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Skin Appendage Disorders Oct 2018There are a number of toxic agents that can cause alopecia. In this review we summarize the known substances that cause alopecia as one of the clinical signs of overdose... (Review)
Review
IMPORTANCE/OBJECTIVE
There are a number of toxic agents that can cause alopecia. In this review we summarize the known substances that cause alopecia as one of the clinical signs of overdose or toxicity.
EVIDENCE REVIEW
A search was conducted using PubMed, EMBASE, and Cochrane for studies describing hair loss of any type as a result of exposure to or ingestion of a toxic agent. The search yielded 856 articles, with 47 studies included in this review.
FINDINGS
Agents with the strongest evidence of association to alopecia include thallium, mercury, selenium, and colchicine. Agents with described incidents include boric acid, arsenic, vitamin A, botulinum toxin, , and the synthetic opioid MT-45.
CONCLUSIONS AND RELEVANCE
Numerous toxic agents have been implicated in alopecia, and the strength of evidence behind each agent varies. Toxic levels of thallium and colchicine have long been established to cause alopecia, as compared to agents such as botulinum toxin A and synthetic recreational drugs which have less literature describing their links to alopecia and will need further investigation to characterize their relationships to hair loss. Knowledge of typical presentations of hair loss will aid in the development of a differential diagnosis for patients presenting with alopecia.
PubMed: 30410891
DOI: 10.1159/000485749 -
Drug and Alcohol Dependence Sep 2021Buprenorphine maintenance treatment (BMT) is widely used in Iran, and its use is growing continuously. We reviewed studies on buprenorphine use, non-prescribed use, use... (Review)
Review
INTRODUCTION
Buprenorphine maintenance treatment (BMT) is widely used in Iran, and its use is growing continuously. We reviewed studies on buprenorphine use, non-prescribed use, use disorder and treatment-seeking for it, buprenorphine-associated poisoning, and mortality in Iran in the current systematic review.
METHODS
An Iranian database (Scientific Information Database; SID) and three International electronic databases (PubMed, Scopus, and Web of Science) were searched for publications up to August 2020 for the relevant data. Opportunistic methods (Contact with experts and backward citation tracking) were also used for this purpose. Identified records were screened for eligibility criteria, and data of included studies were extracted. For context, the trend of BMT in the country was also examined.
RESULTS
Ten studies were found on the prevalence of non-prescribed buprenorphine use, seven were on the regular use and use disorder, and two studies on buprenorphine poisoning. The last 12-month prevalence of non-prescribed use was lower than 0.5 % in the general population, university, and high school students. The indicator was 2.5 % among persons who use drugs in a 2018 national study. The proportion of buprenorphine poisoning was 4.9 % among all illicit substance poisoning cases admitted to a hospital. The proportion of buprenorphine poisoning cases among all acute pediatric drug poisoning cases increased from 1.2 % to 2.5 % in a 3-year study.
CONCLUSION
Despite the expansion of BMT in Iran in the last decade, the adverse health consequences associated with buprenorphine are infrequent, when compared to other opioids used in Iran, suggesting the safety of BMT for future expansion.
Topics: Analgesics, Opioid; Buprenorphine; Child; Humans; Iran; Opioid-Related Disorders
PubMed: 34214882
DOI: 10.1016/j.drugalcdep.2021.108871 -
Epidemiologic Reviews Jan 2022The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models are a tool to help us understand and address...
The opioid overdose crisis is driven by an intersecting set of social, structural, and economic forces. Simulation models are a tool to help us understand and address thiscomplex, dynamic, and nonlinear social phenomenon. We conducted a systematic review of the literature on simulation models of opioid use and overdose up to September 2019. We extracted modeling types, target populations, interventions, and findings; created a database of model parameters used for model calibration; and evaluated study transparency and reproducibility. Of the 1,398 articles screened, we identified 88 eligible articles. The most frequent types of models were compartmental (36%), Markov (20%), system dynamics (16%), and agent-based models (16%). Intervention cost-effectiveness was evaluated in 40% of the studies, and 39% focused on services for people with opioid use disorder (OUD). In 61% of the eligible articles, authors discussed calibrating their models to empirical data, and in 31%, validation approaches used in the modeling process were discussed. From the 63 studies that provided model parameters, we extracted the data sources on opioid use, OUD, OUD treatment, cessation or relapse, emergency medical services, and death parameters. From this database, potential model inputs can be identified and models can be compared with prior work. Simulation models should be used to tackle key methodological challenges, including the potential for bias in the choice of parameter inputs, investment in model calibration and validation, and transparency in the assumptions and mechanics of simulation models to facilitate reproducibility.
Topics: Analgesics, Opioid; Drug Overdose; Humans; Opiate Overdose; Opioid Epidemic; Opioid-Related Disorders; Reproducibility of Results
PubMed: 34791110
DOI: 10.1093/epirev/mxab013 -
Journal of Opioid Management 2016In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to... (Review)
Review
OBJECTIVE
In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to regulate or guide opioid prescribing. The overall impact of these policies is still uncertain. The aim of this systematic review was to examine the existing evidence of provider-level and patient-level outcomes preimplementation and postimplementation of policies and legislation constructed to impact provider prescribing practices around opioid analgesics.
