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Hacker, Karen, Latika Davis Jones, LuAnn Brink, Abby Wilson, Marc Cherna, Erin Dalton, and Eric G. Hulsey. "Linking Opioid-Overdose Data to Human Services and Criminal Justice Data: Opportunities for Intervention." Public Health Reports 133, no. 6 (October 9, 2018): 658–66. http://dx.doi.org/10.1177/0033354918803938.
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Objectives: In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from 17.4 per 100 000 population in 2008 to 23.9 per 100 000 population in 2014. Our objectives were to describe local demographic characteristics of this epidemic, identify public human services targets for intervention, determine temporal relationships between use of public human services and overdose mortality, and provide recommendations about potentially beneficial interventions. Methods: We used autopsy data from the Allegheny County Medical Examiner to link people who died of overdoses from 2008 through 2014 to their premortem incarcerations and use of mental health services and substance use disorder services. We calculated the frequency of use of public human services by decedents and the interval between the last use of these services and overdose death. Results: Of the 1399 decedents, 957 (68.4%) had a public human service encounter before overdose death. Of these 957 decedents, 531 (55.5%) had ever been incarcerated, 616 (64.4%) had ever used a mental health service, and 702 (73.4%) had ever used a substance use disorder service. Of 211 decedents incarcerated in the year before their overdose death, 54 (25.6%) overdosed within 30 days of their last release from jail. Of 510 decedents using mental health services in the year before death, 231 (45.3%) overdosed within 30 days of their last use of the services. Of 350 decedents using substance use disorder services in the year before their overdose death, 134 (38.3%) overdosed within 30 days of their last use of the services. Conclusions: Merging data on overdose mortality with data on use of public human services can be a useful strategy to identify trends in, and factors contributing to, the opioid epidemic; to target interventions; and to stimulate collaboration to address the epidemic.
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Baca-García, Enrique, Carmen Diaz-Sastre, Jeronimo Saiz-Ruiz, and Jose de Leon. "How safe are psychiatric medications after a voluntary overdose?" European Psychiatry 17, no. 8 (December 2002): 466–70. http://dx.doi.org/10.1016/s0924-9338(02)00706-x.
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SummaryPurpose.This study assessed psychiatric medications and their potential lethality in a representative sample of suicide attempts.Materials and methods.During 1996–98, 563 suicide attempts were studied in a general hospital in Madrid (Spain). Medication overdose was used in 456 suicide attempts (81%). The ratio between dose taken and maximum prescription dose recommended was used to evaluate the medication toxicity.Results.Benzodiazepines were the drugs most often used in self-poisoning (65% of overdoses), followed by new antidepressants (11%), tricyclic antidepressants (TCAs) (10%), and antipsychotics (8%). An overdose with any of the three latter psychiatric medications was significantly more frequent in patients prescribed those medications. The overdoses for TCA were potentially lethal in 47% of the cases. However, all patients who overdosed on psychiatric medications recovered well and were discharged without any sequelae.Discussion.This study suggests that psychiatric medications, particularly benzodiazepines, new antidepressants and antipsychotics, are relatively safe when they are used for self-poisoning. If patients with mental illnesses are under treated, there is a clear and documented higher risk for suicide.Conclusion.It is better to prescribe psychiatric medications, particularly the new ones, rather than withhold them due to an exaggerated fear of a lethal overdose
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Griffith, Jennifer, Laura C. Chambers, Benjamin D. Hallowell, Ashley Gaipo, Craig Mailloux, Janette Baird, Francesca L. Beaudoin, and Elizabeth A. Samuels. "Examination of the Accuracy of Existing Overdose Surveillance Systems." JAMA Network Open 6, no. 6 (June 28, 2023): e2320789. http://dx.doi.org/10.1001/jamanetworkopen.2023.20789.
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ImportanceHealth departments have used a variety of methods for overdose surveillance, and the Centers for Disease Control and Prevention (CDC) is implementing a standardized case definition to improve overdose surveillance nationally. The comparative accuracy of the CDC opioid overdose case definition vs existing state opioid overdose surveillance systems is unknown.ObjectiveTo evaluate the accuracy of the CDC opioid overdose case definition and existing Rhode Island Department of Health (RIDOH) state opioid overdose surveillance system.Design, Setting, and ParticipantsThis cross-sectional study of ED opioid overdose visits was conducted at 2 EDs in Providence, Rhode Island, at the state’s largest health system from January to May 2021. Electronic health records (EHRs) were reviewed for opioid overdoses identified by the CDC case definition and opioid overdoses reported to the RIDOH state surveillance system. Included patients were those at study EDs whose visit met the CDC case definition, was reported to the state surveillance system, or both. True overdose cases were confirmed by EHR review using a standard case definition; 61 of 460 EHRs (13.3%) were double reviewed to estimate classification accuracy. Data were analyzed from January through May 2021.Main Outcome and MeasureAccurate identification of an opioid overdose was assessed by estimating the positive predictive value of the CDC case definition and state surveillance system using results from the EHR review.ResultsAmong 460 ED visits that met the CDC opioid overdose case definition, were reported to the RIDOH opioid overdose surveillance system, or both (mean [SD] age, 39.7 [13.5] years; 313 males [68.0%]; 61 Black [13.3%], 308 White [67.0%], and 91 other race [19.8%]; and 97 Hispanic or Latinx [21.1%] among each patient visit), 359 visits (78.0%) were true opioid overdoses. For these visits, the CDC case definition and RIDOH surveillance system agreed that 169 visits (36.7%) were opioid overdoses. Of 318 visits meeting the CDC opioid overdose case definition, 289 visits (90.8%; 95% CI, 87.2%-93.8%) were true opioid overdoses. Of 311 visits reported to the RIDOH surveillance system, 235 visits (75.6%; 95% CI, 70.4%-80.2%) were true opioid overdoses.Conclusions and RelevanceThis cross-sectional study found that the CDC opioid overdose case definition more often identified true opioid overdoses compared with the Rhode Island overdose surveillance system. This finding suggests that using the CDC case definition for opioid overdose surveillance may be associated with improved data efficiency and uniformity.
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Espelt, Albert, Gregorio Barrio, Dolores Álamo-Junquera, Maria José Bravo, Ana Sarasa-Renedo, Fernando Vallejo, Gemma Molist, and M. Teresa Brugal. "Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users." European Addiction Research 21, no. 6 (2015): 300–306. http://dx.doi.org/10.1159/000377626.
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Background: The aim of the study was to estimate the lethality of opioid overdose among young heroin users. Methods: A prospective community cohort study was conducted in Barcelona and Madrid, Spain. Participants included 791 heroin users aged 18-30 years who were followed up between 2001 and 2006. Fatal overdoses were identified by record linkage of the cohort with the general mortality register, while non-fatal overdoses were self-reported at baseline and follow-up interviews. The person-years (py) at risk were computed for each participant. Fatal and non-fatal overdose rates were estimated by city. Transition towards injection shortly before the overdose could not be measured. Overdose lethality (rate of fatal overdose in proportion to total overdose) and its 95% CI was estimated using Bayesian models. Results: The adjusted rates of fatal and non-fatal opioid overdose were 0.7/100 py (95% CI: 0.4-1.1) and 15.8/100 py (95% CI: 14.3-17.6), respectively. The adjusted lethality was 4.2% (95% CI: 2.5-6.5). Conclusions: Four out of 100 opioid overdoses are fatal. These are preventable deaths that could be avoided before or after the overdose takes place. Resources are urgently needed to prevent fatal opioid overdose.
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Samuels, Elizabeth A., William Goedel, Lauren Conkey, Jennifer Koziol, Sarah Karim, Rachel P. Scagos, Lee Ann Jordison Keeler, et al. "41538 Characterizing Opioid Overdose Hotspots for Targeted Overdose Prevention and Treatment." Journal of Clinical and Translational Science 5, s1 (March 2021): 84–85. http://dx.doi.org/10.1017/cts.2021.619.
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ABSTRACT IMPACT: Identifying factors associated with opioid overdoses will enable better resource allocation in communities most impacted by the overdose epidemic. OBJECTIVES/GOALS: Opioid overdoses often occur in hotspots identified by geographic and temporal trends. This study uses principles of community engaged research to identify neighborhood and community-level factors associated with opioid overdose within overdose hotspots which can be targets for novel intervention design. METHODS/STUDY POPULATION: We conducted an environmental scan in three overdose hotspots’‘ two in an urban center and one in a small city’‘ identified by the Rhode Island Department of Health as having the highest opioid overdose burden in Rhode Island. We engaged hotspot community stakeholders to identify neighborhood factors to map within each hotspot. Locations of addiction treatment, public transportation, harm reduction programs, public facilities (i.e., libraries, parks), first responders, and social services agencies were converted to latitude and longitude and mapped in ArcGIS. Using Esri Service Areas, we will evaluate the service areas of stationary services. We will overlay overdose events and use logistic regression identify neighborhood factors associated with overdose by comparing hotspot and non-hotspot neighborhoods. RESULTS/ANTICIPATED RESULTS: We anticipate that there will be differing neighborhood characteristics associated with overdose events in the densely populated urban area and those in the smaller city. The urban area hotspots will have overlapping social services, addiction treatment, and transportation service areas, while the small city will have fewer community resources without overlapping service areas and reduced public transportation access. We anticipate that overdoses will occur during times of the day when services are not available. Overall, overdose hotspots will be associated with increased census block level unemployment, homelessness, vacant housing, and low food security. DISCUSSION/SIGNIFICANCE OF FINDINGS: Identifying factors associated with opioid overdoses will enable better resource allocation in communities most impacted by the overdose epidemic. Study results will be used for novel intervention design to prevent opioid overdose deaths in communities with high burden of opioid overdose.
