , Saúde da População Rural , Adulto , Transtornos de Ansiedade/complicações , Buprenorfina/administração & dosagem , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/complicações , Estudos Retrospectivos
9.
Forensic Sci Int ; 304: 109915, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416646

RESUMO

Fatal intoxications due to accidental or voluntary intake of synthetic opioids represent an actual emerging issue. We report a case where we have analyzed furanyl fentanyl and its metabolite 4-anilino-N-phenetyl-piperidine (4-ANPP) in blood, urine, gastric content, bile and cerebrospinal fluid. In this case, a 53-year-old man was found dead at home with a needle still inserted in a vein; a plastic bag containing a white powder (later identified as a furanyl fentanyl-based product) was discovered in the room. Biological samples were collected during autopsy and extracted/purified onto a SPE cartridge before instrumental analysis. Qualitative and quantitative analyses were performed by LC-MS/MS on peripheral and cardiac blood, urine, cerebrospinal fluid (CSF), bile and gastric content. Furanyl fentanyl was identified and quantified in all the biological fluids collected. Interestingly, gastric content revealed an unexpected high amount of furanyl fentanyl; yet, cardiac blood and femoral blood provided significantly different concentrations (11.8 and 2.7 ng/g respectively). The concentration of furanyl fentanyl in CSF was similar to that measured in femoral blood (2.6 ng/mL), thus confirming that CSF could be a good alternative biological fluid whenever a postmortem redistribution is suspected. Concentrations of 93.5, 50.4, 171.7, 41.9, 10.2 ng/mL(g) were measured for 4-ANPP in cardiac blood, femoral blood, urine, bile and cerebrospinal fluid, respectively. The outcomes from the presented case report suggest that the two substances have been not only injected intravenously, but probably also ingested by the man. Fentanyl derivative and its precursor seemed to undergo an extensive postmortem redistribution.


Assuntos
Analgésicos Opioides/análise , Analgésicos Opioides/farmacocinética , Fentanila/análogos & derivados , Furanos/análise , Furanos/farmacocinética , Mudanças Depois da Morte , Bile/química , Cromatografia Líquida , Fentanila/análise , Fentanila/farmacocinética , Toxicologia Forense/métodos , Conteúdo Gastrointestinal/química , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Medicamentos Sintéticos/análise , Medicamentos Sintéticos/farmacocinética
10.
Braz J Cardiovasc Surg ; 34(4): 444-450, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454198

RESUMO

OBJECTIVES: Postoperative arrhythmia is an important complication of coronary artery bypass grafting (CABG) surgeries among patients. It seems that opioid usage is implicated in the pathogenesis of this condition due to its impacts on different organ systems, such as the autonomic nervous system. The present study was performed to investigate the effect of opium use on postoperative arrhythmia in patients undergoing CABG surgery. METHODS: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery. RESULTS: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population. CONCLUSION: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables.


Assuntos
Arritmias Cardíacas/etiologia , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Transtornos Relacionados ao Uso de Opioides/complicações , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Pressão Sanguínea , Pressão Venosa Central , Epinefrina/efeitos adversos , Feminino , Frequência Cardíaca , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Adulto Jovem
13.
Am Surg ; 85(6): 567-571, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267895

RESUMO

In the past 30 years, opioid prescription rates have quadrupled and hospital admissions for overdose are rising. Previous studies have focused on alcohol use and trauma recidivism, however rarely evaluating recidivism and opioid use. We hypothesized there is an association between opioid use and trauma recidivism. This is a retrospective review of patients with multiple admissions for traumatic injury. Demographics, opioid toxicology screen (TS) results, and injury characteristics were collected. Statistical analysis was performed with chi-squared and Poisson regression models. One thousand six hundred forty-nine patients (age ≥18 years) had multiple trauma admissions. Seven hundred nine patients had TS data for both admissions. Thirty-one per cent (218) were TS positive on the 1st admission compared with 34 per cent (244) on their 2nd admission. Fifty-five per cent of patients who were TS positive on the 1st admission were positive on their 2nd admission, whereas 25 per cent who were TS negative on the 1st admission were subsequently positive on their 2nd admission (P < 0.0001). Patients who were TS positive on the subsequent admission were less severely injured than TS negative patients (Injury Severity Score > 15, 26.3% vs 22.3%, P = 0.04). The only significant risk factor for being TS positive on the 2nd admission was being TS positive on the 1st admission (relative risk = 2.18, P < 0.001). A previous history of opioid use is the strongest predictor of recurrent use in recidivists.


