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1
Robinson, D. "Factors influencing paracetamol overdose." Thesis, Queen's University Belfast, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403484.
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Fallon, Marissa S. "Drug overdose treatment by nanoparticles." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0013055.
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Smith, Rachel. "'Facing the risk of overdose' : a grounded theory study exploring heroin users' experiences of overdose." Thesis, University of East London, 2008. http://roar.uel.ac.uk/3778/.
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Overdose is a significant cause of death among heroin users and up to two-thirds of heroin users will experience at least one non-fatal overdose in their lifetime. Despite a recent increase in the literature on overdose psychological understandings of the processes involved are limited, particularly from the perspective of heroin users. This study explored heroin users' experiences of overdose particularly the two areas of intent and risk. Semi-structured interviews were conducted with thirteen individuals who had a history of heroin use and were attending a treatment service in south London. A social constructionist grounded theory approach was followed and the theory 'facing the risk of overdose' was developed. The findings suggested that risk of overdose was affected by complex inter-relationships between individual, social and substance related factors. Participants located overdose in a context with other risks some of which were linked to a drug-using lifestyle. Therefore, overdose was often not the only risk faced by participants and this had implications for how they considered and managed risks. Overall, 'facing the risk of overdose' was best characterised as a social process influenced by acquaintances, friends, family and professionals. Intent appeared complex and dynamic, and although many overdoses were described as accidents some were intentional or accompanied by ambivalence about survival; attributions were also made to luck or chance. The findings are discussed in relation to existing literature. Clinical implications for services include dissemination of context-specific harm reduction information and the importance of addressing mental health needs as well as substance misuse. Recommendations for clinical psychologists include an increase in psychologically informed interventions. In recognition that overdose was a social behaviour clinical implications are also discussed at the community level. Finally, recommendations for future research are highlighted.
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Coughlan, Geraldine. "Construing alternatives to taking an overdose." Thesis, University of East London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532392.
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Daniels, Katherine. "Difficulties Investigating and Prosecuting Heroin Overdose Cases." Honors in the Major Thesis, University of Central Florida, 2004. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/701.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Legal Studies
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Sharer, Rustan. "Trends In Unintentional Drug Overdose-related Deaths." Thesis, The University of Arizona, 2012. http://hdl.handle.net/10150/221390.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Since undergoing a radical paradigm shift in prescribing trends in the late 80s/early 90s, the therapeutic use and non-therapeutic abuse of controlled prescription drugs (specifically opioids) has reached prolific levels in the US. Despite seemingly widespread awareness of such trends and associated dangers, mortality and morbidity associated with such medications continues to escalate in the face of rapidly increasing prescribing patterns. This investigation attempts to further characterize time trends of accidental deaths secondary to overdoses of various drugs (primarily comparing Arizona to national trends with respect to various demographic identifiers). Utilizing publicly available data sources, a statistical analysis was performed on yearly mortality rates for selected drug-overdose related causes of death between 1999 and 2007. Arizona consistently exhibited higher death rates--with Pinal County claiming the highest among all urbanizations--(but lower annual rates of increase) than the national trends. Men were also shown to have much higher death rates than women (although women’s rates are increasing much faster than men). Furthermore, Hispanics demonstrated significantly lower death rates than non-Hispanics (whose death rates were shown to be increasing three times faster than Hispanics). Rapidly increasing death rates pose a significant concern at both the state and national levels.
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Lees, Rosemary Jane. "The role of alcohol in fatal opioid overdose." Thesis, University of Bristol, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573136.
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Fatal opioid overdose is the leading cause of death in UK opioid users, and increasingly a clinical concern for chronic pain management. Concomitant use of central nervous system depressants, in particular alcohol, is identified as a risk factor for opioid overdose. It is plausible alcohol and heroin may interact pharmacologically to enhance overdose risk, however other psychological or social factors may be important. The primary aim of this thesis was to further elucidate the role of alcohol in opioid overdose. Simulating opioid overdose is inherently difficult, so a multi-method approach comprising three complementary studies was used. Firstly, a metabolite of alcohol, ethyl glucuronide, was posed as a tool to provide a drug consumption history in post-mortem opioid overdose samples. Detecting hair ethyl glucuronide did however not prove a sensitive technique for quantitating alcohol history. Secondly a qualitative study was completed to document the behaviours and patterns associated with alcohol use in heroin users. Using focus groups, opioid dependent individuals were interviewed about their alcohol and opioid use. The results of this study indicate alcohol is used very purposefully as a 'substitute' or 'enhancer' to the effects of heroin. This is an important finding and informed the design of the third study presented here, a pharmacological alcohol challenge. In this paradigm alcohol was administered to opioid-dependent individuals to mimic a drinking binge and provide a human model in which to measure the alcohol-opioid interaction. Limited differences were observed between opioid-dependent participants and healthy controls for objective and subjective parameters, providing little support for a pharmacological role of alcohol in opioid overdose. The strong evidence for a role of alcohol in opioid overdose is not fully explained by the findings presented in this thesis. Defining the nature of opioid overdose, and elucidating the differential roles of different risk factors may allow for the development of specific targeted interventions and evidence-based advice for opioid users.
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Clark, Angela K. "A Feasibility Study of a Group-based Opioid Overdose Prevention Educational Intervention." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1427980151.
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LaBrosse, A. D., and John B. Bossaer. "Accidental Overdose of Everolimus Secondary to Poor Patient Education." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2354.
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Shi, Yun, and 施昀. "Escalation with overdose control for phase I drug-combination trials." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B49799733.
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The escalation with overdose control (EWOC) method is a popular modelbased dose finding design for phase I clinical trials. Dose finding for combined drugs has grown rapidly in oncology drug development. A two-dimensional EWOC design is proposed for dose finding with two agents in combination based on a four-parameter logistic regression model. During trial conduct, the posterior distribution of the maximum tolerated dose (MTD) combination is updated continuously in order to find the appropriate dose combination for each cohort of patients. The probability that the next dose combination exceeds the MTD combination can be controlled by a feasibility bound, which is based on a prespecified quantile for the MTD distribution such as to reduce the possibility of over-dosing. Dose escalation, de-escalation or staying at the same doses is determined by searching the MTD combination along rows and columns in a two-drug combination matrix. Simulation studies are conducted to examine the performance of the design under various practical scenarios, and illustrate it with a trial example.published_or_final_version
Statistics and Actuarial Science
Master
Master of Philosophy
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McDonald, Rebecca Silvia. "Non-injectable naloxone for the prevention of opioid overdose deaths." Thesis, King's College London (University of London), 2018. https://kclpure.kcl.ac.uk/portal/en/theses/noninjectable-naloxone-for-the-prevention-of-opioid-overdose-deaths(854e176a-6483-4f70-9340-b3806e03fb21).html.
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Background and Aims: Naloxone is the standard treatment for reversal of opioid overdoses. Due to risk of needle-stick injury, licensed injectable naloxone products are not well suited for layperson administration or take-home naloxone distribution. The aims of this thesis are threefold: Aim 1) assess the effectiveness and limitations of take-home naloxone provision (any naloxone formulation); Aim 2) compare the pharmacokinetic profiles of non-injectable naloxone formulations; Aim 3) identify non-injectable formulations that provide early naloxone exposure similar to a 0.4mg intramuscular dose. Methods: Primary and secondary data analyses were conducted in two stages. The first stage involved evidence syntheses (including two systematic reviews), with secondary data retrieval from the peer-reviewed literature and international patent applications. The second stage involved pharmacokinetic data analysis of two clinical trials (n=12 and 38 healthy volunteers; open-label randomized cross-over design) of concentrated intranasal naloxone formulations (1mg/0.1mL–16mg/0.4mL range). Results: Re Aim 1: Take-home naloxone meets the Bradford Hill criteria. The intervention is effective at reducing opioid overdose mortality and has a low rate of adverse events. Re Aim 2: Improvised nasal kits using non-concentrated spray (1mg/ml per nostril) have low bioavailability of FIM ≤ 10% (relative to intramuscular administration). Concentrated intranasal spray (≥10mg/ml; administered as ≤0.2mL per nostril) has good bioavailability of FIM = 26-57%. Re Aim 3: Relative to the 0.4mg intramuscular reference, a 2mg/0.1mL nasal spray provided equal naloxone exposure in the first 10-minutes post-dosing and then exceeded blood levels for two hours. Conclusions: Take-home naloxone distribution to opioid users should be introduced as standard of care for the community-based prevention of overdose-related deaths and injury. In the presence of licensed alternatives, continued off-label use of improvised nasal kits is not justified. If approved by relevant regulatory agencies, the 2mg/0.1mL naloxone nasal spray could offer greater acceptability and suitability for take-home naloxone provision.