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von Borstel, R., J. O'Neil, and M. Bamat. "Vistonuridine: An orally administered, life-saving antidote for 5-fluorouracil (5FU) overdose." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 9616. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.9616.
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9616 Background: 5FU is widely used to treat solid tumors and is often administered via infusion pump at or near its maximum tolerated dose (MTD). Toxicities and even death can occur in patients over-exposed to 5FU. Uridine is a direct biochemical antagonist of 5FU toxicity; uridine nucleotides dilute intracellular fluorouridine nucleotides derived from 5FU, reducing their lethal incorporation into RNA. However, uridine is poorly bioavailable (7%) and is therefore not a clinically viable antidote. Vistonuridine is an orally administered prodrug of uridine that delivers approximately 8-fold more uridine than administration of uridine itself. Methods: 17 patients overdosed with 5FU have been treated with vistonuridine as an antidote. Patients received vistonuridine (10g q6h for 20 doses) beginning 8 to 96 hours after overdose. Data from 13 patients with similar 5FU overdoses provide the time course and outcomes for patients receiving available supportive care without vistonuridine. A severity score, integrating dose and infusion rate, was calculated for all the patients, and this tool could be used by healthcare workers to determine the expected severity and outcome of a 5FU overdose. Results: All 17 overdose patients treated with vistonuridine recovered fully. Most, especially those for whom vistonuridine treatment was initiated sooner, had relatively modest toxicity. In marked contrast, all 11 of the literature-reported cases of 5FU overdose for which an outcome of death would have been predicted died from the overdose despite receiving available supportive care. Conclusions: These clinical data illustrate the serious, debilitating and life threatening nature of 5FU overdose and the current lack of effective treatments. Vistonuridine appears to be a safe and effective, life-saving antidote to 5FU overdose. [Table: see text]
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Falade-Nwulia, Oluwaseun, Kathleen Ward, Karla D. Wagner, Hamidreza Karimi-Sari, Jeffrey Hsu, Mark Sulkowski, Carl Latkin, and Evaristus Nwulia. "Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs." PLOS ONE 19, no. 2 (February 21, 2024): e0297209. http://dx.doi.org/10.1371/journal.pone.0297209.
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Background People who inject drugs (PWID) experience high rates of drug overdose death with the risk of mortality increasing after each non-fatal event. Racial differences exist in drug overdose rates, with higher rates among Black people who use drugs. Psychological factors may predict drug overdose. Methods Cross-sectional data from a survey administered to PWID in Baltimore, MD enrolled in a social network-based intervention were analyzed. Linear regression methods with generalized estimating equations were used to analyze data from indexes and network members to assess for psychological factors significantly associated with self-reported number of lifetime drug overdoses. Factors associated with number of overdoses were assessed separately by race. Results Among 111 PWID enrolled between January 2018 and January 2019, 25.2% were female, 65.7% were Black, 98.2% reported use of substances in addition to opioids, and the mean age was 49.0 ± 8.3 years. Seventy-five individuals (67.6%) had a history of any overdose with a mean of 5.0 ± 9.7 lifetime overdoses reported. Reports of feeling fearful (β = 9.74, P = 0.001) or feeling lonely all of the time (β = 5.62, P = 0.033) were independently associated with number of drug overdoses. In analyses disaggregated by race, only the most severe degree of fearfulness or loneliness was associated with overdose among Black participants, whereas among White participants, any degree of fearfulness or loneliness was associated with overdose. Conclusions In this study of PWID loneliness and fearfulness were significantly related to the number of reported overdose events. These factors could be targeted in future interventions.
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Whipple, Julianne K., Edward J. Quebbeman, Kelly S. Lewis, Mark S. Gottlieb, and Robert K. Ausman. "Difficulties in Diagnosing Narcotic Overdoses in Hospitalized Paitents." Annals of Pharmacotherapy 28, no. 4 (April 1994): 446–50. http://dx.doi.org/10.1177/106002809402800403.
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OBJECTIVE: To describe the clinical presentation of narcotic overdose in hospitalized patients and to differentiate this circumstance from other conditions often misdiagnosed as overdose. DESIGN: Case series. SETTING: Two acute-care teaching hospitals. PATIENTS: Forty-three hospitalized patients who received naloxone for a clinically suspected narcotic overdose. INTERVENTIONS: Two investigators independently evaluated each incident to determine whether the patient had a narcotic overdose. The patients were judged to have had an overdose if caregivers documented an immediate improvementin mental status, respiratory rate, or blood pressure after naloxone administration. MEASUREMENTS: The clinical presentation of a narcotic overdose in hospitalized patients was defined. Conditions misdiagnosed as an overdose were determined. MAIN RESULTS: Symptoms improved rapidly with the administration of naloxone in 28 incidents (65 percent) and were designated overdose. In 15 other instances there was no improvement in symptoms; these patients were designated nonoverdose. Only half of the overdose patients had a respiratory rate <8 breaths/min immediately prior to naloxone administration. Only two of the overdose patients had the classic triad of symptoms (respiratory depression, coma, and pinpoint pupils). Other overdose patients had only one or two of the classic signs. The clinical presentation of narcotic overdoses in hospitalized patients did not include respiratory depression, hypotension, or coma in the majority of patients. All overdose patients showed a decrease in mental status. The majority of nonoverdose patients had pulmonary conditions that were misdiagnosed as a narcotic overdose. CONCLUSIONS: Narcotic overdoses in hospitalized patients seldom fit the classic description. The lack of respiratory depression does not mean the absence of a narcotic overdose. Patients who receive narcotics and develop a signficant decrease in mental status should be evaluated for a possible overdose. Pulmonary, neurologic, cardiovascular, and electrolyte abnormalities often are misdiagnosed as a narcotic overdose in hospitalized patients.
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Athavale, Vinit, Cameron Green, Kai Zheong Lim, Caroline Wong, and Ravindranath Tiruvoipati. "Characteristics and outcomes of patients with drug overdose requiring admission to Intensive Care Unit." Australasian Psychiatry 25, no. 5 (July 13, 2017): 489–93. http://dx.doi.org/10.1177/1039856217706824.
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Objective: Approximately 20% of patients admitted to hospital with drug overdose will require intensive care unit (ICU) admission. An understanding of the characteristics of these patients may assist with their management and identify those patients at risk of multiple hospital presentations due to drug overdose. Our aim was to examine the characteristics of patients admitted to ICU following drug overdoses and identify the predictors of multiple hospital presentations due to drug overdose. Methods: Patients admitted to a metropolitan ICU over a three-year period following drug overdoses were identified using ICU patient databases, and their medical records. Results: There were 254 admissions due to drug overdoses. The majority of overdoses were intentional (82.7%) and included multiple agents (68.1%). Two-thirds of patients had psychiatric diagnosis, and 54% had documented history of substance use disorders. In-hospital mortality was 2.8%. Over half of patients admitted had documented history of prior hospital presentation due to overdoses. Personality disorder and schizophrenia were independent predictors of multiple hospital presentations due to overdoses. Conclusion: Personality disorders or schizophrenia were independent predictors of patients with multiple overdose presentations. Preventative strategies focusing on these patients may reduce the incidence of their hospital presentations and ICU admissions.
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Canning, Peter, Suzanne Doyon, Sarah Ali, Susan B. Logan, Aliese Alter, Katherine Hart, Raffaella Coler, et al. "Using Surveillance With Near–Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019." Public Health Reports 136, no. 1_suppl (November 2021): 18S—23S. http://dx.doi.org/10.1177/00333549211015662.
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In 2019, Connecticut launched an opioid overdose–monitoring program to provide rapid intervention and limit opioid overdose–related harms. The Connecticut Statewide Opioid Response Directive (SWORD)—a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups—required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients’ status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD’s near–real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.
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Maurano, Megan, David Bukusi, Sarah Masyuko, Rose Bosire, Esther Gitau, Brandon L. Guthrie, Aliza Monroe-Wise, et al. "“We only trust each other”: A qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya." PLOS Global Public Health 4, no. 7 (July 2, 2024): e0003435. http://dx.doi.org/10.1371/journal.pgph.0003435.