Assuntos
Analgésicos Opioides/efeitos adversos , Uso de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ferimentos e Lesões/induzido quimicamente , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/uso terapêutico , Análise Química do Sangue , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/induzido quimicamente , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Determinação de Necessidades de Cuidados de Saúde , Transtornos Relacionados ao Uso de Opioides/complicações , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Taxa de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
14.
Am J Dermatopathol ; 41(8): e84-e86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335429

RESUMO

Crospovidone, a polymer of poly N-vinyl-2-pyrrolidone, is an inert insoluble disintegrant found in pharmaceutical tablets. This material has been encountered in the lungs of intravenous drug users and embolized with other components such as talc and microcrystalline cellulose. More recently, crospovidone has also been described in the gastrointestinal tract. We present 2 cases of cutaneous crospovidone deposition resulting from subcutaneous injection of crushed tablets, commonly known as "skin popping." Clinical presentation includes painful, inflamed papules, nodules, or ulcers with overlying eschar. Crospovidone has a distinct and reproducible histochemical staining profile. Histologic recognition of this material is important because it can guide clinicians in their diagnosis and management decisions.


Assuntos
Analgésicos Opioides/efeitos adversos , Corpos Estranhos/etiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Excipientes Farmacêuticos/efeitos adversos , Povidona/efeitos adversos , Pele/química , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Analgésicos Opioides/análise , Composição de Medicamentos , Feminino , Corpos Estranhos/patologia , Humanos , Injeções Subcutâneas , Excipientes Farmacêuticos/análise , Povidona/análise , Pele/patologia , Comprimidos
15.
Injury ; 50(8): 1429-1432, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279477

RESUMO

INTRODUCTION: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). METHODS: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. RESULTS: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p <  0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3-6) than for the NORCS group (median, 3; IQR 2-4) (p =  0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16-38) compared with the NORCS group (median, 9 days; IQR: 5-13) (p <  0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p <  0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p <  0.001). All ORCS patients presented >8 h after immobilization in a dependent position. CONCLUSION: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.


Assuntos
Síndromes Compartimentais/etiologia , Fáscia/lesões , Dependência de Heroína/complicações , Transtornos Relacionados ao Uso de Opioides/complicações , Insuficiência Renal/epidemiologia , Rabdomiólise/epidemiologia , Lesões do Sistema Vascular/complicações , Adulto , Síndromes Compartimentais/epidemiologia , Síndromes Compartimentais/fisiopatologia , Síndromes Compartimentais/terapia , Fáscia/irrigação sanguínea , Fasciotomia , Feminino , Dependência de Heroína/epidemiologia , Dependência de Heroína/fisiopatologia , Dependência de Heroína/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/fisiopatologia , Transtornos Relacionados ao Uso de Opioides/terapia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia
16.
Forensic Sci Int ; 302: 109858, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279508

RESUMO

Fentanyl is a potent synthetic opioid with a variety of possible applications. Transdermal fentanyl patches are regularly prescribed for patients with severe chronic or cancer-related pain. The potential for abuse is well-known and cases associated with illicit fentanyl intake are common. Fentanyl related fatalities due to unintentional misuse are relatively rare. This study focused on those instances and their identification in forensic examinations and adds new cases and consolidates the existing femoral blood concentrations in the event of fatal fentanyl patch misapplications. A total of 35 cases between 2010 and 2018 in which transdermal fentanyl patches were detected during forensic autopsies were identified and reviewed for the frequency of unspecific macroscopic signs of opioid intoxication. Furthermore, a detailed examination is presented for 11 cases in which toxicological results were available. The cause of death was eventually considered to be related to fentanyl patch misuse in 5 of these 11 cases. Co-administered drugs and signs of opioid intoxication, especially pulmonary edema, were frequently found. Lastly, it is advised to include norfentanyl and hair analysis in the interpretation of post-mortem fentanyl concentrations.


Assuntos
Analgésicos Opioides/efeitos adversos , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/complicações , Uso Indevido de Medicamentos sob Prescrição , Adesivo Transdérmico/efeitos adversos , Adolescente , Adulto , Idoso , Analgésicos Opioides/análise , Analgésicos Opioides/envenenamento , Cromatografia Líquida , Feminino , Fentanila/análogos & derivados , Fentanila/análise , Fentanila/envenenamento , Cabelo/química , Humanos , Masculino , Espectrometria de Massas , Edema Pulmonar/patologia , Estudos Retrospectivos , Retenção Urinária/patologia
17.
J Opioid Manag ; 15(3): 235-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343725

