Prior use of medications for opioid use disorder in ED patients with opioid overdose: prevalence, misuse and overdose severity

2021 ◽  
Author(s):  
Siri Shastry ◽  
Ishak Nobel ◽  
Lisa R. Allen ◽  
Lynne D. Richardson ◽  
Kavey Vidal ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Prior Use

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

Predicting Opioid Overdose Readmission and Opioid Use Disorder with Machine Learning

2020 ◽  
Author(s):  
Sarah McDougall ◽  
Priyanka Annapureddy ◽  
Praveen Madiraju ◽  
Nicole Fumo ◽  
Stephen Hargarten
Keyword(s):  
Machine Learning ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age

2019 ◽  
Vol 15 (5) ◽  
pp. 428-432
Author(s):  
Amer Raheemullah, MD ◽  
Neal Andruska, MD, PhD
Keyword(s):  
Addiction Treatment ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Health Departments ◽  
Opioid Use ◽  
Public Health Departments ◽  
Disorder Treatment ◽  
Fentanyl Analogues ◽  
Overdose Deaths

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.

scholarly journals Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose

2021 ◽  
Vol 2 (4) ◽  
pp. 365-378
Author(s):  
Amber N. Edinoff ◽  
Catherine A. Nix ◽  
Tanner D. Reed ◽  
Elizabeth M. Bozner ◽  
Mark R. Alvarez ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Physical Damage ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Opioid Intoxication

Opioid use disorder is a well-established and growing problem in the United States. It is responsible for both psychosocial and physical damage to the affected individuals with a significant mortality rate. Given both the medical and non-medical consequences of this epidemic, it is important to understand the current treatments and approaches to opioid use disorder and acute opioid overdose. Naloxone is a competitive mu-opioid receptor antagonist that is used for the reversal of opioid intoxication. When given intravenously, naloxone has an onset of action of approximately 2 min with a duration of action of 60–90 min. Related to its empirical dosing and short duration of action, frequent monitoring of the patient is required so that the effects of opioid toxicity, namely respiratory depression, do not return to wreak havoc. Nalmefene is a pure opioid antagonist structurally similar to naltrexone that can serve as an alternative antidote for reversing respiratory depression associated with acute opioid overdose. Nalmefene is also known as 6-methylene naltrexone. Its main features of interest are its prolonged duration of action that surpasses most opioids and its ability to serve as an antidote for acute opioid overdose. This can be pivotal in reducing healthcare costs, increasing patient satisfaction, and redistributing the time that healthcare staff spend monitoring opioid overdose patients given naloxone.

scholarly journals Canadian Guidelines on Opioid Use Disorder Among Older Adults

2020 ◽  
Vol 23 (1) ◽  
pp. 123-134
Author(s):  
Launette M. Rieb ◽  
Zainab Samaan ◽  
Andrea D. Furlan ◽  
Kiran Rabheru ◽  
Sid Feldman ◽  
...  
Keyword(s):  
Older Adults ◽  
English Language ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Assessment And Treatment ◽  
Noncancer Pain ◽  
Health Canada

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

scholarly journals Convergence of case-specific epigenetic alterations identify a confluence of genetic vulnerabilities tied to opioid dependence

2021 ◽  
Author(s):  
Olivia Corradin ◽  
Richard Sallari ◽  
An T. Hoang ◽  
Bibi S Kassim ◽  
Gabriella Ben Hutta ◽  
...  
Keyword(s):  
Cortical Neurons ◽  
Opioid Dependence ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Prefrontal Cortical ◽  
Patient Heterogeneity ◽  
Dorsolateral Prefrontal ◽  
Number Of Sexual Partners ◽  
Genetic And Environmental Factors

Opioid dependence is a highly heterogeneous disease driven by a variety of genetic and environmental risk factors which have yet to be fully elucidated. We interrogated the effects of opioid dependence on the brain using ChIP-seq to quantify patterns of H3K27 acetylation in dorsolateral prefrontal cortical neurons isolated from 51 opioid-overdose cases and 51 accidental death controls. Among opioid cases, we observed global hypoacetylation and identified 388 putative enhancers consistently depleted for H3K27ac. Machine learning on H3K27ac patterns predicts case-control status with high accuracy. We focus on case-specific regulatory alterations, revealing 81,399 hypoacetylation events, uncovering vast inter-patient heterogeneity. We developed a strategy to decode this heterogeneity based on convergence analysis, which leveraged promoter-capture Hi-C to identify five genes over-burdened by alterations in their regulatory network or "plexus": ASTN2, KCNMA1, DUSP4, GABBR2, ENOX1. These convergent loci are enriched for opioid use disorder risk genes and heritability for generalized anxiety, number of sexual partners, and years of education. Overall, our multi-pronged approach uncovers neurobiological aspects of opioid dependence and captures genetic and environmental factors perpetuating the opioid epidemic.

scholarly journals 1203. A Descriptive Analysis of an Opioid Use Disorder Care Continuum in an Infectious Diseases Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S692-S692
Author(s):  
Sarah R Blevins ◽  
James A Grubbs ◽  
Tiffany Stivers ◽  
Kathryn Sabitus ◽  
Ryan Weeks ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Clinic Visit ◽  
Opioid Use Disorder ◽  
Retention Rates ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Care Continuum ◽  
Patient Attrition ◽  
Small Team ◽  
Overdose Deaths

Abstract Background On December 17, 2020, U.S. CDC released an advisory reporting the highest drug overdose rate on record. Kentucky ranks in the top 5 states for opioid overdose deaths. Retention in opioid use disorder (OUD) treatment is associated with decreased overdose deaths. University of Kentucky HealthCare’s infectious disease division (UKID) implemented a multi-disciplinary approach to expand access to medication for opioid use disorder (MOUD) for patients with injection drug use-associated infections (IDU-AI). This program is modelled after the Ryan White Cares Act to engage and retain patients. Methods . This ongoing project began enrollment in June 2019. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. Patients are eligible for transportation assistance, mental health services, and medical case management. They may start MOUD with UKID or be referred elsewhere. In this analysis, we describe our opioid use disorder care continuum and identify reasons for patient attrition and areas to improve Results Our continuum components are referral, eligible, enrolled, start MOUD, and retention at month 1, 3, and 6. To date, 533 patients have been referred. Of these, 383 (71.9%) were eligible and 150 (39%) enrolled. Reasons patients did not enroll: discharged stable (41.5%), left AMA (16.9%), declined (10.8%), deceased (6.7%), discharged to other hospital (3.6%), missed clinic visit (9.7%), hospice (1%), other (10.8%). Reasons patients declined: no reason (28.6%), refused to discuss (19.1%), no interest (14.3%), travel (4.8%), declined ID follow-up (4.8%), time limits (9.5%). Ninety-three patients have been enrolled ≥6 months; 83 are on MOUD. Sixty-seven, 29, and 20 patients were retained at month 1, 3, and 6, respectively. Conclusion UKID engages patients in OUD treatment, but retention rates are comparable to those described in non-ID settings. Most attrition occurs between eligibility and month 3, suggesting patients are most vulnerable when they consider change and start MOUD. These time points should be priority for patient engagement by clinic staff. Also our staff size struggles to meet the demand. The number of referrals is prohibitive for our small team to approach everyone in a timely manner. More programs like this one are needed. Disclosures All Authors: No reported disclosures

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