A case of delayed post-hypoxic leukoencephalopathy following opioid intoxication

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

Download Full-text

Reversal of Opioid Intoxication

CNS Drugs ◽

10.2165/00023210-199707030-00002 ◽

1997 ◽

Vol 7 (3) ◽

pp. 176-186 ◽

Cited By ~ 1

Author(s):

Oliver L. Hung ◽

Robert S. Hoffman

Keyword(s):

Opioid Intoxication

Download Full-text

A DELIRIOUS PATIENT WITH OPIOID INTOXICATION AFTER CHEWING A FENTANYL PATCH

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2006.00832.x ◽

2006 ◽

Vol 54 (8) ◽

pp. 1298-1299 ◽

Cited By ~ 6

Author(s):

Rein Van Rijswijk ◽

Coen Van Guldener

Keyword(s):

Fentanyl Patch ◽

Delirious Patient ◽

Opioid Intoxication

Download Full-text

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

Psychiatry International ◽

10.3390/psychiatryint2040028 ◽

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.

Download Full-text

Epigenome-Wide Study of Brain DNA Methylation Among Opioid Users and Controls

10.1101/2020.11.10.377069 ◽

2020 ◽

Author(s):

Chang Shu ◽

David W. Sosnowski ◽

Ran Tao ◽

Amy Deep-Soboslay ◽

Joel E. Kleinman ◽

...

Keyword(s):

Dna Methylation ◽

Multiple Testing ◽

The United States ◽

Opioid Abuse ◽

Current Evidence ◽

Opioid Use ◽

Multiple Testing Correction ◽

Potential Biomarker ◽

Opioid Intoxication ◽

Opioid Users

AbstractOpioid abuse poses significant risk to individuals in the United States and epigenetic changes are a leading potential biomarker of abuse. Current evidence, however, is mostly limited to candidate gene analysis in whole blood. To clarify the association between opioid abuse and DNA methylation, we conducted an epigenome-wide analysis (EWAS) of DNA methylation in brains of individuals who died from opioid intoxication and controls. Tissue samples were extracted from the dorsolateral prefrontal cortex of 160 deceased individuals (Mage = 35.15, SD = 9.42 years; 62% male; 78% White). The samples included 73 individuals who died of opioid intoxication, 59 group-matched psychiatric controls, and 28 group-matched normal controls. EWAS was implemented using the Illumina Infinium MethylationEPIC BeadChip; analyses adjusted for sociodemographic characteristics, negative control and ancestry principal components, cellular composition, and surrogate variables. Epigenetic age was calculated using the Horvath and Levine clocks, and gene ontology (GO) analyses were performed. No CpG sites were epigenome-wide significant after multiple testing correction, but 13 sites reached nominal significance (p < 1.0 x 10-5). There was a significant association between opioid use and Levine phenotypic age (b = 2.24, se = 1.11, p = .045). Opioid users were approximately two years phenotypically older compared to controls. GO analyses revealed enriched pathways related to cell function and neuron differentiation, but no terms survived multiple testing correction. Results inform our understanding of the neurobiology of opioid use, and future research with larger samples across stages of opioid use will elucidate the complex genomics of opioid abuse.

Download Full-text

Incidence and correlates of opioid-related psychiatric emergency care: A retrospective, multiyear cohort study

Journal of Opioid Management ◽

10.5055/jom.2020.0572 ◽

2020 ◽

Vol 16 (3) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Anees Bahji, MD

Keyword(s):

Cohort Study ◽

Psychiatric Inpatient ◽

Decision Support Tool ◽

Relevant Information ◽

Case Managers ◽

Fiscal Year ◽

Opioid Use ◽

Psychiatric Admission ◽

Support Tool ◽

Opioid Intoxication

Background: In 2018, nearly 4,000 Canadian lives were claimed by the opioid epidemic. To date, only a few studies have reviewed shifts in emergency department (ED) utilization for opioid-related psychiatric presentations. Aims: To describe the characteristics of patients seeking ED care for opioid-related psychiatric presentations and to identify demographic and clinical characteristics that were associated with psychiatric inpatient admission for such presentations.Methods: Retrospective cohort study with multivariate logistic regression.Findings: Over a 4-year period, 555 opioid-related presentations were recorded (50 percent female, mean age 40.0 years). Time trend analysis showed a nonsignificant increase in the number of visits by fiscal year. The most common reason for ED presentation relevant to opioids was opioid withdrawal (49 percent). Nearly 20 percent of all visits required psychiatric admission; predictors of psychiatric admission were arrival by ambulance (adjusted odds ratio (AOR) = 2.03), older age (AOR = 1.05), longer length of ED stay (AOR = 1.10), and more severe triage score (AOR = 0.4). Sex and referring service were not associated with disposition in the ED. Admissions were more likely for opioid intoxication and withdrawal.Conclusion: EDs are serving increasing numbers of patients in psychiatric crisis related to opioid-use. A decision support tool could be developed and validated in the future to provide reliable, clinically relevant information to providers and case managers relevant to opioid-related ED presentations.