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Sterling, Pamela Beth. "The Grieving Process of Opioid Overdose Bereaved Parents in Maryland." Thesis, Virginia Tech, 2020. http://hdl.handle.net/10919/99467.
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In recent years, the opioid epidemic in the United States has garnered attention on a federal and local level due to the increasing number of fatal overdoses. This study aimed to explore the experiences of parents who have an adult child who has passed away from an opioid overdose. This study used the Double ABC-X model of family stress theory. Bonadaptation versus maladaptation of each parent was discussed across a multitude dimensions. Qualitative semi-structured interviews were conducted with six parents living in the state of Maryland who each had an adult child, age 18+, die from an opioid overdose 2 or more years prior to the study. Data was analyzed using thematic analysis. Themes that emerged were as follows: the grieving process, support vs. stigma, experiences with state and local services, parental guilt, shame, and unanswered questions, coping mechanisms, and post-mortem life changes. While overall adaptation levels varied among participants, all participants reported positive and negative outcomes related to their experience of grief and loss. Implications for clinical practice and intervention are discussed. Researchers also make recommendations for future research.Master of Science
This study aimed to explore the experiences of parents who have had an adult child pass away from an opioid overdose. The study utilized Family Stress theory, a theory which focuses on how families respond and adapt after a crisis occurs, for this research. The following themes emerged from interviews with parents: the grieving process itself, support vs. stigma, experiences with state and local services, parental guilt, shame, and unanswered questions, coping mechanisms, and post-mortem life changes. While adaptation varied among participants, participants reported both positive and negative outcomes related to their experiences of grief and loss.
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Aguilar, Carlos A. M. D. ""Predictors of inpatient narcotic overdose in a non-surgical population"." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342728730.
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Buykx, Penelope. "The relationship between non-fatal overdose of pharmaceutical medications, suicidality and depression." Thesis, Curtin University, 2007. http://hdl.handle.net/20.500.11937/1348.
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This thesis examines three main themes; depression, suicidality, and non-fatal overdose involving pharmaceutical and over-the-counter (OTC) medications. At any given time depression affects approximately one in every twenty adults in Australia. People with depression are at elevated risk of attempted and completed suicide compared to those without. Medication overdose is a frequently chosen method of suicidal behaviour, and accounts for one in ten suicide deaths and close to nine out of ten non-fatal episodes of suicidal behaviour for which hospital treatment is sought. The study reported here had six primary aims; (i) to quantify medication overdose presentations over a 12-month period to the Emergency Department (ED) of a major metropolitan public hospital in Melbourne, Australia, (ii) to describe the medication overdose patient group, including comparison with two other relevant types of presentation, illicit drug overdose, and actual or potential self-harm by means other than overdose, (iii) to explore the relationship between depression, suicidal ideation and medication overdose, (iv) to identify the medications typically used in overdose and their means of acquisition, (v) to explore patient experiences of emergency care following a medication overdose, and (vi) to comment on the feasibility of introducing a brief intervention within the ED with the intention of addressing the issue of medication overdose. Three data sources were employed: computerised ED records, interviews with a sub-sample of patients attending the ED following a medication overdose, and observation of ED processes in relation to these cases.One of the most important findings of the study was the large contribution made by benzodiazepine medications to the overall medication overdose statistics. When considered in conjunction with the patient interview data, it appeared that many patients included in the study were prescribed benzodiazepines in a manner that contradicts current national prescribing guidelines. The problem of medication overdose could be partially addressed by working with doctors to ensure the appropriateness of their prescribing practices, to encourage them to more closely monitor the treatment progress of at-risk patients, and to increase awareness of other evidence-based forms of treatment for depression and anxiety.
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Donovan, Stuart. "A study to investigate if there is a potential link between the prescription of antidepressant drugs and the occurance of deliberate self harm." Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285772.
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Fathalla, Salem Mehdi. "Cardiotoxic effects of antipsychotic drugs in therapeutic doses and in overdose." Thesis, University of Newcastle upon Tyne, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.547996.
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Pape, Anthony P. "Overdose: Constructing Television from the Cracks in the Superhero Content Conglomerate." Ohio University Honors Tutorial College / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ouhonors162025124846866.
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Mathis, S., Angela Hagaman, David Kirschke, and Nicholas E. Hagemeier. "Carter County, Tennessee: A Rural Community’s Response to Opioid Overdose Deaths." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1444.
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Buykx, Penelope. "The relationship between non-fatal overdose of pharmaceutical medications, suicidality and depression." Curtin University of Technology, National Drug Research Institute, 2007. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=17328.
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This thesis examines three main themes; depression, suicidality, and non-fatal overdose involving pharmaceutical and over-the-counter (OTC) medications. At any given time depression affects approximately one in every twenty adults in Australia. People with depression are at elevated risk of attempted and completed suicide compared to those without. Medication overdose is a frequently chosen method of suicidal behaviour, and accounts for one in ten suicide deaths and close to nine out of ten non-fatal episodes of suicidal behaviour for which hospital treatment is sought. The study reported here had six primary aims; (i) to quantify medication overdose presentations over a 12-month period to the Emergency Department (ED) of a major metropolitan public hospital in Melbourne, Australia, (ii) to describe the medication overdose patient group, including comparison with two other relevant types of presentation, illicit drug overdose, and actual or potential self-harm by means other than overdose, (iii) to explore the relationship between depression, suicidal ideation and medication overdose, (iv) to identify the medications typically used in overdose and their means of acquisition, (v) to explore patient experiences of emergency care following a medication overdose, and (vi) to comment on the feasibility of introducing a brief intervention within the ED with the intention of addressing the issue of medication overdose. Three data sources were employed: computerised ED records, interviews with a sub-sample of patients attending the ED following a medication overdose, and observation of ED processes in relation to these cases.One of the most important findings of the study was the large contribution made by benzodiazepine medications to the overall medication overdose statistics. When considered in conjunction with the patient interview data, it appeared that many patients included in the study were prescribed benzodiazepines in a manner that contradicts current national prescribing guidelines. The problem of medication overdose could be partially addressed by working with doctors to ensure the appropriateness of their prescribing practices, to encourage them to more closely monitor the treatment progress of at-risk patients, and to increase awareness of other evidence-based forms of treatment for depression and anxiety.
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Hall, Madeline. "The Effectiveness of State Policy in Combating Prescription Drug Abuse and Overdose." Scholarship @ Claremont, 2014. http://scholarship.claremont.edu/cmc_theses/833.
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Since the 1990s rates of prescription drug abuse and overdose have skyrocketed to unprecedented levels. As a result states have enacted and implemented new drug control policies in hopes of slowing and reversing this health epidemic. The goals of this study were to (a) determine the impact these state-based drug control policies have on prescription drug abuse and overdose and (b) deduce what leads some states to pass stricter policies than others. Results indicated that the prevalence of prescription drug overdose in 2008 largely impacted the future strength of a state’s drug control policy. States with higher rates of drug overdose and abuse in earlier years tended to develop tougher policy by 2013. In addition, states’ Prescription Drug Monitoring Programs (PDMPs) were found to be strongly related to the growth rate of prescription drug abuse in states. While not significantly differing from national trends at first, after about five years of PDMP operation, states began to see a slow or decrease in their rates of prescription drug abuse. Though much more can be done to combat prescription drug abuse and overdose, PDMPs that provide unsolicited reports to users and are accessible to law enforcement and are an effective step to begin to curb the problem.