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In Kenya, overdose remains a major public health concern with approximately 40% of persons who inject drugs (PWID) reporting personal overdoses. PWID living with HIV (PWID-LH) are particularly vulnerable to experiencing fatal and non-fatal overdoses because of the surrounding physical, social, economic, and political environments, which are not fully understood in Kenya. Through qualitative inquiry, this study characterizes Kenya’s overdose risk environment. Participants were purposively recruited from a larger cohort study from September to December 2018 using the following inclusion criteria: HIV-positive, age ≥18 years, injected drugs in the last year, and completed cohort study visits. Semi-structured interviews explored experiences of personal and observed overdoses, including injection settings, sequence of events (e.g., pre-, during, and post-overdose), safety strategies, and treatment. Interviews were transcribed, translated (Swahili to English), reviewed, and analyzed thematically, applying a risk environment framework. Nearly all participants described personal and/or observed overdose experiences (96%) and heroin was the most frequently reported substance (79%). Overdose precursors included increased consumption, polysubstance use, recent incarceration, and rushed injections. There were also indications of female-specific precursors, including violence and accessing prefilled syringes within occupational settings. Overdose safety strategies included avoiding injecting alone, injecting drugs incrementally, assessing drug quality, and avoiding polysubstance use. Basic first-aid techniques and naloxone use were common treatment strategies; however, naloxone awareness was low (25%). Barriers to treatment included social network abandonment, police discrimination, medical stigma, fatalism/religiosity, medical and transportation costs, and limited access to treatment services. In Kenya, the overdose risk environment highlights the need for comprehensive overdose strategies that address the physical, social, economic, and political environments. Morbidity and mortality from overdose among PWID-LH could be reduced through overdose prevention initiatives that support harm reduction education, naloxone awareness, and access, destigmatization of PWID, and reforming punitive policies that criminalize PWID-LH.
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Hallowell, Benjamin D., Laura C. Chambers, Jason Rhodes, Melissa Basta, Samara Viner-Brown, and Leanne Lasher. "Using Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses in Real Time." Public Health Reports 136, no. 1_suppl (November 2021): 40S—46S. http://dx.doi.org/10.1177/00333549211018989.
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Objective No case definition exists that allows public health authorities to accurately identify opioid overdoses using emergency medical services (EMS) data. We developed and evaluated a case definition for suspected nonfatal opioid overdoses in EMS data. Methods To identify suspected opioid overdose–related EMS runs, in 2019 the Rhode Island Department of Health (RIDOH) developed a case definition using the primary impression, secondary impression, selection of naloxone in the dropdown field for medication given, indication of medication response in a dropdown field, and keyword search of the report narrative. We developed the case definition with input from EMS personnel and validated it using an iterative process of random medical record review. We used naloxone administration in consideration with other factors to avoid misclassification of opioid overdoses. Results In 2018, naloxone was administered during 2513 EMS runs in Rhode Island, of which 1501 met our case definition of a nonfatal opioid overdose. Based on a review of 400 randomly selected EMS runs in which naloxone was administered, the RIDOH case definition accurately identified 90.0% of opioid overdoses and accurately excluded 83.3% of non–opioid overdose–related EMS runs. Use of the case definition enabled analyses that identified key patterns in overdose locations, people who experienced repeat overdoses, and the creation of hotspot maps to inform outbreak detection and response. Practice Implications EMS data can be an effective tool for monitoring overdoses in real time and informing public health practice. To accurately identify opioid overdose–related EMS runs, the use of a comprehensive case definition is essential.
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Olding, Michelle, Andrew Ivsins, Samara Mayer, Alex Betsos, Jade Boyd, Christy Sutherland, Coco Culbertson, Thomas Kerr, and Ryan McNeil. "A Low-Barrier and Comprehensive Community-Based Harm-Reduction Site in Vancouver, Canada." American Journal of Public Health 110, no. 6 (June 2020): 833–35. http://dx.doi.org/10.2105/ajph.2020.305612.
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“The Molson” is a low-barrier, peer-staffed, supervised consumption site located in Vancouver, Canada. In addition to overdose response, this site offers drug checking and a colocated injectable hydromorphone treatment program, and it distributes tablet and liquid hydromorphone to service users at high risk of overdose. Our evaluation suggests benefits of this program in creating service continuums and preventing overdose deaths. From September 2017 to August 2019, the site had 128 944 visits, reversed 770 overdoses, and had no overdose deaths.
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Fernando, Irosh. "Predicting serum drug level using the principles of pharmacokinetics after an overdose: a case of lithium overdose." Australasian Psychiatry 25, no. 4 (February 7, 2017): 391–94. http://dx.doi.org/10.1177/1039856216689624.
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Objective: In cases of drug overdose, clinicians often find it challenging to predict serum drug level and decide the optimum time for recommencing the overdosed drug. Method: This paper describes how to predict serum drug level using the principles of pharmacokinetics. Results: The proposed method and recommencement of the overdosed drug is demonstrated using a clinical case of lithium overdose. Conclusion: The proposed method can assist clinicians in predicting serum drug levels and deciding the optimum time for recommencing the overdosed drug safely. Therefore, it may reduce unnecessary repeat serum drug level procedures.
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Lombardi, Alexa Rose, Ritikraj Arya, Joseph G. Rosen, Erin Thompson, Ralph Welwean, Jessica Tardif, Josiah D. Rich, and Ju Nyeong Park. "Overdose Detection Technologies to Reduce Solitary Overdose Deaths: A Literature Review." International Journal of Environmental Research and Public Health 20, no. 2 (January 10, 2023): 1230. http://dx.doi.org/10.3390/ijerph20021230.
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Drug overdoses were a leading cause of injury and death in the United States in 2021. Solitary drug use and solitary overdose deaths have remained persistent challenges warranting additional attention throughout the overdose epidemic. The goal of this narrative review is to describe recent global innovations in overdose detection technologies (ODT) enabling rapid responses to overdose events, especially for people who use drugs alone. We found that only a small number of technologies designed to assist in overdose detection and response are currently commercially available, though several are in the early stages of development. Research, development, and scale-up of practical, cost-effective ODTs remains a public health imperative. Equipping places where people live, learn, work, worship, and play with the necessary tools to detect and prevent overdose deaths could complement ongoing overdose prevention efforts.
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Hartz, Sarah M., Robert C. Culverhouse, Carrie M. Mintz, Matthew S. Ellis, Zachary A. Kasper, Patricia Cavazos-Rehg, Richard A. Grucza, Laura J. Bierut, and Theodore J. Cicero. "Association between recent overdose and chronic pain among individuals in treatment for opioid use disorder." PLOS ONE 17, no. 11 (November 28, 2022): e0271379. http://dx.doi.org/10.1371/journal.pone.0271379.
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Chronic pain increases risk for opioid overdose among individuals with opioid use disorder. The purpose of this study is to evaluate the relationship between recent overdose and whether or not chronic pain is active. 3,577 individuals in treatment for opioid use disorder in 2017 or 2018 were surveyed regarding recent overdoses and chronic pain. Demographics from the 2017 Treatment Episode Data Set, which includes all U.S. facilities licensed or certified to provide substance use care, were used to evaluate the generalizability of the sample. χ2 tests and logistic regression models were used to compare associations between recent overdoses and chronic pain. Specifically, active chronic pain was associated with opioid overdose among people in treatment for opioid use disorder. Individuals with active chronic pain were more likely to have had a past month opioid overdose than those with no history chronic pain (adjusted OR = 1.55, 95% CI 1.16–2.08, p = 0.0003). In contrast, individuals with prior chronic pain, but no symptoms in the past 30 days, had a risk of past month opioid overdose similar to those with no history of chronic pain (adjusted OR = 0.88, 95% CI 0.66–1.17, p = 0.38). This suggests that the incorporation of treatment for chronic pain into treatment for opioid use disorder may reduce opioid overdoses.
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Tiesman, Hope M., Srinivas Konda, Lauren Cimineri, and Dawn N. Castillo. "Drug overdose deaths at work, 2011–2016." Injury Prevention 25, no. 6 (April 10, 2019): 577–80. http://dx.doi.org/10.1136/injuryprev-2018-043104.
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Drug overdose fatalities have risen sharply and the impact on US workplaces has not been described. This paper describes US workplace overdose deaths between 2011 and 2016. Drug overdose deaths were identified from the Census of Fatal Occupational Injuries and fatality rates calculated using denominators from the Current Population Survey. Fatality rates were compared among demographic groups and industries. Negative binomial regression was used to analyse trends. Between 2011 and 2016, 760 workplace drug overdoses occurred for a fatality rate of 0.9 per 1 000 000 full-time equivalents (FTEs). Workplace overdose fatality rates significantly increased 24% annually. Workplace overdose fatality rates were highest in transportation and mining industries (3.0 and 2.6 per 1 000 000 FTEs, respectively). One-third of workplace overdose fatalities occurred in workplaces with fewer than 10 employees. Heroin was the single most frequent drug documented in workplace overdose deaths (17%). Workplace overdose deaths were low, but increased considerably over the six-year period. Workplaces are impacted by the national opioid overdose epidemic.