RESUMO

INTRODUCTION AND OBJECTIVES: Opioid use disorder has become increasingly prevalent in recent years. Previous studies have shown that patients with opioid use disorder undergoing orthopedic, elective abdominopelvic, and cardiac procedures have poorer postoperative outcomes. The aim of this study was to examine the effect of pre-existing opioid use disorder on postoperative outcomes including in-hospital mortality, hospital length of stay (LOS), hospital readmission, and postoperative complications in patients undergoing appendectomy or cholecystectomy. METHODS: The authors used administrative data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007-2014 from California, Florida, Kentucky, Maryland, and New York. The authors compared unadjusted rates of in-hospital mortality, postoperative complications, LOS, and 30-day and 90-day readmission status. The authors calculated the adjusted odds ratio (OR) for their outcomes using logistic regression models. RESULTS: In all, 488,981 appendectomy patients and 790,491 cholecystectomy patients aged ≥ 18 years were included in the analysis. Appendectomy (OR 2.26) but not cholecystectomy patients with opioid use disorder had statistically significant adjusted odds of in-hospital death. Patients with opioid use disorder (overall reported, and by each procedure separately) had higher adjusted odds of postoperative complication (OR 1.46), 30-day readmission (OR 1.80), 90-day readmission (OR 1.98), and longer LOS (OR 1.37). CONCLUSIONS: The authors found higher unadjusted rates and adjusted ORs of in-patient mortality, hospital readmission, and postoperative complications in patients with opioid use disorder undergoing common abdominal surgeries. The authors' study shows that opioid use disorder is a risk factor for poorer postoperative outcomes in this surgical patient population.


Assuntos
Analgésicos Opioides/administração & dosagem , Apendicectomia , Transtornos Relacionados ao Uso de Opioides , Dor Pós-Operatória/prevenção & controle , Colecistectomia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Transtornos Relacionados ao Uso de Opioides/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
18.
Curr HIV Res ; 17(2): 94-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210115

RESUMO

The US is in the midst of a major epidemic of opioid addiction and related comorbidities. People with opioid use disorder (OUD) are at significant risk for transmission of several blood-borne pathogens including the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Commonly abused opioids and their receptors promote viral replication and virus-mediated pathology. However, most studies demonstrating an adverse effect of drugs of abuse have been conducted in vitro, the specific effects of synthetic opioids on viral replication have been poorly characterized, and the evaluation of opioid-virus interactions in clinically relevant populations is rare. Rigorous characterization of the interactions among synthetic opioids, host cells, and common injection-associated viral infections will require an interdisciplinary research approach and translational studies conducted on humans. Such research promises to improve clinical management paradigms for difficult-to-treat populations, facilitate rational public health policies given severely strained resources, and reveal additional pathways for novel target-specific therapeutic interventions. This mini-review examines the published literature on the effects of opioids on HIV, HBV, and HCV pathogenesis and proposes a series of scientific questions and considerations to establish a translational research agenda focused on opioid-virus interactions.


Assuntos
Analgésicos Opioides/farmacologia , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/virologia , Viroses/complicações , Viroses/virologia , Vírus/efeitos dos fármacos , Humanos
19.
CMAJ ; 191(17): E462-E468, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036608

RESUMO

BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.


Assuntos
Transmissão de Doença Infecciosa/prevenção & controle , Usuários de Drogas/estatística & dados numéricos , Hepatite C/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Buprenorfina/administração & dosagem , Estudos de Coortes , Feminino , Hepatite C/etiologia , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/complicações
20.
Expert Opin Drug Saf ; 18(6): 465-475, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31033357

RESUMO

INTRODUCTION: There has been an exponential increase in overdose fatalities as illicitly manufactured fentanyl and its analogs (IMF) are becoming more prevalent in the illicit drug supply. In response, overdose education and naloxone distribution (OEND) programs have been implemented throughout the United States as a harm reduction strategy. However, there are increasing reports that higher naloxone doses or repeat administration might be required for overdose victims involving IMF. AREAS COVERED: In this article, we provide a comprehensive review of the epidemiology, public health impact, and pharmacologic properties of IMF. The pharmacokinetic properties of currently available take-home naloxone (THN) kits, the role of THN as a harm reduction strategy and available data on its clinical use are discussed. Implications of occupational IMF exposure for first responders are also described. EXPERT OPINION: THN administration by a bystander is an effective harm reduction intervention. However, there is growing evidence that higher dose or multiple administrations of naloxone are required to fully reverse IMF related toxicity. Recently, the US Food and Drug Administration approved THN kits with a concentrated naloxone dose that produce high bioavailability. However, limited presence of OEND programs and cost of these new devices impede their accessibility to the general public.


Assuntos
Overdose de Drogas/tratamento farmacológico , Fentanila/envenenamento , Naloxona/administração & dosagem , Analgésicos Opioides/envenenamento , Animais , Overdose de Drogas/epidemiologia , Fentanila/análogos & derivados , Redução do Dano , Humanos , Naloxona/farmacocinética , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/farmacocinética , Transtornos Relacionados ao Uso de Opioides/complicações , Estados Unidos
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