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Zador, Deborah Public Health & Community Medicine Faculty of Medicine UNSW. "Studies in opioid drug related death." Awarded by:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/44765.
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Opioid drug related death is the topic of this thesis. Each of the published works submitted in this volume has investigated an aspect of opioid drug related death. The publications have been grouped into three sub-themes: i. Characteristics of opioid drug related deaths ii. Methadone-related deaths in and out of treatment iii. Improving the quality of treatment for opioid drug dependence: a focus on injectable opioid treatment The introduction and background (Chapter1) will briefly review-the-relevant literature on opioid drug death predating my own contribution to the field. The next chapter of the thesis, 'Publications' (Chapter 2), will comprise the body of published work being submitted for the degree of Doctor of Medicine. Each article is accompanied by text on the preceding page outlining my individual contribution to that research study. The thesis will conclude with a discussion of the published works (Discussion, Chapter 3) which summarises the chief findings and reflects on the international significance and impact of the work. Finally, the Conclusion (Chapter 4) will submit suggestions for areas of future research into opioid drug related death.
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Beckman, Royder Mona Lee. "An Investigation of the Ratio of Free to Bound Phenytoin in Overdose Cases." Thesis, North Texas State University, 1985. https://digital.library.unt.edu/ark:/67531/metadc501077/.
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An investigation of the ratio of free to bound phenytoin in overdose cases was accomplished by three studies to answer these questions: 1. Will the free to bound ratio change with increasing total phenytoin concentration? 2. Will the free to bound ratio be altered with decreasing total protein concentration? 3. Do these results correlate with overdose cases? The results demonstrated that the ratio of free to bound phenytoin remains constant throughout the therapeutic range as long as a person has a normal total protein concentration. However, the free to bound ratio changes significantly when the total protein decreases by 25 per cent. This substantiates the importance of monitoring free and total phenytoin concentrations in hypoproteinemia.
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Strobel, Spencer. "A pilot study of an emergency department's overdose education and naloxone distribution program." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21257.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Opioid overdoses are increasing and several efforts are being made to reduce this problem. One potential solution is overdose education and naloxone distribution. Project ASSERT began distributing naloxone in conjunction with its overdose education program in 2009. Project ASSERT’s overdose education and naloxone distribution program trained opioid users in recognition, risk factors, and response to overdoses, as well as how to use nasal naloxone kits. Opioid users that had received overdose education only were compared with those that received overdose education and naloxone kits. The goal was to determine if there were any differences in occurrence of nonfatal overdoses, overdose response, illicit opioid use, and opioid agonist treatment. This retrospective study involved phone-surveying patients from a hospital billing list. It was obtained through Project ASSERT and contained the names of patients that had received overdose education only or overdose education and naloxone distribution from January 2011 to February 2012. Questions were asked about the respondents’ naloxone kits, overdose history since their Project ASSERT visit, response to the last witnessed overdose, 30-day substance use, and overdose risk knowledge. Chi-square tests were used to compare the groups. 51 out of 415 eligible were successfully surveyed from March 2012 to October 2012. The surveys occurred on average 11.8 months after their Project ASSERT visit. 73% (37) had naloxone kits and most kept them where they lived (12). There were 9 successful overdose reversals reported. 76% (39) of the respondents did not overdose in the intervening period. There was no statistical difference between the two groups in overdose occurrence, 19% trained with naloxone versus 29% trained without naloxone (p=0.45). 16 out of 19 (84%) of the naloxone group properly responded to an overdose, whereas 3 out of 8 (38%) of those trained without naloxone properly responded (p=.03). There was no statistical difference in illicit opioid use (p=1.0) and opioid agonist treatment (p=.53), 36% of the group trained with naloxone versus 35% of the group trained without naloxone, and 49% of those trained with naloxone versus 36% of those trained without naloxone, respectively. In studying the association between overdose education only and overdose education and naloxone distribution, it was found that there is not an increase in overdose and illicit opioid use. There also is no reduction in seeking for opioid agonist treatment. However, it was found that having naloxone kits does increase proper response to overdose. This is a promising result that could have an impact in reducing opioid overdose deaths.
2031-01-01
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Salwan, A., Nicholas E. Hagemeier, Karilynn Dowling, Kelly N. Foster, J. Arnold, Arsham Alamian, and Robert P. Pack. "Community Pharmacist Engagement in Co-Dispensing Naloxone to Patients at Risk for Opioid Overdose." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/5427.
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Poist, Jennifer, Regina Wu, Lourdes Peralta, and Marion Slack. "Prescriber Knowledge and Perception of Naloxone Use for Opioid Overdose Reversal among Intravenous Drug Users." The University of Arizona, 2015. http://hdl.handle.net/10150/614097.
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Class of 2015 AbstractObjectives: Evaluate prescriber knowledge on naloxone use for opioid overdose reversals in intravenous drug users. Interview prescribers on their perceptions about intravenous drug users, syringe access programs, and other related topics. Subjects: Prescribers and medical professionals in the State of Arizona. Methods: Medical facilities were contacted by email, fax, or telephone requesting for prescribers to complete the survey and return by email or fax, or call to schedule a face-to-face appointment. The respondents of the survey were kept anonymous and were permitted to answer the survey in free text. Surveys were sent to the 68 selected medical facilities at least twice during the study period. Results: All of the six respondents were male, of the respondents had at least 11 years experience, with two having >30 years. A majority practiced in rehab centers or worked with drug abuse patients, however the number of patients treated per week by respondent varies from 10-320. Also of note five of the six respondents had a family member or relative with an addiction to opioids. The respondents seem to be in support of a naloxone distribution program however it is difficult to draw any conclusions since the number of responses was low. Conclusions: It appears that prescribers have a favorable perception of naloxone use and support harm reduction strategies, however response rate was too low to make any definitive conclusions.
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Chiew, Angela. "Changing paradigms of paracetamol poisoning." Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23382.
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The overall objective of this thesis was to identify and examine areas for improvement in the management of paracetamol poisoning. Paracetamol is one of the commonest drugs taken in overdose in Australia and a common cause of acute liver injury in Western countries. Management of paracetamol poisoning includes assessment for the need of antidote (acetylcysteine) administration and decontamination in patients at risk of toxicity. Management in most follows standard guidelines and in those receiving early acetylcysteine are at very low risk of developing acute liver injury. However, circumstances were arising when some patients were developing acute liver injury despite early acetylcysteine. In this thesis we firstly review the evidence for the current assessment and treatment of paracetamol poisoning and identified risk factors associated with treatment failure. This allowed us to identify and examine those patient groups that were at higher risk of acute liver injury with standard treatment protocols such as massive and modified-release paracetamol overdose. However, these cases were uncommon so a means to recruit these patients from many centres was required. The Australian Toxicology Monitoring study (ATOM) is a prospective observational study that recruits patients from calls to two poisons information centres and five clinical toxicology units. An arm of ATOM the Australian Paracetamol Project (APP) recruited an enriched dataset of problematic paracetamol poisoning. From APP three studies form a part of this thesis. ATOM-2 investigated massive immediate-release paracetamol ingestion and found increased acetylcysteine dose and early decontamination decreases the risk of liver injury. ATOM-3 investigated modified-release paracetamol ingestion and found many required prolonged treatment and some developed liver injury despite early acetylcysteine treatment. The results of these studies subsequently resulted in change to the national guidelines for the management of these patients. ATOM-5 examined a new biomarker paracetamol-protein adducts and showed that it can be used to stratify patients at low and high risk of acute liver injury. This thesis shows that recruitment of patients from many centres can be performed to examine uncommon and problematic overdoses.
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Oliver, Phillip. "The role of concomitant drugs in the aetiology of fatal heroin- and methadone-related overdose." Thesis, University of Sheffield, 2008. http://etheses.whiterose.ac.uk/3639/.