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Whipple, Julianne K., Robert K. Ausman, and Edward J. Quebbeman. "Narcotic Use in the Hospital: Reasonably Safe?" Annals of Pharmacotherapy 26, no. 7-8 (July 1992): 897–901. http://dx.doi.org/10.1177/106002809202600705.
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OBJECTIVE: To determine the causes and frequency of overdoses associated with the administration of opioid analgesics in hospitalized patients. DESIGN: Case series. SETTING: Two acute care teaching hospitals. PATIENTS: Eighty-one hospitalized patients who received naloxone for a clinically suspected narcotic overdose. INTERVENTIONS: Three investigators reviewed each patient who received naloxone during a 12-month period. The patients were judged to have a narcotic overdose if caregivers documented an immediate improvement in mental status, respiratory rate, or blood pressure after naloxone administration. MAIN OUTCOME MEASURES: The number and causes of narcotic overdoses were determined. The frequency of morphine and meperidine overdoses was calculated. The number of incidents reported using incident or adverse drug reaction reports or the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. RESULTS: In the 22 overdoses that occurred, 14 (64 percent) were caused by medication prescribing, compounding, or administration errors and potentially were preventable. The remaining eight patients experienced an overdose despite receiving appropriate amounts of opioids. The frequency of overdoses was 0.4 and 0.2 percent of total patients receiving morphine or meperidine, respectively, at the two hospitals. Nonreporting of these narcotic overdoses was frequent. In one hospital, 1 incident report and 3 adverse drug reactions were reported for 17 overdoses. At the second hospital, 1 incident report and 1 adverse drug reaction were reported for 6 overdoses. None of the patient charts included an ICD-9-CM code that documented the problem. CONCLUSIONS: The causes of overdoses are not limited to prescribing and administration errors. Some patients, despite proper execution of appropriate orders, develop a narcotic overdose. Caregivers must be aware of this problem and monitor patients for a decrease in mental status and respiratory rate. In addition, we conclude that an important number of hospitalized patients develop an overdose even though the frequency is low related to the number of patients receiving narcotics.
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Jian, Low Qin. "A Fatal Case of Metformin and Gliclazide Poisoning and its Management." Borneo Journal of Medical Sciences (BJMS) 11, no. 3 (December 12, 2017): 35–40. http://dx.doi.org/10.51200/bjms.v11i3.978.
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Both metformin and gliclazide have been used extensively in the management of type II diabetes mellitus. Metformin and gliclazide overdose can lead to severe hypoglycaemia refractory to intravenous (IV) dextrose rescue therapy. A 21-year-old man complained of vomiting and felt dizzy after four hours of taking 70 tablets of Metformin 500 mg and 40 tablets of Gliclazide 80 mg. He had major depressive disorder and wanted to commit suicide. He was given IV Dextrose 50% 50 cc immediately. Octreotide had been used successfully to reverse the refractory hypoglycaemia caused by gliclazide overdose. Unfortunately, he developed severe lactic acidosis with acute kidney injury. Dialysis had been done by continuous venovenous haemodiafiltrationa and intravenous sodium bicarbonate 8.4% infusion was given. However, the patient succumbed due to the severe lactic acidosis and kidney failure despite of urgent dialysis. Octreotide infusion helps in preventing refractory hypoglycaemia secondary to sulfonylurea overdose by inhibit calcium-mediated insulin release. Metformin overdose causes severe lactic acidosis due to conversion of glucose to lactate. Sodium bicarbonate therapy in metformin induced lactic acidosis is also controversial. Though sulfonylurea and metformin are the most commonly-prescribed anti-hypoglycaemic agents, thus during prescribing everyone has to be careful about the overdoses and side effects of these drugs.Keywords: metformin, gliclazide, poisoning, octreotide
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Sivaraman, Josie J., Scott K. Proescholdbell, David Ezzell, and Meghan E. Shanahan. "Characterizing Opioid Overdoses Using Emergency Medical Services Data." Public Health Reports 136, no. 1_suppl (November 2021): 62S—71S. http://dx.doi.org/10.1177/00333549211026802.
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Objectives Tracking nonfatal overdoses in the escalating opioid overdose epidemic is important but challenging. The objective of this study was to create an innovative case definition of opioid overdose in North Carolina emergency medical services (EMS) data, with flexible methodology for application to other states’ data. Methods This study used de-identified North Carolina EMS encounter data from 2010-2015 for patients aged >12 years to develop a case definition of opioid overdose using an expert knowledge, rule-based algorithm reflecting whether key variables identified drug use/poisoning or overdose or whether the patient received naloxone. We text mined EMS narratives and applied a machine-learning classification tree model to the text to predict cases of opioid overdose. We trained models on the basis of whether the chief concern identified opioid overdose. Results Using a random sample from the data, we found the positive predictive value of this case definition to be 90.0%, as compared with 82.7% using a previously published case definition. Using our case definition, the number of unresponsive opioid overdoses increased from 3412 in 2010 to 7194 in 2015. The corresponding monthly rate increased by a factor of 1.7 from January 2010 (3.0 per 1000 encounters; n = 261 encounters) to December 2015 (5.1 per 1000 encounters; n = 622 encounters). Among EMS responses for unresponsive opioid overdose, the prevalence of naloxone use was 83%. Conclusions This study demonstrates the potential for using machine learning in combination with a more traditional substantive knowledge algorithm-based approach to create a case definition for opioid overdose in EMS data.
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Lasher, Leanne, Benjamin D. Hallowell, Laura C. Chambers, Jennifer Koziol, James McDonald, Rachael Elmaleh, Sarah Karim, and Samara Viner-Brown. "Using Timely Overdose Data to Address a Spike in Nonfatal Overdoses and Inform a Coordinated Community-Level Response in Rhode Island, 2019." Public Health Reports 136, no. 1_suppl (November 2021): 24S—30S. http://dx.doi.org/10.1177/00333549211012407.
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The Rhode Island Department of Health (RIDOH) uses emergency department data to monitor nonfatal opioid overdoses in Rhode Island. In April 2019, RIDOH detected an increase in nonfatal opioid overdoses in Woonsocket, Rhode Island, and sent an alert to state and local partners (eg, fire departments, emergency departments, faith leaders) with guidance on how to respond. To guide community-level, strategic response efforts, RIDOH analyzed surveillance data to identify overdose patterns, populations, and geographic areas most affected. During April–June 2019, nonfatal opioid overdoses in Woonsocket increased 463% (from 13 to 73) when compared with the previous 3 months. Because of the sustained increase in nonfatal opioid overdoses, RIDOH brought together community partners at a meeting in June 2019 to discuss RIDOH opioid overdose data and coordinate next steps. Data analyses were essential to framing the discussion and allowed community partners at the event to identify an unexpected increase in cocaine-involved nonfatal opioid overdoses in Woonsocket. Many patients with cocaine-involved nonfatal overdoses also had fentanyl in their system, and input from community partners suggested that many patients were unaware of using fentanyl. Community response actions included targeting harm reduction services (eg, distribution of naloxone, mobile needle exchange); deploying peer recovery support specialists to overdose hotspots to connect people to treatment and recovery resources; placing harm reduction messaging in high-traffic areas; and targeted social media messaging. After the meeting, nonfatal opioid overdoses returned to pre-outbreak levels. This case study provides an example of how timely opioid overdose data can be effectively used to detect a spike in nonfatal opioid overdoses and inform a strategic, community-level response.
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Borgemenke, Samuel. "Factors Related to Drug Overdose Deaths in Ohio." Ohio Journal of Public Health 5, no. 2 (April 17, 2023): 1–8. http://dx.doi.org/10.18061/ojph.v5i2.8885.
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Background: Drug overdoses have had a devastating impact on public health in Ohio. Improving our understand-ing of the relationships between factors that are associated with drug overdose deaths can enhance the quality of public policy and health care reach in Ohio. Methods: Utilizing data from the Centers for Disease Control and Prevention (CDC) and University of Wisconsin Population Health Institute, this research seeks to quantify the associations between the drug overdose rate for counties in Ohio with various factors via statistical regressions. Results: The overwhelming majority of drug/alcohol overdose deaths during the years 2017-2019 were uninten-tional. Drug overdose deaths and life expectancy are strongly associated. Communities with higher overdose rates have lower life expectancies. Socioeconomic status and health care factors, such as mental distress and physical inactivity, are significantly correlated with increased drug overdose deaths. Household income is significantly correlated with increased access to health care, implying that communities of lower socioeconomic status may lack adequate access to quality care and suffer from increased overdose deaths. Conclusion: The data indicate the importance of access to health care and health care providers in response to drug overdoses in Ohio. Health care access is currently proportional to income; higher income households have a greater proportion of insured, as well as a greater number of primary care physicians. Thus, implementing policies that support health care infrastructure should be prioritized to increase the capacity of treatment in under-resourced (low-income and low socioeconomic status) communities.
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Lax-Pericall, M. T., and A. Cox. "The consequences of maternal overdoses on children." Psychiatric Bulletin 20, no. 11 (November 1996): 648–50. http://dx.doi.org/10.1192/pb.20.11.648.