Download Full-text

The opioid epidemic: helping rheumatologists prevent a crisis

RMD Open ◽

10.1136/rmdopen-2019-001029 ◽

2019 ◽

Vol 5 (2) ◽

pp. e001029 ◽

Cited By ~ 4

Author(s):

Anne-Priscille Trouvin ◽

Francis Berenbaum ◽

Serge Perrot

Keyword(s):

Developed Countries ◽

European Federation ◽

French Society ◽

Risk Of Death ◽

Number Of Patients ◽

Opioid Intoxication ◽

The Usa ◽

American Society ◽

Strong Opioids

An endemic increase in the number of deaths attributable to prescribed opioids is found in all developed countries. In 2016 in the USA, more than 46 people died each day from overdoses involving prescription opioids. European data show that the number of patients receiving strong opioids is increasing. In addition, there is an upsurge in hospitalisations for opioid intoxication, opioid abuse and deaths in some European countries. This class of analgesic is increasingly used in many rheumatological pathologies. Cohort studies, in various chronic non-cancer pain (CNCP) (osteoarthritis, chronic low back pain, rheumatoid arthritis, etc), show that between 2% and 8% of patients are treated with strong opioids. In order to help rheumatologists prescribe strong opioids under optimal conditions and to prevent the risk of death, abuse and misuse, recommendations have recently been published (in France in 2016, the recommendations of the French Society of Study and Treatment of Pain, in 2017, the European recommendations of the European Federation of IASP Chapters and the American Society of International Pain Physicians). They agree on the same general principles: opioids may be of interest in situations of CNCP, but their prescription must follow essential rules. It is necessary to make an accurate assessment of the pain and its origin, to formulate therapeutic objectives (pain, function and/or quality of life), to evaluate beforehand the risk of abuse and to get a specialised opinion beyond a certain dose or duration of prescription.

Download Full-text

Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances

Harm Reduction Journal ◽

10.1186/s12954-019-0354-y ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Lisa Andersson ◽

Anders Håkansson ◽

Peter Krantz ◽

Björn Johnson

Keyword(s):

Health Care ◽

Social Services ◽

Health Care Services ◽

Statistical Testing ◽

Opioid Substitution Treatment ◽

Exact Test ◽

Regional Health Care ◽

Opioid Intoxication ◽

The Social ◽

Probation Service

Abstract Background Opioid-related deaths have increased in Western countries over recent decades. Despite numerous studies investigating opioid-related mortality, only a few have focused on the lives of the deceased individuals prior to their deaths, specifically regarding contact with care-providing authorities such as health, social and correctional services. Furthermore, a change has been noted in the last two decades as to which opioids cause most deaths, from heroin to prescription opioids. However, studies comparing fatalities caused by different substances are rare. The aim of this study was to investigate contact with care-providing authorities during the year prior to death among individuals who died as a result of opioid intoxication and to analyse differences relating to which opioids caused their deaths. Methods The study is based on retrospective register data and includes 180 individuals with a history of illicit drug use, who died from opioid intoxication in Skåne, Sweden, between 1 January 2012 to 31 December 2013 and 1 July 2014 to 30 June 2016. Intoxications caused by heroin, methadone, buprenorphine and fentanyl were included. Data were collected from the National Board of Forensic Medicine, regional health care services, municipal social services and the Prison and Probation Service. Statistical testing was performed using Pearson’s chi-square test, Fisher’s exact test and the Mann-Whitney U test to analyse group differences. Results A total of 89% of the deceased individuals had been in contact with one or more of the care-providing authorities during the year prior to death; 75% had been in contact with health care, 69% with the social services, 28% with the Prison and Probation Service, and 23% had been enrolled in opioid substitution treatment at some point during their final year of life. Few differences appeared between the substance groups with regard to which opioid contributed to the death. In addition to opioids, sedatives were present in more than 80% of the cases. Individuals whose deaths were buprenorphine-related had been in contact with the social services to a significantly lesser extent during the year prior to death. Conclusions The studied population is characterised by extensive contact with care-providing authorities, thus providing numerous opportunities for authorities to reach this group with preventive and other interventions. Few differences emerged between groups with regard to which opioid had contributed to the death.

Download Full-text