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Heroin and methadone poisoning are significant causes of death of young people in the United Kingdom. In a high proportion of these fatalities concomitant substances are also detected. This thesis is concerned with the significance of this observation and the hypothesis that these substances are risk factors for fatal heroin- and methadone-related overdose. A referential database was developed incorporating post-mortem toxicology data from 1,222 heroin and methadone overdose fatalities from around England and Wales. The most commonly detected concomitant drugs were ethanol, diazepam, temazepam, an additional opioid and cocaine. In the first of two studies, statistical models were derived, using multiple linear regression, to assess the potential effect of these concomitant substances on the lethality of heroin and methadone. Log-log and semi-log models were considered and regression coefficients were estimated by ordinary least squares. Ethanol blood concentrations were associated with significantly reduced blood levels of total morphine and methadone, consistent with a causal role for this substance. There was an absence of evidence of a similar effect for other commonly detected concomitants.
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Pan, Yuhan. "Examining Opioid-related Overdose Events in Dayton, OH using Police, Emergency Medical Services and Coroner’s Data." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586441323153728.
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Kobelt, Paula Anne. "Nasal Spray Can Save Lives: Engaging Emergency Department Nurses in the Provision of Naloxone Nasal Spray to High Risk Patients." Otterbein University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1493059037547445.
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Ancona, Rachel M. "Prescribed Opioids as an Initial Exposure in Emergency Department Patients Reporting Nonmedical Opioid or Heroin Use." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1459244023.
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Zhang, Ting. "DEVELOPMENT AND PRECLINICAL EVALUATION OF LONG-LASTING COCAINE HYDROLASES FOR COCAINE OVERDOSE AND COCAINE USE DISORDER TREATMENT." UKnowledge, 2018. https://uknowledge.uky.edu/pharmacy_etds/93.
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Cocaine is a plant-based illicit drug commonly involved in substance use disorder. Although cocaine overdose and cocaine use disorders cause adverse health consequences to individuals and the economic burden on their family and society, there are no FDA (Food and Drug Administration) approved medications for treatment. Recently, it has been recognized that delivery of cocaine hydrolase (CocH) is a promising therapeutic strategy. Human butyrylcholinesterase (hBChE), the primary enzyme involved in cocaine metabolism in human, have advantages over other candidates for the development of CocH. Previous studies in our laboratory have designed and characterized hBChE mutants that have ~4,000-fold improved catalytic efficiency against naturally occurring (-)-cocaine as compared to the wild-type hBChE. Besides the catalytic efficiency, the biological half-life is another essential factor that influences the desired therapeutic value in the long-term treatment of cocaine use disorder. In order to provide prolonged effects to reduce administration frequency in clinical use, efforts have been made to increase the retention time of CocHs in blood circulation by fusing CocHs with other thermostable proteins or their mutants, including human serum albumin (Albu) or the Fc region of the human IgG (Fc).
In this dissertation, we demonstrated the clinical potential and the benefits of long-lasting CocHs for cocaine overdose treatment. We used rodent models to show the ability of AlbuCocH1 to block or reverse manifestations of toxic effects of cocaine. In addition, a concomitant LC-MS/MS-based analysis was conducted to investigate the pharmacokinetic profile of a lethal dose of cocaine with the presence of AlbuCocH1. These experimental data demonstrated AlbuCocH1 as an effective cocaine detoxification agent by accelerating the metabolism of cocaine.
In order to examine the potential therapeutic value of Fc-fused CocHs in the treatment of cocaine use disorder, we conducted a series of behavioral experiments in rats to evaluate the effectiveness and duration of Fc-fused CocHs in blocking or attenuating cocaine-induced psychostimulant and discriminative stimulus effects. In addition, the intravenous self-administration model was used to investigate the long-term effectiveness of Fc-fused CocHs in blocking or attenuating the reinforcing effects of cocaine. It has been shown that a single dose of E30-6-Fc (3 mg/kg) was able to effectively alter the cocaine dose-response curve and attenuate the reinforcing efficacy of cocaine for at least a month in both male and female rats.
In summary, AlbuCocH1 (TV-1380), which failed to meet the primary efficacy endpoint in clinical trials for facilitating abstinence in cocaine-dependent subjects with a weekly dosing schedule (due to the short biological half-life), is more suitable to be developed as a cocaine detoxification agent. On the contrary, the newly designed Fc-fused CocH (e.g. CocH3-Fc, E30-6-Fc) with higher catalytic efficiency and longer biological half-life will be beneficial for long-term abstinence management in cocaine-dependent individuals.
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Electricwala, Batul. "Prevalence, Incremental Cost and Resource Utilization Associated with Opioid Overdoses." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4590.
Full textAbstract:
Background –
An increase in opioid prescribing has led to an increase in opioid overdoses.1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”.
Objectives –
The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated with opioid overdoses in these groups.
Methods –
This study is a retrospective analysis using claims data from SelectHealth, a not-for-profit health insurance organization in Utah and southern Idaho. We estimated the prevalence of opioid overdoses in the sample population, as well as in each group, by year. For the cost estimation we collapsed family members and others into one category – “non-medical users”. To estimate costs we used an incremental cost approach whereby we used propensity scores to match cases (patients who suffered from an opioid overdose) to appropriate controls (patients who did not suffer from an opioid overdose) and estimated the direct medical costs incurred in each group in the year following an overdose. Generalized Linear Models were used to estimate incremental costs and resource utilization. Sensitivity analyses were conducted to measure the robustness of the estimates.
Results –
The prevalence of opioid overdoses increased by 84.8% in prescription opioid users (from 55.6 per 100,000 in 2011 to 102.8 per 100,000 in 2014), increased by 37.9% in family members of prescription opioid users (from 5.9 per 100,000 in 2011 to 8.2 per 100,000 in 2014) and increased by 179.9% in others (from 8.2 per 100,000 in 2011 to 23.1 per 100,000 in 2014).
The prevalence of opioid overdoses in acute users increased by 14.7% (from 43.8 per 100,000 in 2011 to 50.3 per 100,000 in 2014) as compared to 165.9% in chronic users (from 187.0 per 100,000 in 2011 to 497.3 per 100,000 in 2014).
The incremental direct medical costs per patient per year were estimated to be $65,277 (p-value<0.05) in prescription opioid users who suffered from an overdose and $41,102 (p-value<0.05) in non-medical users who suffered from an overdose. Overdose-specific costs were estimated to be $12,111 for prescription opioid users and $11,070 in non-users.
Conclusions –
Our study found that the prevalence of opioid overdoses increased steadily from 2011 to 2014 in the sample population. The prevalence of overdoses was much higher in chronic opioid users as compared to acute users. Differences between overdose-specific costs and total incremental costs may suggest that overdoses are associated with substantial costs in addition to costs for the initial treatment of the overdose. While the cost to payers due to overdoses in prescription opioid users is substantial, payers also incur costs from diversion of opioids.
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Cheung, Hing-fu, and 張興富. "Attempted suicide by drug overdose in Hong Kong: what are the differences between impulsive and non-impulsivesuicide attempters?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45171257.
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Floriano, Maureen Elizabeth. "Models of Addiction and Health Seeking Behaviors: Understanding Participant Utilization of an Overdose Education and Naloxone Distribution Clinic." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1619772720856071.
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Saulol, Hamid Nur Fazila. "Investigations on the effect of fasting on liver function and the response to acetaminophen overdose in two mouse models." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3001066/.
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Zheng, Xirong. "Pharmacokinetic and Pharmacodynamic Evaluation of Cocaine Hydrolases for the Treatment of Cocaine Overdose and Cocaine Addiction Using Rodent Models." UKnowledge, 2019. https://uknowledge.uky.edu/pharmacy_etds/102.
Full textAbstract:
Overdose and addiction are two medical complications of cocaine abuse. To date, there is no FDA approved pharmacotherapy specific for cocaine abuse. Cocaine hydrolases (CocHs) have been extensively investigated for its potential in anti-cocaine therapy. Previous studies have demonstrated that CocHs efficiently hydrolyze cocaine to generate biologically inactive metabolites both in vivo and in vitro. However, it has not been studied whether there is gender difference in the therapy using CocHs. In addition, the effectiveness of CocHs is unknown for treating cocaine toxicity when alcohol is co-administered.