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The children of women who take overdoses may suffer due to the same factors that predispose to the overdose, to witnessing the event and the immediate and long-term consequences of it. We examined what arrangements had been made for the children of 21 women admitted to hospital after an overdose, and enquired into the explanation that the mother planned to give the children. Children of mothers with psychiatric disorder were more likely to have witnessed the overdose. Mothers preferred that the children did not know about the overdose. The importance of this for the psychological development of the children is discussed.
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King, Brian, Ruchi Patel, and Andrea Rishworth. "Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania." Journal of Drug Issues 51, no. 4 (May 28, 2021): 648–60. http://dx.doi.org/10.1177/00220426211006362.
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COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.
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Geier, Michelle, and James J. Gasper. "Naloxone prescribing by psychiatric clinical pharmacists for patients receiving opioid agonist treatment." Mental Health Clinician 5, no. 1 (January 1, 2015): 46–49. http://dx.doi.org/10.9740/mhc.2015.01.046.
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Take-home naloxone is an important intervention for addressing opioid overdoses. Patients with a history of a substance use disorder are at an elevated risk of experiencing an overdose, and even in substance-abuse treatment, they may continue to witness peer overdoses. The purpose of this innovative practice was for psychiatric clinical pharmacists to improve access to intranasal naloxone and provide opioid overdose prevention training for patients receiving opioid agonist treatment (OAT). This program took place at a San Francisco Department of Public Health pharmacy that provides OAT (buprenorphine and methadone) to approximately 200 patients with opioid use disorders as part of an integrated treatment program. During the 17-month study period, 47 intranasal naloxone kits were prescribed. Patients reported 3 successful opioid overdose reversals using intranasal naloxone. Based on these findings, psychiatric clinical pharmacists can improve patient safety by increasing access to intranasal naloxone and opioid overdose prevention training for patients receiving OAT.
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Burgess-Hull, Albert J., Kirsten E. Smith, Leigh V. Panlilio, Destiny Schriefer, Kenzie L. Preston, Aliese Alter, Christopher Yeager, et al. "Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change." PLOS ONE 17, no. 3 (March 9, 2022): e0263893. http://dx.doi.org/10.1371/journal.pone.0263893.
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Background The Covid-19 pandemic and its accompanying public-health orders (PHOs) have led to (potentially countervailing) changes in various risk factors for overdose. To assess whether the net effects of these factors varied geographically, we examined regional variation in the impact of the PHOs on counts of nonfatal overdoses, which have received less attention than fatal overdoses, despite their public health significance. Methods Data were collected from the Overdose Detection Mapping Application Program (ODMAP), which recorded suspected overdoses between July 1, 2018 and October 25, 2020. We used segmented regression models to assess the impact of PHOs on nonfatal-overdose trends in Washington DC and the five geographical regions of Maryland, using a historical control time series to adjust for normative changes in overdoses that occurred around mid-March (when the PHOs were issued). Results The mean level change in nonfatal opioid overdoses immediately after mid-March was not reliably different in the Covid-19 year versus the preceding control time series for any region. However, the rate of increase in nonfatal overdose was steeper after mid-March in the Covid-19 year versus the preceding year for Maryland as a whole (B = 2.36; 95% CI, 0.65 to 4.06; p = .007) and for certain subregions. No differences were observed for Washington DC. Conclusions The pandemic and its accompanying PHOs were associated with steeper increases in nonfatal opioid overdoses in most but not all of the regions we assessed, with a net effect that was deleterious for the Maryland region as a whole.
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Hess, Gregory S., and Charlie H. Zhang. "Clustering Patterns and Hot Spots of Opioid Overdoses in Louisville, Kentucky." International Journal of Applied Geospatial Research 13, no. 1 (January 2022): 1–15. http://dx.doi.org/10.4018/ijagr.298303.
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Using data obtained from the Louisville Metro Emergency Medical Services, this article examined the spatial and temporal patterns of opioid overdoses in Louisville, Kentucky. We aggregated opioid overdoses to street segments and applied the optimized hot spot analysis to identify areas with significant high overdose rates. Multiple spatial regression models were used to explore the ecological risk factors potentially associated with the spatial variations of the epidemic. The results suggest an overall clustered pattern of opioid overdoses with all overdose incidents concentrated in less than 8% of all the street segments. The consecutive hot spots largely overlapped with the most disadvantaged inner-city neighborhoods in Louisville. Regression results provided statistical evidence regarding the effects of socioeconomic correlates including uninsured, vacancy rates, and criminal activity. The spatial discrepancy between the overdose hot spots and lack of medical facilities or hospitals in the disadvantaged neighborhoods points to the critical issue of health inequity.
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Vivolo-Kantor, Alana, Emilia Pasalic, Stephen Liu, Pedro D. Martinez, and Robert Matthew Gladden. "Defining indicators for drug overdose emergency department visits and hospitalisations in ICD-10-CM coded discharge data." Injury Prevention 27, Suppl 1 (March 2021): i56—i61. http://dx.doi.org/10.1136/injuryprev-2019-043521.
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IntroductionThe drug overdose epidemic has worsened over the past decade; however, efforts have been made to better understand and track nonfatal overdoses using various data sources including emergency department and hospital admission data from billing and discharge files.Methods and findingsThe Centers for Disease Control and Prevention (CDC) has developed surveillance case definition guidance using standardised discharge diagnosis codes for public health practitioners and epidemiologists using lessons learnt from CDC’s funded recipients and the Council for State and Territorial Epidemiologists (CSTE) International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Drug Poisoning Indicators Workgroup and General Injury ICD-10-CM Workgroup. CDC’s guidance was informed by health departments and CSTE’s workgroups and included several key aspects for assessing drug overdose in emergency department and hospitalisation discharge data. These include: (1) searching all diagnosis fields to identify drug overdose cases; (2) estimating drug overdose incidence using visits for initial encounter but excluding subsequent encounters and sequelae; (3) excluding underdosing and adverse effects from drug overdose incidence indicators; and (4) using codes T36–T50 for overdose surveillance. CDC’s guidance also suggests analysing intent separately for ICD-10-CM coding.ConclusionsCDC’s guidance provides health departments a key tool to better monitor drug overdoses in their community. The implementation and validation of this standardised guidance across all CDC-funded health departments will be key to ensuring consistent and accurate reporting across all entities.
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Raheemullah, MD, Amer, and Neal Andruska, MD, PhD. "Fentanyl analogue overdose: Key lessons in management in the synthetic opioid age." Journal of Opioid Management 15, no. 5 (September 1, 2019): 428–32. http://dx.doi.org/10.5055/jom.2019.0531.
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Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into heroin and counterfeit prescription opioid pills without the customer’s knowledge and only detected upon laboratory analysis. This is problematic because fentanyl analogues like carfentanil are 10,000 times more potent than morphine and pose new challenges to opioid overdose management. A 62-year-old male with an overdose from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2 mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his trachea was intubated and he was admitted to the intensive care unit. He subsequently developed ventilator-associated pneumonia and then a pulmonary embolism. He did not receive any opioid use disorder treatment and returned back to the emergency department with an opioid overdose 21 days after discharge.We are encountering an unprecedented rise in synthetic opioid overdose deaths as we enter the third decade of the opioid epidemic. Thus, it is imperative to be aware of the features and management of overdoses from fentanyl and its analogues. This includes protecting against occupational exposure, administering adequate doses of naloxone, and working with public health departments to respond to fentanyl outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to move beyond acute stabilization, start buprenorphine or methadone for opioid use disorder during hospitalization, link patients to ongoing addiction treatment, and distribute naloxone into the community to help curb the overdose epidemic.
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Palis, Heather, Wenqi Gan, Chloe Xavier, Roshni Desai, Marnie Scow, Kali-olt Sedgemore, Leigh Greiner, Tonia Nicholls, and Amanda Slaunwhite. "Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration." JAMA Network Open 5, no. 11 (November 23, 2022): e2243653. http://dx.doi.org/10.1001/jamanetworkopen.2022.43653.
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ImportanceStudies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk.ObjectiveTo examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration.Design, Setting, and ParticipantsIn this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022.ExposuresSubstance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics.Main Outcomes and MeasuresHazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events.ResultsThe study identified 6816 people (5980 male [87.7%]; 2820 aged &lt;30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses.Conclusions and RelevanceThis cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.
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Savage, Mark, Ross Kung, Cameron Green, Brandon Thia, Dinushka Perera, and Ravindranath Tiruvoipati. "Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department." Australasian Psychiatry 28, no. 1 (January 8, 2020): 75–79. http://dx.doi.org/10.1177/1039856219889317.
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Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.
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Pouget, Enrique R., Alex S. Bennett, Luther Elliott, Andrew Rosenblum, and Peter C. Britton. "Recent Overdose Experiences in a Community Sample of Military Veterans Who Use Opioids." Journal of Drug Issues 47, no. 3 (March 22, 2017): 479–91. http://dx.doi.org/10.1177/0022042617701255.
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Rising rates of overdose mortality underscore the importance of understanding and preventing overdose. We developed a seven-item scale for the assessment of nonfatal opioid-related overdose experiences, adding items on others’ perceptions of whether the participant had overdosed and whether an intervention was attempted to frequently used criteria. We administered the scale to 240 primarily male and minority veterans, recruited using venue-based and chain-referral sampling, who separated from the military post-9/11 and reported current opioid use. The items were internally consistent, and correlated well with overdose risk behaviors ( r = .13-.45). The new scale detected overdose events in a significantly higher proportion of participants (36.5%) than that using either self-report criterion (18.2%) or difficulty breathing and losing consciousness criteria (23.8%). These experiences or perceptions should be investigated to inform and better tailor the development of more effective overdose prevention and response programs.
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Ray, Bradley, Steven J. Korzeniewski, George Mohler, Jennifer J. Carroll, Brandon del Pozo, Grant Victor, Philip Huynh, and Bethany J. Hedden. "Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose, Indianapolis, Indiana, 2020–2021." American Journal of Public Health 113, no. 7 (July 2023): 750–58. http://dx.doi.org/10.2105/ajph.2023.307291.
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Objectives. To test the hypothesis that law enforcement efforts to disrupt local drug markets by seizing opioids or stimulants are associated with increased spatiotemporal clustering of overdose events in the surrounding geographic area. Methods. We performed a retrospective (January 1, 2020 to December 31, 2021), population-based cohort study using administrative data from Marion County, Indiana. We compared frequency and characteristics of drug (i.e., opioids and stimulants) seizures with changes in fatal overdose, emergency medical services nonfatal overdose calls for service, and naloxone administration in the geographic area and time following the seizures. Results. Within 7, 14, and 21 days, opioid-related law enforcement drug seizures were significantly associated with increased spatiotemporal clustering of overdoses within radii of 100, 250, and 500 meters. For example, the observed number of fatal overdoses was two-fold higher than expected under the null distribution within 7 days and 500 meters following opioid-related seizures. To a lesser extent, stimulant-related drug seizures were associated with increased spatiotemporal clustering overdose. Conclusions. Supply-side enforcement interventions and drug policies should be further explored to determine whether they exacerbate an ongoing overdose epidemic and negatively affect the nation’s life expectancy. (Am J Public Health. 2023;113(7):750–758. https://doi.org/10.2105/AJPH.2023.307291 )
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Walters, Jaime K., Paul Lewis, and Kim Dileo. "Evaluation of a Suspected Overdose Form for Timely Surveillance of Fatal Drug Overdoses, Multnomah County, OR, 2020-2021." Journal of Public Health Management & Practice 30, no. 4 (June 12, 2024): 586–92. http://dx.doi.org/10.1097/phh.0000000000001942.
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Objectives: There is a significant delay in finalization of drug overdose deaths, and a need to more quickly identify suspected overdoses to improve public health response. The objective of our study was to describe creation of a suspect overdose form and evaluate its use. Design: Evaluation of a suspected overdose form used to record information related to death investigation with matching to state vital records. We calculated the toxicology turnaround time for matched records, and also calculated sensitivity, specificity, positive predictive value, and negative predictive value of the form compared to vital records as the gold standard. Setting: Multnomah County, Oregon, deaths investigated by the County Medical Examiner between January 2020 and December 2021. Main Outcome Measure: Sensitivity of the suspected overdose form. Results: We analyzed 2818 matched death records in total during the study period. The average turnaround time for the 1673 records with toxicology results was 101 days. In 2020, sensitivity of the form was 74%, but this increased to nearly 95% in 2021. Conclusions: Multnomah County’s suspected evaluation form provides a timelier indicator of deaths suspected to be from drug overdose, has good sensitivity to detect true overdoses, and can help guide more rapid public health and public safety response activities.
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Brinkley-Rubinstein, Lauren, David H. Cloud, Chelsea Davis, Nickolas Zaller, Ayesha Delany-Brumsey, Leah Pope, Sarah Martino, Benjamin Bouvier, and Josiah Rich. "Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings." International Journal of Prisoner Health 13, no. 1 (March 13, 2017): 25–31. http://dx.doi.org/10.1108/ijph-08-2016-0039.
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Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.
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Beausir, Abby, and Keith A. King. "Reducing Overdoses Among African American Individuals in Ohio: An Emerging Public Health Crisis." Ohio Journal of Public Health 6, no. 1 (November 3, 2023): 1–7. http://dx.doi.org/10.18061/ojph.v6i1.9410.
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The drug overdose death rate is a major public health crisis with overdoses now being considered a leading cause of death within the United States, including in Ohio. Currently, opioid overdoses primarily involve heroin, fentanyl, and other drugs such as cocaine and MDMA laced with fentanyl. Of particular concern has been the recent demographic shift regarding those who overdose. Opioid overdoses are increasing at a disproportionately higher rate among African American individuals as compared to individuals in other racial and ethnic populations. A public health approach is needed to address the rising epidemic of opioid overdoses impacting African American individuals. Such an approach would comprise a comprehensive and coordinated strategy in providing prevention, intervention, treatment, and recovery services to achieve a sustainable public health impact.
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Hargrove, Sarah L., Terry L. Bunn, Svetla Slavova, Dana Quesinberry, Tracey Corey, William Ralston, Michael D. Singleton, and Van Ingram. "Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices." Injury Prevention 24, no. 1 (July 24, 2017): 60–67. http://dx.doi.org/10.1136/injuryprev-2016-042308.
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BackgroundAccording to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population.ObjectiveThe elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS).MethodsDOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths.ResultsDOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013–2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids.ConclusionsA comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.
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Walley, Alexander Y., Dana Bernson, Marc R. Larochelle, Traci C. Green, Leonard Young, and Thomas Land. "The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015." Public Health Reports 134, no. 6 (October 2, 2019): 667–74. http://dx.doi.org/10.1177/0033354919878429.
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Objectives: Opioid-related overdoses are commonly attributed to prescription opioids. We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens. Methods: Among opioid-related overdose decedents in Massachusetts during 2013-2015, we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report. We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents’ toxicology reports. Results: Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death. Conclusion: Linking overdose toxicology reports to prescription drug monitoring program records can help attribute overdoses to prescribed opioids, diverted prescription opioids, heroin, and illicitly made fentanyl.
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Buchanich, Jeanine M., Lauren C. Balmert, Karl E. Williams, and Donald S. Burke. "The Effect of Incomplete Death Certificates on Estimates of Unintentional Opioid-Related Overdose Deaths in the United States, 1999-2015." Public Health Reports 133, no. 4 (June 27, 2018): 423–31. http://dx.doi.org/10.1177/0033354918774330.
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Objectives: A complete and accurate count of the number of opioid-related overdose deaths is essential to properly allocate resources. We determined the rate of unintentional overdose deaths (non–opioid-related, opioid-related, or unspecified) in the United States and by state from 1999 to 2015 and the possible effects of underreporting on national estimates of opioid abuse. Methods: We abstracted unintentional drug overdose deaths ( International Classification of Diseases, 10th Revision, codes X40-X44) with contributory drug-specific T codes (T36.0-T50.9) from the Mortality Multiple Cause Micro-Data Files. We assumed that the proportion of unspecified overdose deaths that might be attributed to opioids would be the same as the proportion of opioid-related overdose deaths among all overdose deaths and calculated the number of deaths that could be reallocated as opioid-related for each state and year. We then added these reallocated deaths to the reported deaths to determine their potential effect on total opioid-related deaths. Results: From 1999 to 2015, a total of 438 607 people died from unintentional drug overdoses. Opioid-related overdose deaths rose 401% (from 5868 to 29 383), non–opioid-related overdose deaths rose 150% (from 3005 to 7505), and unspecified overdose deaths rose 220% (from 2255 to 29 383). In 5 states (Alabama, Indiana, Louisiana, Mississippi, and Pennsylvania), more than 35% of unintentional overdose deaths were coded as unspecified. Our reallocation resulted in classifying more than 70 000 unspecified overdose deaths as potential additional opioid-related overdose deaths. Conclusions: States may be greatly underestimating the effect of opioid-related overdose deaths because of incomplete cause-of-death reporting, indicating that the current opioid overdose epidemic may be worse than it appears.
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Otterstatter, Michael C., Alexis Crabtree, Sabina Dobrer, Brooke Kinniburgh, Salman Klar, Anthony Leamon, Jennifer May-Hadford, et al. "Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort." Health Promotion and Chronic Disease Prevention in Canada 38, no. 9 (September 2018): 328–38. http://dx.doi.org/10.24095/hpcdp.38.9.04.
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Introduction British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners’ investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results Two-thirds (66%) of overdose cases were male and about half (49%) were 20–39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health–related concerns were the most common diagnoses among people who went on to overdose. Conclusion People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.
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Melvin, Holly. "Are drug consumption facilities an effective intervention to reduce drug related mortality? A critical review of the literature." BJPsych Open 7, S1 (June 2021): S273. http://dx.doi.org/10.1192/bjo.2021.726.