The main purpose of this dissertation is to characterize and evaluate efficient CocHs for cocaine overdose and cocaine addiction treatment. In the first set of studies, the effectiveness of human serum albumin-fused CocH1 were studied in male and female rats. The pharmacokinetic profiles, as well as the pharmacodynamic effects of CocH1-HSA were compared in male and female rats. The obtained data clearly demonstrated that CocH1-HSA was equally effective in both genders. The second set of studies investigated the efficiency of Fc-fused CocH5 in reversing cocaine toxicity in rats receiving simultaneous administration of cocaine and alcohol. Results showed that CocH5-Fc rapidly hydrolyzed cocaine and cocaine’s toxic metabolites in rats, and demonstrated that CocH5-Fc was efficient in treating cocaine toxicity when alcohol was simultaneously administered.
In later studies to investigate the effects of CocH5-Fc for the treatment of cocaine addiction, a mathematical model was developed and validated to predict the effects of CocH5-Fc on the disposition of cocaine in rat blood and brain. This model adequately described the effects of CocH5-Fc in accelerating the elimination of cocaine and its toxic metabolites in both rat blood and brain. In conclusion, the studies within the current dissertation demonstrate the clinical potential of CocHs for the treatment of both cocaine overdose and cocaine addiction.
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Whitehead, Paul Neville. "Survival after local anaesthetic overdose : a comparison of the success of resuscitation after established cardiotoxicity caused by ropivacaine or bupivacaine." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26250.
Full textAbstract:
The purpose of this thesis is to review the pharmacology and toxicity of local anaesthetics, particularly highlighting the differences between bupivacaine and ropivacaine and to present an experiment attempting to establish whether ropivacaine is a safer drug, once cardiotoxicity has occurred.
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Sauer, Brian C. "Medication use performance indicator evaluation a systems perspective /." [Gainesville, Fla.] : University of Florida, 2004. http://purl.fcla.edu/fcla/etd/UFE0006469.
Full textAbstract:
Thesis (Ph.D.)--University of Florida, 2004.Typescript. Title from title page of source document. Document formatted into pages; contains 172 pages. Includes Vita. Includes bibliographical references.
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Bennevi, Veronica, and Theres Lindqvist. "Systematisk granskning av metoder och strategier för att förhindra drogrelaterade dödsfall." Thesis, Malmö universitet, Malmö högskola, Institutionen för socialt arbete (SA), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-41516.
Full textAbstract:
The mortality in drug related deaths has increased in many countries, calling it an epidemic. Overdose caused by opioids have contributed to the increasing drug related deaths. This study aims to examine and compile which methods and strategies have shown to reduce the mortality in drug related deaths. Using a systematic review and no limitation to countries a mix of methods and strategies was found. Some Ministries of Health department list them as important in reducing damages and risk behavior related to addiction. The repressive approach that was historically dominated has shown less successful. Individuals own strengths and access to treatments and strategies are momentous. It is also of great importance that governments and health care applies the listed methods and strategies. Blood diseases have decreased with needle exchange programs as a result of having implemented the method. Medications for addiction treatment are improving living conditions for people with opioid addiction. Still there are problems and difficulties with access to addiction treatment and harm reduction strategies. Stigma and the historical perception of drug use and addiction are some of the reasons for the inaccessibility and lack of harm reduction strategies.
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Spataro, Josie 1973. "Gender differences in child sexual abuse characteristics and long-term outcomes of mental illness, suicide, and fatal overdose : a prospective investigation." Monash University, Dept. of Psychological Medicine, 2002. http://arrow.monash.edu.au/hdl/1959.1/8111.
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Powell, Anne Terese. "A Retrospective Study of the Opioid Epidemic and Fentanyl Related Overdose Fatality Cases in a Florida West Coast Medical Examiner District Population." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7892.
Full textAbstract:
Opioids are scheduled by the propensity for misuse and abuse with a high rate of dependency and risk of fatal overdose. Opioids can be divided into different classes, including, natural, synthetic, and semi-synthetic. Opiates are naturally occurring and come directly from the opium poppy plant; whereas the semi synthetics opioids are chemical modifications of the poppy plant. Synthetic opioids attach to the opioid receptor but contain no part of the poppy plant. The increased variety and frequency in opioid prescriptions contributed to an opioid epidemic in the United States which is still on going.
According to the CDC, the opioid epidemic has occurred in three waves. The first wave of the epidemic began in the 1990’s with the increase in opioid prescription pain medication overdoses. The second wave began around 2010 when heroin overdoses became more prevalent. This was followed by a sharp uptick in fentanyl deaths beginning around the year 2013, indicating the start of the third wave. The opioid epidemic has had a huge cost to society, not just due to deaths but also because of lost productivity, medical expenses and judicial system costs (Florence, Zhou, Luo, & Xu, 2016). To best design and implement strategies to combat this issue, an understanding of the population effected is needed. Since many public health policies are implemented at the regional level, knowing the characteristics and demographics of the epidemic at the local level is important. This study evaluates trends in drug related death cases in the Florida District 6 Medical Examiner Office (MEO) from the calendar years 2011 through 2016.
Specifically, it focuses on opioids and the role of fentanyl in overdose related mortality. Additional attention is given to fentanyl and fentanyl analog related deaths. Fentanyl analogs present challenges from an analytical toxicology perspective. Fentanyl analogs can be difficult to detect. Two sets of data from each calendar year were obtained from the MEO. This data was collated, standardized and then statistically analyzed.
It was determined that there was not a significant difference in month of the year or the day of the week that drug related fatalities occurred. The time of day was statistically significant with more drug related mortalities occurring during the hours of 8:00am and 4:00pm. When assessing mortality rates, Pinellas and Pasco county demonstrated differences. Pasco county has higher overall mortality for opioid related deaths. Pinellas county has almost twice the number of the opioid, fentanyl, related overdose fatalities. Racial demographics, divided into White, Black, and Asian populations, demonstrated that the White population is disproportionally affected by fentanyl drug related mortality. Binary logistic regression showed that fentanyl and heroin tend to co-occur, and that ethanol, hydrocodone, methadone, morphine, and oxycodone do not usually co-occur with fentanyl in drug related fatalities.
These data help elucidate trends in the opioid epidemic at a regional level. There are differences between Pinellas and Pasco county; with the former having more fentanyl related drug deaths and the latter having more opioid related drug deaths over the six years analyzed. An interesting result is derived from the binary logistic regression. It is shown here that fentanyl and heroin tend to co-occur together. It is also shown that ethanol, hydrocodone, morphine, oxycodone, and methadone do not co-occur with fentanyl related overdose cases. Notably, methadone has the strongest negative association with fentanyl related overdoses.
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Levi, Jacob. "Plexar Imaging Entrepreneurship in the CT Industry." Case Western Reserve University School of Graduate Studies / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1323200002.
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Gaspar, Danielle MacÃdo. "Estudo farmacolÃgico e de alteraÃÃes neuroquÃmicas em cÃrtex prÃ-frontal e corpo estriado de camundongos apÃs convulsÃes e morte induzidas por overdose de cocaÃna." Universidade Federal do CearÃ, 2005. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=99.
Full textAbstract:
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorConvulsÃes e morte sÃo as principais conseqÃÃncias relacionadas à overdose de cocaÃna (COC). Para determinar os sistemas neurotransmissores envolvidos com as convulsÃes induzidas pela droga camundongos Swiss machos (20-30 g), foram prÃ-tratados (i.p.) 15, 30 ou 60 min antes da administraÃÃo de COC 90 mg/kg com drogas que interferem com vÃrios sistemas de neurotransmissÃo, observados por 30 min e avaliados quanto à latÃncia para o inÃcio da primeira convulsÃo, percentagem de animais que convulsionaram e percentagem de animais que sobreviveram ao tratamento. Dentre as drogas estudadas as GABAÃrgicas (diazepam, fenobarbital e gabapentina) apresentaram melhor resultado, aumentando a latÃncia para o inÃcio da primeira convulsÃo, reduzindo a percentagem de convulsÃes e morte. Das drogas dopaminÃrgicas, o antagonista do receptor D1, SCH23390, melhorou os 3 parÃmetros avaliados, enquanto o antagonista D2 pimozide reduziu a latÃncia. O antagonista muscarÃnico M1, pirenzepina, reduziu a percentagem de animais que convulsionaram. A fluoxetina, um inibidor da recaptaÃÃo da 5HT, reduziu a latÃncia das convulsÃes e a sobrevivÃncia, o mesmo acontecendo com o antagonista do receptor 5HT2, mianserina. A buspirona, agonista parcial do receptor 5HT1A, aumentou a sobrevivÃncia dos animais na menor dose estudada (5 mg/kg). O NMDA reduziu a latÃncia e a sobrevivÃncia dos animais, enquanto a cetamina, antagonista NMDA melhorou os trÃs parÃmetros estudados. Uma reduÃÃo na percentagem de animais que convulsionaram foi vista com o lÃtio, enquanto a vitamina E reduziu a percentagem de animais que convulsionaram e aumentou a percentagem de sobrevivÃncia. O antagonista opiÃide naltrexone reduziu a latÃncia e aumentou a morte. Observou-se que apÃs a overdose de COC alguns animais apresentaram estado de mal epilÃptico (EME), enquanto outros morreram apÃs as convulsÃes. Assim, para a realizaÃÃo dos estudos neuroquÃmicos estes animais foram dissecados para retirada do corpo estriado (CE) e cÃrtex prÃ-frontal (CPF) e divididos em dois grupos, EME e morte. ApÃs EME ocorreu uma reduÃÃo (40 %) e aumento (125 %) nos nÃveis de dopamina (DA), respectivamente em CE e CPF, havendo tambÃm um aumento nos metabÃlitos DOPAC e HVA, respectivamente em CPF e CE. ApÃs a morte os nÃveis de DA reduziram (38 %) em CPF e ambos os metabÃlitos aumentaram em CE. As taxas metabÃlicas para esta monoamina aumentaram apÃs EME no CE e apÃs a morte no CE e CPF. O aumento no metabolismo da DA està relacionado à formaÃÃo de radicais livres. A 5HT aumentou (123 %) apenas no CPF apÃs EME, enquanto seu metabÃlito 5HIAA reduziu no CPF apÃs EME e morte induzida por cocaÃna. A taxa metabÃlica da 5HT reduziu apÃs EME no CPF e apÃs a morte em ambas as Ãreas estudadas. A NA no EME diminuiu (52 %) no CE e aumentou (56 %) no CPF, enquanto na morte aumentou no CE e reduziu em CPF. O EME promoveu reduÃÃo (46 %) no nÃmero de receptores D1-sÃmile em CE e CPF. Esta reduÃÃo foi acompanhada por uma reduÃÃo e aumento, respectivamente da afinidade (Kd) do receptor pelo ligante radioativo. Tanto EME como morte aumentaram (48 % em CPF e 82 % no CE) o nÃmero de receptores D2-sÃmile, com aumento na afinidade no CPF e reduÃÃo no CE. Os receptores M1-sÃmile reduziram no CPF apÃs EME e morte induzida por COC. A atividade da AChE aumentou apÃs EME (CE) e apÃs a morte (CE e CPF). Os receptores 5HT2 aumentaram (em torno de 46 e 460 %, respectivamente, no CPF e CE) apÃs EME e morte. Os receptores GABAÃrgicos e glutamatÃrgicos apresentaram a mesma alteraÃÃo, com reduÃÃo do nÃmero apÃs EME nas duas Ãreas estudadas, e na morte apenas no CPF. Os nÃveis de nitrito/nitrato aumentaram em ambas condiÃÃes experimentais e Ãreas cerebrais que no caso dos receptores GABAÃrgicos e glutamatÃrgicos. Os nÃveis de MDA aumentaram (46 %) no CE apÃs a morte induzida por cocaÃna. Das enzimas antioxidantes a catalase teve sua atividade reduzida pela overdose de COC no CPF e CE e pela COC em baixas doses (10 e 30 mg/kg) apenas no CE. O prÃ-tratamento com diazepam levou a catalase para nÃveis controle. A glutationa reduzida (GSH) aumentou apÃs a morte no CE e CPF. Os resultados mostram que as convulsÃes e morte induzidas por cocaÃna sÃo eventos multimediados e que as Ãreas cerebrais estudadas, CPF e CE tÃm uma importante participaÃÃo neste processo. O estresse oxidativo tambÃm parece estar envolvido neste mecanismo. Estes achados podem ser importantes para a determinaÃÃo de um mecanismo neural para a toxicidade aguda induzida pela cocaÃna.
Seizures and death are the most important toxic consequences related to cocaine (COC) overdose. In order to determine the main neurotransmitter systems involved with cocaine-induced seizures, male Swiss mice (20-30 g) were pretreated (i.p.) 15, 30 or 60 min before COC 90 mg/kg administration with drugs that interferes with various neurotransmitter systems. The animals were observed (30 min) to determine: latency to first seizure, number of seizures, and number of deaths after cocaine overdose. Gabaergic drugs (diazepam, Phenobarbital and gabapentin) were the best ones, increasing latency to 1st seizure and decreasing cocaine-induced seizures and mortality. The D1 receptor antagonist SCH23390 improved the three parameters observed, while the D2 antagonist pimozide (20 mg/kg) decreased latency. Pirenzepine, a M1 receptor antagonist decreased the number of animals that seized. Fluoxetine, an inhibitor of serotonin reuptake, decreased latency to 1st seizure and survival, and the same happened with mianserin, a 5-HT2 receptor antagonist. Buspirone, a partial agonist of 5HT1A receptor increased animals survival, while ketamine, a NMDA receptor antagonist improved all three parameters evaluated. Lithium decreased the number of animals that seized, while vitamin E decreased the number of animals that seized and also mortality. The opioid antagonist naltrexone, decreased latency and increased cocaine-induced death. It was observed that after cocaine overdose some animals presented only status epilepticus (SE), while others died after seizures. Thus, for neurochemical studies these animals were dissected, striatum (ST) and prefrontal cortex (PFC) removed, and divided in two groups, SE and death. SE decreased (40 %) and increased (125 %) DA levels in ST and PFC, respectively. There was also an increase in DA metabolites, DOPAC and HVA in PFC and ST, respectively. After death, DA levels decreased (38%) in PFC and both metabolites increased in ST. Metabolic rates for this monoamine increased after SE in ST and after death in ST and PFC. The increase in DA metabolism is related to free radicals formation. 5HT increased (123 %) only in PFC after SE, while its metabolite 5HIAA decreased in PFC after SE and death induced by cocaine. The metabolic rate for 5HT decreased after SE in PFC and after death in both areas studied. NA decreased (52 %) in ST and increased (56 %) in PFC during SE, while after death increased in ST and decreased in PFC. Dopaminergic D1-like receptors decreased (46 %) in ST and PFC after SE. This reduction was followed by a decrease and increase, respectively, of the affinity (Kd) receptor-radioactive ligand. An increase (48 % in PFC and 82 % in ST) in D2-like receptors number was observed and followed by an increase in affinity in PFC and decrease in ST. Muscarinic M1 receptors decreased in PFC after cocaine-induced SE and death. AChE activity increased after SE (ST) and after death (ST and PFC). Serotonergic 5HT2 receptors increased (around 46 % and 460 %, respectively to PFC and ST) after SE and death. GABAergic and glutamatergic receptors presentes the same alterations, reduction after SE in both brain areas studied and only in PFC after death. Nitrite/nitrate levels increased in all conditions determined for GABAergic and glutamatergic receptors. MDA levels increased (46 %) only after death in ST. From antioxidant enzymes, catalase had its activity decreased after cocaine overdose in ST and PFC, the same happened with cocaine in low doses (10 and 30 mg/kg), only in ST. Pretreatment with diazepam brought catalase levels to control values. Glutathione increased after death in ST and PFC. Taken together these results showed that cocaine-induced seizures and death are multimediated events and that the brain areas studied, PFC and ST are important to this brain process. Oxidative stress also seems to be involved in this mechanism. These findings may be important for determining the neural mechanisms that mediate acute cocaine toxicity.