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AimsTo critically appraise the literature regarding the effect of Drug Consumption Facilities in reducing overdose mortalityDrug consumption facilities (DCF) are places where people can use illicit drugs in the presence of medically trained staff, they aim to reduce fatal overdose risk, reduce risky injecting practices, and to serve as a bridge for users into mainstream treatment, healthcare and social services. Increasing numbers of fatal overdoses due to illicit drug use are a significant public health concern. The UK's statutory independent advisory body (the Advisory Council on the Misuse of Drugs) has recommended DCFs as a mechanism to reduce fatal overdoses due to illicit drugs. However, current UK legislation prohibits their provision.MethodSystematic extraction of relevant literature from PubMed, using a search string with a focus on observational cohort studies with fatal overdose as the outcome. Appraisal of identified papers using the CASP toolResult184 papers were identified, two of these met the inclusion criteria. Quality was fair/good. Neither demonstrated a clear effect of DCFs in reducing overdose mortalityConclusionIt is difficult to draw firm conclusions due to design weaknesses and potential confounding variables. Robust design is difficult in this research area, due to lack of suitability for RCTs. Despite the lack of a clear effect on overdose mortality, DCFs may exert other positive effects and are a pragmatic and humane response to reducing risk in this target population
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Crowell, et al, Tara. "Examining Opioid Overdose Data in Atlantic County: A Descriptive Case Study." New Jersey Studies: An Interdisciplinary Journal 5, no. 2 (July 16, 2019): 125. http://dx.doi.org/10.14713/njs.v5i2.170.
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Between 2015-2017, local police, state troopers and emergency medical personnel in Atlantic County, NJ collected data on opioid overdose victims within the County. Forms on 311 overdose victims were ultimately completed. Early in 2018, a partnership between the Atlantic County Prosecutor’s Office and Stockton University was formed in order to analyze this information and better understand Atlantic County’s opioid overdose statistics. Results painted a picture of who is using, and showed that quick response to opioid overdoses and prompt administration of the drug naloxone can save lives. Recommendations for the future include collecting additional data points for overdose victims going forward to allow for deeper study, along with increased distribution of naloxone. Such recommendations can positively contribute to future educational and prevention efforts.
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Miller, John J. "Baclofen overdose mimicking anoxic encephalopathy: a case report and review of the literature." Therapeutic Advances in Drug Safety 8, no. 5 (February 1, 2017): 165–67. http://dx.doi.org/10.1177/2042098617693571.
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A patient who has overdosed on baclofen can present with significant neurological symptoms suggestive of a serious brain insult, but with appropriate diagnosis and treatment they often fully recover within 72 h. If the patient had been maintained on chronic baclofen therapy prior to the overdose, one must be watchful for signs of baclofen withdrawal as recovery from the overdose occurs.
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Macmadu, Alexandria, Annajane Yolken, Lisa Frueh, Jai’el R. Toussaint, Roxxanne Newman, Brendan P. Jacka, Alexandra B. Collins, and Brandon D. L. Marshall. "Characteristics of events in which police responded to overdoses: an examination of incident reports in Rhode Island." Harm Reduction Journal 19, no. 1 (October 18, 2022). http://dx.doi.org/10.1186/s12954-022-00698-2.
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Abstract Background Narrow or non-existent Good Samaritan Law protections and harsh drug selling statutes in the USA have been shown to deter bystanders from seeking medical assistance for overdoses. Additionally, little is known about the actions that police take when responding to overdose events. The objectives of this study were to assess the prevalence and correlates of naloxone administration by police, as well as to examine overdose events where arrests were made and those in which the person who overdosed was described as combative. Methods We analyzed incident reports of police responding to an overdose between September 1, 2019, and August 31, 2020 (i.e., 6 months prior to and during the COVID-19 pandemic), from a city in Rhode Island. We examined characteristics of incidents, as well as individual characteristics of the person who overdosed. Correlates of police naloxone administration were assessed using Wilcoxon rank sum tests and Fisher’s exact tests, and we examined incidents where arrests occurred and incidents in which the person who overdosed was described as combative descriptively. Results Among the 211 incidents in which police responded to an overdose during the study period, we found that police administered naloxone in approximately 10% of incidents. In most incidents, police were the last group of first responders to arrive on scene (59%), and most often, naloxone was administered by others (65%). Police were significantly more likely to administer naloxone when they were the first professionals to arrive, when naloxone had not been administered by others, and when the overdose occurred in public or in a vehicle. Arrests at overdose events were rarely reported (1%), and people who overdosed were rarely (1%) documented in incident reports as being ‘combative.’ Conclusions Considering these findings, ideally, all jurisdictions should have sufficient first responder staffing and resources to ensure a rapid response to overdose events, with police rarely or never dispatched to respond to overdoses. However, until this ideal can be achieved, any available responders should be dispatched concurrently, with police instructed to resume patrol once other professional responders arrive on scene; additionally, warrant searches of persons on scene should be prohibited.
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Ahmad, Zara, Jiin Kim, Aleksandra Udovica, and Renna Lee. "Comparison of Fatal Recreational Drug Overdoses between Celebrities and Non-Celebrities." STEM Fellowship Journal, June 25, 2020, 1–7. http://dx.doi.org/10.17975/sfj-2020-003.
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Previous studies have examined drug overdoses among celebrities, but not in comparison to the general population. This study’s goal was to analyze whether celebrities have higher fatal overdose rates from recreational drug use than the non-celebrity population. It is often presumed that celebrities engage in more drug use to cope with their stressful and taxing lifestyles. To test this claim, we gathered a list of American celebrities that fatally overdosed on drugs from 1999 to 2017 (inclusive), as well as the number of overdoses in the general American population during this time frame. Certain drugs of interest were kept and less commonly occurring drugs that resulted in overdose were excluded, leaving us with opioids, heroin, cocaine, benzodiazepines, psychostimulants, and antidepressants. Descriptive statistics of both populations including gender and specific professions of celebrities were collected. Then, an independent samples t-test was used to discover if there was a significant difference between fatal overdoses for the celebrity versus non-celebrity population in general and for each drug listed previously from the years 1999 to 2017. Pearson’s correlation analysis was used to find if there was a difference in the yearly trend of overdoses for celebrities versus non-celebrities during the same time range. Descriptive statistics demonstrated that males comprised 62.9% of fatal overdoses for non-celebrities and 73.5% for celebrities, and musicians (24.3%), athletes (23.6%), and actors (17.6%) tend to overdose the most in terms of celebrity professions. In addition, the results from the t-test showed that non-celebrities had not fatally overdosed at significantly different rates than celebrities from 1999 to 2017. as well as overdosed at no significantly different rate for each individual drug than celebrities during this time frame. However, the exceptions were any opioids and benzodiazepines, for which the former group overdosed at a significantly higher rate. Pearson’s correlation analysis yielded an insignificant negative correlation between fatal overdoses and years passed between 1999 to 2017 for celebrities, and a significant positive correlation between fatal overdoses and years passed for non-celebrities. The judgmental heuristics may make us believe that more celebrities fatally overdose than non-celebrities, and that this presumption could potentially be problematic because celebrities have a massive influence on society, which could lead the general population to engage in these self-destructive behaviours themselves.
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Guarino, Honoria, David Frank, Kelly Quinn, Dongah Kim, Krista Gile, Kelly Ruggles, Samuel R. Friedman, and Pedro Mateu-Gelabert. "Syndemic factors associated with non-fatal overdose among young opioid users in New York City." Frontiers in Public Health 11 (June 26, 2023). http://dx.doi.org/10.3389/fpubh.2023.1195657.
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IntroductionRates of illicit opioid use are particularly high among young adults, yet research on overdose experience and factors associated with overdose in this population remains limited. This study examines the experiences and correlates of non-fatal overdose among young adults using illicit opioids in New York City (NYC).Methods539 participants were recruited via Respondent-Driven Sampling in 2014-2016. Eligibility criteria included: aged 18–29 years old; current residence in NYC; and nonmedical prescription opioid (PO) use and/or heroin use in the past 30 days. Participants completed structured interviews to assess their socio-demographics, drug use trajectories, current substance use and lifetime and most recent overdose experiences, and were tested on-site for hepatitis C virus (HCV) antibodies.Results43.9% of participants reported lifetime overdose experience; of these, 58.8% had experienced two or more overdose events. The majority of participants’ most recent overdoses (63.5%) were due to polysubstance use. In bivariable analyses, after RDS adjustment, having ever overdosed was correlated with: household income of >$100,00 growing up (vs. $51,000-100,000); lifetime homelessness; HCV antibody-positive status; lifetime engagement in regular nonmedical benzodiazepine use, regular heroin injection and regular PO injection; and using a non-sterile syringe in the past 12 months. Multivariable logistic regression identified childhood household income >$100,00 (AOR=1.88), HCV-positive status (AOR=2.64), benzodiazepine use (AOR=2.15), PO injection (AOR=1.96) and non-sterile syringe use (AOR=1.70) as significant independent correlates of lifetime overdose. A multivariable model with multiple overdoses (vs. one) found only lifetime regular heroin use and PO injection to be strong correlates.DiscussionResults indicate a high prevalence of lifetime and repeated overdose among opioid-using young adults in NYC, highlighting a need for intensified overdose prevention efforts for this population. The strong associations of HCV and indices of polydrug use with overdose suggest that prevention efforts should address the complex risk environment in which overdose occurs, attending to the overlapping nature of disease-related risk behavior and overdose risk behavior among young people who inject opioids. Overdose prevention efforts tailored for this group may find it useful to adopt a syndemic conception of overdose that understands such events as resulting from multiple, and often interrelated, risk factors.