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Macêdo, Danielle Silveira. "Estudo farmacológico e de alterações neuroquímicas em córtex pré-frontal e corpo estriado de camundongos após convulsões e morte induzidas por overdose de cocaína." reponame:Repositório Institucional da UFC, 2005. http://www.repositorio.ufc.br/handle/riufc/2707.
Full textAbstract:
MACEDO, Danielle Silveira. Estudo farmacológico e de alterações neuroquímicas em córtex pré-frontal e corpo estriado de camundongos após convulsões e morte induzida por oversose de cocaína. 2005. 298 f. Tese (Doutorado em Farmacologia) - Universidade Federal do Ceará. Faculdade de Medicina, Fortaleza, 2005.Submitted by denise santos (denise.santos@ufc.br) on 2012-06-06T15:50:47Z No. of bitstreams: 1 2005_tese_dsmacêdo.pdf: 3175085 bytes, checksum: cd598b9b14a21e6d5cd4ccabbb539d9a (MD5)
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Seizures and death are the most important toxic consequences related to cocaine (COC) overdose. In order to determine the main neurotransmitter systems involved with cocaine-induced seizures, male Swiss mice (20-30 g) were pretreated (i.p.) 15, 30 or 60 min before COC 90 mg/kg administration with drugs that interferes with various neurotransmitter systems. The animals were observed (30 min) to determine: latency to first seizure, number of seizures, and number of deaths after cocaine overdose. Gabaergic drugs (diazepam, Phenobarbital and gabapentin) were the best ones, increasing latency to 1st seizure and decreasing cocaine-induced seizures and mortality. The D1 receptor antagonist SCH23390 improved the three parameters observed, while the D2 antagonist pimozide (20 mg/kg) decreased latency. Pirenzepine, a M1 receptor antagonist decreased the number of animals that seized. Fluoxetine, an inhibitor of serotonin reuptake, decreased latency to 1st seizure and survival, and the same happened with mianserin, a 5-HT2 receptor antagonist. Buspirone, a partial agonist of 5HT1A receptor increased animals survival, while ketamine, a NMDA receptor antagonist improved all three parameters evaluated. Lithium decreased the number of animals that seized, while vitamin E decreased the number of animals that seized and also mortality. The opioid antagonist naltrexone, decreased latency and increased cocaine-induced death. It was observed that after cocaine overdose some animals presented only status epilepticus (SE), while others died after seizures. Thus, for neurochemical studies these animals were dissected, striatum (ST) and prefrontal cortex (PFC) removed, and divided in two groups, SE and death. SE decreased (40 %) and increased (125 %) DA levels in ST and PFC, respectively. There was also an increase in DA metabolites, DOPAC and HVA in PFC and ST, respectively. After death, DA levels decreased (38%) in PFC and both metabolites increased in ST. Metabolic rates for this monoamine increased after SE in ST and after death in ST and PFC. The increase in DA metabolism is related to free radicals formation. 5HT increased (123 %) only in PFC after SE, while its metabolite 5HIAA decreased in PFC after SE and death induced by cocaine. The metabolic rate for 5HT decreased after SE in PFC and after death in both areas studied. NA decreased (52 %) in ST and increased (56 %) in PFC during SE, while after death increased in ST and decreased in PFC. Dopaminergic D1-like receptors decreased (46 %) in ST and PFC after SE. This reduction was followed by a decrease and increase, respectively, of the affinity (Kd) receptor-radioactive ligand. An increase (48 % in PFC and 82 % in ST) in D2-like receptors number was observed and followed by an increase in affinity in PFC and decrease in ST. Muscarinic M1 receptors decreased in PFC after cocaine-induced SE and death. AChE activity increased after SE (ST) and after death (ST and PFC). Serotonergic 5HT2 receptors increased (around 46 % and 460 %, respectively to PFC and ST) after SE and death. GABAergic and glutamatergic receptors presentes the same alterations, reduction after SE in both brain areas studied and only in PFC after death. Nitrite/nitrate levels increased in all conditions determined for GABAergic and glutamatergic receptors. MDA levels increased (46 %) only after death in ST. From antioxidant enzymes, catalase had its activity decreased after cocaine overdose in ST and PFC, the same happened with cocaine in low doses (10 and 30 mg/kg), only in ST. Pretreatment with diazepam brought catalase levels to control values. Glutathione increased after death in ST and PFC. Taken together these results showed that cocaine-induced seizures and death are multimediated events and that the brain areas studied, PFC and ST are important to this brain process. Oxidative stress also seems to be involved in this mechanism. These findings may be important for determining the neural mechanisms that mediate acute cocaine toxicity.
Convulsões e morte são as principais conseqüências relacionadas à overdose de cocaína (COC). Para determinar os sistemas neurotransmissores envolvidos com as convulsões induzidas pela droga camundongos Swiss machos (20-30 g), foram pré-tratados (i.p.) 15, 30 ou 60 min antes da administração de COC 90 mg/kg com drogas que interferem com vários sistemas de neurotransmissão, observados por 30 min e avaliados quanto à latência para o início da primeira convulsão, percentagem de animais que convulsionaram e percentagem de animais que sobreviveram ao tratamento. Dentre as drogas estudadas as GABAérgicas (diazepam, fenobarbital e gabapentina) apresentaram melhor resultado, aumentando a latência para o início da primeira convulsão, reduzindo a percentagem de convulsões e morte. Das drogas dopaminérgicas, o antagonista do receptor D1, SCH23390, melhorou os 3 parâmetros avaliados, enquanto o antagonista D2 pimozide reduziu a latência. O antagonista muscarínico M1, pirenzepina, reduziu a percentagem de animais que convulsionaram. A fluoxetina, um inibidor da recaptação da 5HT, reduziu a latência das convulsões e a sobrevivência, o mesmo acontecendo com o antagonista do receptor 5HT2, mianserina. A buspirona, agonista parcial do receptor 5HT1A, aumentou a sobrevivência dos animais na menor dose estudada (5 mg/kg). O NMDA reduziu a latência e a sobrevivência dos animais, enquanto a cetamina, antagonista NMDA melhorou os três parâmetros estudados. Uma redução na percentagem de animais que convulsionaram foi vista com o lítio, enquanto a vitamina E reduziu a percentagem de animais que convulsionaram e aumentou a percentagem de sobrevivência. O antagonista opióide naltrexone reduziu a latência e aumentou a morte. Observou-se que após a overdose de COC alguns animais apresentaram estado de mal epiléptico (EME), enquanto outros morreram após as convulsões. Assim, para a realização dos estudos neuroquímicos estes animais foram dissecados para retirada do corpo estriado (CE) e córtex pré-frontal (CPF) e divididos em dois grupos, EME e morte. Após EME ocorreu uma redução (40 %) e aumento (125 %) nos níveis de dopamina (DA), respectivamente em CE e CPF, havendo também um aumento nos metabólitos DOPAC e HVA, respectivamente em CPF e CE. Após a morte os níveis de DA reduziram (38 %) em CPF e ambos os metabólitos aumentaram em CE. As taxas metabólicas para esta monoamina aumentaram após EME no CE e após a morte no CE e CPF. O aumento no metabolismo da DA está relacionado à formação de radicais livres. A 5HT aumentou (123 %) apenas no CPF após EME, enquanto seu metabólito 5HIAA reduziu no CPF após EME e morte induzida por cocaína. A taxa metabólica da 5HT reduziu após EME no CPF e após a morte em ambas as áreas estudadas. A NA no EME diminuiu (52 %) no CE e aumentou (56 %) no CPF, enquanto na morte aumentou no CE e reduziu em CPF. O EME promoveu redução (46 %) no número de receptores D1-símile em CE e CPF. Esta redução foi acompanhada por uma redução e aumento, respectivamente da afinidade (Kd) do receptor pelo ligante radioativo. Tanto EME como morte aumentaram (48 % em CPF e 82 % no CE) o número de receptores D2-símile, com aumento na afinidade no CPF e redução no CE. Os receptores M1-símile reduziram no CPF após EME e morte induzida por COC. A atividade da AChE aumentou após EME (CE) e após a morte (CE e CPF). Os receptores 5HT2 aumentaram (em torno de 46 e 460 %, respectivamente, no CPF e CE) após EME e morte. Os receptores GABAérgicos e glutamatérgicos apresentaram a mesma alteração, com redução do número após EME nas duas áreas estudadas, e na morte apenas no CPF. Os níveis de nitrito/nitrato aumentaram em ambas condições experimentais e áreas cerebrais que no caso dos receptores GABAérgicos e glutamatérgicos. Os níveis de MDA aumentaram (46 %) no CE após a morte induzida por cocaína. Das enzimas antioxidantes a catalase teve sua atividade reduzida pela overdose de COC no CPF e CE e pela COC em baixas doses (10 e 30 mg/kg) apenas no CE. O pré-tratamento com diazepam levou a catalase para níveis controle. A glutationa reduzida (GSH) aumentou após a morte no CE e CPF. Os resultados mostram que as convulsões e morte induzidas por cocaína são eventos multimediados e que as áreas cerebrais estudadas, CPF e CE têm uma importante participação neste processo. O estresse oxidativo também parece estar envolvido neste mecanismo. Estes achados podem ser importantes para a determinação de um mecanismo neural para a toxicidade aguda induzida pela cocaína.