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Demeter, Natalie, Jaynia Angela Anderson, Mar-y.-sol Pasquires, and Stephen Wirtz. "Enhanced Surveillance of Nonfatal Emergency Department Opioid Overdoses in California." Online Journal of Public Health Informatics 11, no. 1 (May 30, 2019). http://dx.doi.org/10.5210/ojphi.v11i1.9918.
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ObjectiveTo track and monitor nonfatal emergency department opioid overdoses in California for use in the statewide response in the opioid epidemic.IntroductionThe opioid epidemic is a multifaceted public health issue that requires a coordinated and dynamic response to address the ongoing changes in the trends of opioid overdoses. Access to timely and accurate data allows more targeted and effective programs and policies to prevent and reduce fatal and nonfatal drug overdoses in California. As a part of a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance grant, the goals of this surveillance are to more rapidly identify changes in trends of nonfatal drug overdose, opioid overdose, and heroin overdose emergency department visits; identify demographic groups or areas within California that are experiencing these changes; and to provide these data and trends to state and local partners addressing the opioid crisis throughout California. Emergency department (ED) visit data are analyzed on an ongoing quarterly basis to monitor the proportion of all ED visits that are attributed to nonfatal drug, opioid, and heroin overdoses as a portion of the statewide opioid overdose surveillance.MethodsCalifornia emergency department data were obtained from the California Office of Statewide Health Planning and Development. Data were (and continue to be) analyzed by quarter as the data become available, starting in quarter 1 (Q1) 2016 through Q1 2018. Quarters were defined as standard calendar quarters; January-March (Q1), April-June (Q2), July-September (Q3), and October-December (Q4). Counts of nonfatal ED visits for all drug overdoses, all opioid overdoses, and heroin overdoses were defined by the following ICD-10 codes in the principle diagnosis or external cause of injury fields respectively; T36X-T50X (all drug), T40.0X-T40.4X T40.6 and T40.69 (all opioid), and T40.1X (heroin). Eligible ED visits were limited to CA residents, patients greater than 10 years of age, initial encounters, and were classified as unintentional overdoses or overdoses of undetermined intent. Overdose ED visits are described by quarter, drug, sex, and age for Q1 2016 – Q1 2018.ResultsOn average, 6,450 emergency department visits in California are attributed to drug overdose every quarter. Between Q1 2016 and Q1 2018, on average 1,785 (range: 1,559-2,011 ED visits) of those visits were due to opioid overdoses and a further 924 (52%) of those ED visits were due to heroin overdoses. About 26-30% of all drug overdose ED visits were for opioid overdoses in California during Q1 2016 – Q1 2018. Quarterly, that is around 6.00-7.64 opioid overdose ED visits for every 10,000 ED visits (Table 1), with about half those (3.09-4.30 ED visits) being heroin overdose ED visits. Males accounted for approximately 52% of all drug overdose ED visits, 65% of all opioid overdose ED visits, and 76% of all heroin overdose ED visits per quarter. Across all quarters, 25-34 year olds had the highest proportion of emergency department visits attributed to opioid and heroin overdose compared to all other age groups. However, 11-24 year olds had the highest proportion of emergency department visits attributed to all drug overdoses compared to all other age groups for all quarters except one. Between Q1 2016 and Q1 2018, the proportion of emergency department visits attributed to all drug overdoses increased by 1.8%, all opioid overdoses increased 3.1%, and heroin overdoses increased by 13.5%.ConclusionsOverall trends for the proportion of all emergency department visits for all drug overdoses and all opioid overdoses are relatively stable over this time period, however the proportion of heroin overdose ED visits shows a more substantial increase between Q1 2016 and Q1 2018. In addition, heroin overdose ED visits account for over half of all opioid overdose ED visits during this time in California. Ongoing surveillance of drug, opioid, and heroin overdose ED visits is a crucial component of assessing and responding to the opioid overdose crisis in California and helps to better understand the demographics of those who could be at risk of a future fatal opioid overdose. Timely data such as these (in addition to prescribing, hospitalization, and death data) can inform local and statewide efforts to reduce opioid overdoses and deaths.
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Ochani, Sidhant, Fatima Binte Athar, Muhammad Wajeeh Nazar, Suraksha Rani, Khushi Ochani, Md Al Hasibuzzaman, and Kaleem Ullah. "Drug overdose in Pakistan, a growing concern; A Review." International Journal of Surgery: Global Health 6, no. 5 (September 2023). http://dx.doi.org/10.1097/gh9.0000000000000356.
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The primary cause of overdose in Pakistan is a lack of implementation of pharmaceutical drug sales regulations. The use of a drug or medicine over the recommended safe dose, whether accidentally or purposely, constitutes a drug overdose. The type of drug, amount consumed, and medical history of the person who overdosed determine its severity. It can be accidental or intentional and can result in serious medical issues or even death. In Pakistan, there is growing concern about two major categories of overdoses: opioid overdose and recreational drug overdose. About 700 people die of drug-related complications and overdose in Pakistan every day, which translates to 250 000 deaths every year. In Pakistan, an estimated 7 million individuals take drugs regularly. Among them, 4 million use cannabis, and 2.7 million use opiates. Since 2005, ANF Model Addiction Treatment & Rehabilitation Centers (MATRC) have treated more than 14 000 patients. At least 604 individuals connected to Pakistani drug trafficking have been found guilty by the ANF since 2014. Another promising cause of drug overdose is qualified doctors negligence. Many doctors do not spend enough time with their patients and do not adequately educate them about the disease, drug dosage, timing, drug-drug interactions, drug-food interactions, and adverse effects. There is a need for immediate action, which includes employee training, psychoeducational campaigns on mental health and suicide, medical resources for quick treatment of self-poisoning, and revised government regulations on drug sales. To lower the prevalence and negative effects of overdoses in Pakistan, it may be necessary to educate the ‘chemist’ and restrict the number of tablets that can be prescribed at once.
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Smiley-McDonald, Hope M., Peyton R. Attaway, Nicholas J. Richardson, Peter J. Davidson, and Alex H. Kral. "Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone." Health & Justice 10, no. 1 (February 25, 2022). http://dx.doi.org/10.1186/s40352-022-00172-y.
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Abstract Background Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer’s perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. Methods The qualitative study examined officers’ experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. Results Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. Conclusion These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.
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Skurtveit, Svetlana, Ingvild Odsbu, Linn Gjersing, Marte Handal, Torgeir Gilje Lid, Thomas Clausen, and Aleksi Hamina. "Individuals Dying of Overdoses Related to Pharmaceutical Opioids Differ from Individuals Dying of Overdoses Related to Other Substances: A Population-Based Register Study." European Addiction Research, September 29, 2022, 1–6. http://dx.doi.org/10.1159/000526145.
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<b><i>Background:</i></b> Pharmaceutical opioid (PO) overdose deaths have increased in many Western countries. There are indications that those dying from a PO overdose differ from those dying from other types of overdoses. These differences might pose a challenge as the majority of current preventive measures are tailored toward those with the characteristics of “conventional” overdose deaths. <b><i>Objective:</i></b> We investigated differences in the characteristics of persons who died from PO overdoses compared to all other overdoses. <b><i>Material and Methods:</i></b> Using the Norwegian Cause of Death Registry, we retrieved information on overdoses classified according to ICD-10 and identified PO overdoses (T40.2; T40.4) and all other overdoses (T40.X; T43.6) in 2010–2019. By linking data from nationwide registers, we analyzed data on opioid dispensations and the history of mental and behavioral disorders. 1,224 persons were registered with PO overdoses and 1,432 persons with other overdoses. <b><i>Results:</i></b> Persons in the PO overdose group were older and were more frequently women (35.0% vs. 20.5%) than persons with other overdoses. They had a higher prevalence of chronic pain (35.8% vs. 13.2%), history of cancer (8.1% vs. 1.8%), filled prescriptions of analgetic opioids more frequently the month before death (38.8% vs. 12.0%), and used threefold higher doses of prescribed opioids compared to individuals in all other overdose group (66 vs. 26 oral morphine equivalents/day). In the PO overdose group, oxycodone and fentanyl were more frequently dispensed, while codeine was more frequently dispensed in the other overdose groups. A lower proportion of those in the PO overdose group had recorded diagnoses of substance use disorders, schizophrenia, and hyperkinetic disorder compared to the other overdose groups. <b><i>Conclusion:</i></b> Persons dying from overdoses on POs often differ from the population targeted by existing prevention strategies, as they are more frequently older women with chronic pain and using high doses of prescription opioids.