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Condé, Saran. "Motivationsarbete och överföring till beroendebehandling för patienter som drabbas av heroinöverdos." Thesis, Sophiahemmet Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1809.
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Kheibari, Athena. "SUICIDE ATTITUDES AND TERROR MANAGEMENT THEORY." UKnowledge, 2019. https://uknowledge.uky.edu/csw_etds/26.
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Virtually every mental health problem carries stigma, but suicide appears to run so counter to our accumulative, achievement-oriented society, that it poses even greater threat of stigma. While suicide is inherently troubling in that it opposes the fundamental human instinct for self-preservation, the tendency to stigmatize and reject individuals affected by suicide appears to be counterproductive and excessive. Hence, the purpose of this three-manuscript dissertation is to gain a more nuanced understanding of suicide attitudes from an exploratory and terror management theory perspective. More specifically, this dissertation attempts to answer three general questions: (1) how do suicide attitudes differ from other stigmatized deaths – namely, unintentional opioid overdose, (2) does death anxiety and baseline self-esteem impact attitudes toward suicide, and (3) can the effects of death anxiety on suicide attitudes be reversed by temporarily boosting self-esteem? To address the first question, Study 1 compares suicide attitudes to attitudes toward opioid overdose death – another type of stigmatized death that has emerged as a major public health issue in the U.S. in recent years. Study 2 addresses the second question by examining the effect of mortality salience on attitudes toward suicide and by investigating whether participants’ baseline self-esteem will moderate this effect, in keeping with the theory’s claim that self-esteem buffers against death anxiety. Building on the theoretical assumptions of the second study, Study 3 tests whether the effects of death anxiety on suicide attitudes can be reversed by temporarily bolstering the participant’s self-esteem using experimental manipulation. In other words, can cultural worldview validation and self-esteem enhancement inhibit the awareness of personal death and promote prosocial attitudes and behavior? All three proposed studies used quantitative research strategies to examine the research questions detailed above. Study 1 used a traditional questionnaire method to explore and compare attitudes toward suicide and drug overdose death; whereas Study 2 and 3 employed an experimental design to test the MS hypothesis on suicide attitudes. Participants were recruited online using an inexpensive crowdsourcing service called Amazon MTurk. Findings from these studies could have important implications for how we understand the psychological underpinnings of suicide stigma and contribute to the growing body of evidence of the role of existential mortality concerns in hostile attitudes and discriminatory behavior. Not only are we confronted with death reminders in our everyday lives, the topic of suicide is inherently a reminder of death – making the problem of death anxiety even more relevant and unavoidable. These findings could expand our understanding of how cultural worldview and self-esteem are relevant to mitigating death anxiety, and the relationship between death anxiety and suicide.
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Pendleton, Morgan, Stacy D. Brown, Christan M. Thomas, and Brian Odle. "Potential Toxicity of Caffeine when Used as a Dietary Supplement for Weight Loss." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/5321.
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Background: Caffeine is added to dietary supplements to increase energy and suppress appetite. Many people take dietary supplements for weight loss. Patients may be unaware that supplements can contain caffeine, even if caffeine is not listed as an ingredient. Commonly used herbal dietary supplement ingredients, such as guarana, are natural sources of caffeine. Objective: To describe a case of possible caffeine-induced seizure in a patient taking an over-the-counter weight loss supplement. Case Report: A previously healthy 38-year-old female experienced blurring of vision and a new onset grand mal seizure. The patient had a two-month history of taking the dietary supplement, Zantrex - 3™. Zantrex - 3™ is advertised as a weight loss supplement which may provide rapid weight loss and extreme energy in one “power packed pill.” Conclusions/Summary: After discontinuation of Zantrex - 3™, the patient experienced no further seizure activity. Outpatient follow up at 2 and 6 weeks was noncontributory with follow up MRI and EEG both within normal limits.
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Turckheim, Robert de. "Propositions pour une prévention des décès par overdose à l'héroïne, chez les toxicomanes de l'agglomération de Mulhouse : aspects épidémiologiques de la toxicomanie, en 1990 et 1991, à Mulhouse." Université Louis Pasteur (Strasbourg) (1971-2008), 1992. http://www.theses.fr/1992STR1M120.
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Strandberg, Joakim. "Toxicological studies of opiate-related death /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-191-3/.
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Inocencio, Timothy. "The Economic Burden of Opioid Poisoning in the United States and Determinants of Increased Costs in Opioid Poisoning." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2930.
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Introduction: Opioid poisoning has been rapidly increasing in the past decade, and has been driven in large part due to increases in opioid prescribing. This has been accompanied by intervention efforts aimed at preventing and reversing opioid poisoning through naloxone prescription programs. Current literature have not quantified the economic burden of opioid poisoning. Understanding this information can help inform these efforts and bring light to this growing problem. In addition understanding various determinants of increased costs can help to identify the types of populations more likely to have greater costs. Main Objectives: The objectives are 1) to quantify the economic burden of opioid poisoning, 2) to evaluate differences in costs, LOS, and in-hospital mortality depending on opioid type, 3) to identify opioids most likely to result in hospitalization for opioid-related ED visits and 4) to determine differences in the odds of admission to various hospital admission categories with respect to opioid type. Methods: A cost-of-illness approach was used to estimate the economic burden of opioid poisoning. Direct costs and prevalence estimates were obtained from nationally representative databases. Other sources of direct costs were obtained from the literature. Indirect costs were measured using the human capital method. Differences in costs, LOS, and in-hospital mortality were measured through generalized linear models using the National Inpatient Sample in 2009 from the Healthcare Cost and Utilization Project. The Drug Abuse Warning Network database was used to evaluate opioids most likely to result in hospitalization and to evaluate the likelihood of different opioids to cause admission into different types of hospital settings. Results: Opioid poisoning resulted in an economic burden approximately $20.4 billion dollars in 2009. Productivity losses were associated with 89% of this total. Direct medical costs were associated with $2.2 billion. Methadone was associated with the greatest inpatient costs and LOS, while heroin was associated with a greater likelihood of in-patient mortality compared to prescription opioids. Heroin, methadone, and morphine were associated with the greatest odds of hospitalization. Among admitted patients, methadone, morphine, and fentanyl were each associated with the greatest odds of ICU admission compared with other opioids. Conclusions: Opioid poisoning results in a significant economic burden to society. Costs, length of stay, in-patient mortality and the odds of hospitalization and admission type depend on the type of opioid involved. The results from this study can be used to inform policy efforts in providing interventions to reduce opioid poisoning and help focus efforts on populations at highest risk for increased costs.