DESIGN
A systematic search of MEDLINE, EMBASE, the Web of Science, and the Cochrane Database of Systematic Reviews was conducted to identify studies evaluating the impact of opioid prescribing policies on provider-level and patient-level outcomes. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Eleven studies were included in the review. A meta-analysis was not possible due to between-study heterogeneity. Six of the studies assessed state-level policies, and five were at the level of the healthcare system or hospital. Studies showed temporal associations between policy implementation and reductions in opioid prescribing, as well as opioid-related overdoses. Results were mixed regarding the impact of policies on misuse. The majority of the studies were judged to be of low quality based on the GRADE criteria.
CONCLUSIONS
There is low to moderate quality evidence suggesting that the presence of opioid prescribing policy will reduce the amount and strength of opioid prescribed. The presence of these policies may impact the number of overdoses, but there is no clear evidence to suggest that it reduces opioid misuse.
Topics: Analgesics, Opioid; Cause of Death; Drug Overdose; Drug Prescriptions; Health Policy; Humans; Inappropriate Prescribing; Models, Organizational; Opioid-Related Disorders; Patient Safety; Policy Making; Practice Patterns, Physicians'; Prescription Drug Misuse; Regional Health Planning; Risk Assessment; Risk Factors; State Government; State Health Plans
PubMed: 27194195
DOI: 10.5055/jom.2016.0322 -
Regional Anesthesia and Pain Medicine Jan 2023The COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future... (Review)
Review
IMPORTANCE
The COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.
OBJECTIVE
To summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.
EVIDENCE REVIEW
We searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.
FINDINGS
Among 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.
INTERPRETATION
Significant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.
PROSPERO REGISTRATION NUMBER
CRD42021236464.
Topics: Humans; United States; Analgesics, Opioid; Narcotic Antagonists; Opiate Overdose; COVID-19; Pandemics; Naloxone; Opioid-Related Disorders; Drug Overdose
PubMed: 36202619
DOI: 10.1136/rapm-2022-103591 -
Journal of Addictions Nursing 2018Opioid abuse and overdose is a public health concern as it relates to increased morbidity and mortality. This systematic review focuses on the application of take-home... (Review)
Review
PURPOSE
Opioid abuse and overdose is a public health concern as it relates to increased morbidity and mortality. This systematic review focuses on the application of take-home naloxone programs and its association with decreased mortality among those who abuse opioids. Take-home naloxone programs consist of distributed naloxone kits and corresponding education of overdose recognition. The purpose of this systematic review was to determine if programs that supply take-home naloxone are effective in preventing fatal overdoses among those who abuse opioids.
METHODS
A systematic search was conducted in Academic Search Complete, CINHAL, MEDLINE, PsychINFO, and SocINDEX. The key words searched were "programs," "take-home kits," "Narcan," "Naloxone," and "mortality." On the basis of the predefined inclusion and exclusion criteria, nine studies were found for inclusion.
RESULTS
Study results were then synthesized, qualitatively, and within the current research, there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses. A significant limitation of this systematic review is the lack of randomized controlled trials as it is viewed as unethical withholding a known lifesaving medication from an at-risk population.
PRACTICE IMPLICATIONS
On the basis of the most current evidence, there is overwhelming support of take-home naloxone programs associated with decreased mortality among those who abuse opioids. As a result, there is an implication for a practice change that take-home naloxone programs should be more widely implemented throughout communities as a method of decreasing mortality associated with opioid overdoses. It is recommended that further research is done examining the cost-effectiveness of these programs.
Topics: Cost-Benefit Analysis; Drug Overdose; Humans; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Patient Education as Topic; Self Care; United States
PubMed: 30180002
DOI: 10.1097/JAN.0000000000000230 -
Forensic Science International. Mind... Nov 2020A narrative systematic review was undertaken of the literature concerning the health of people on probation. In this paper, we provide an up-to-date summary of what is...
A narrative systematic review was undertaken of the literature concerning the health of people on probation. In this paper, we provide an up-to-date summary of what is known about suicide and suicidal ideation and probation. This includes estimates of prevalence and possible predictors of suicide and suicidal ideation. Searches were conducted on nine databases from January 2000 to May 2017, key journals from 2000 to September 2017, and the grey literature. A total of 5125 papers were identified in the initial electronic searches but after careful double-blind review only one research paper related to this topic met our criteria, although a further 12 background papers were identified which are reported. We conclude that people on probation are a very high risk group for completed suicide, and factors associated with this include drug overdose, mental health problems, and poor physical health. There is a clear need for high quality partnership working between probation and mental health services, and investment in services, to support appropriate responses to suicide risk.
PubMed: 35112089
DOI: 10.1016/j.fsiml.2020.100012 -
American Journal of Kidney Diseases :... Jan 2022Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The...
Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The EXTRIP workgroup conducted systematic reviews of the literature and summarized findings following published methods. Thirty-three articles (30 patient reports and 3 pharmacokinetic studies) met the inclusion criteria. High gabapentinoid extracorporeal clearance (>150mL/min) and short elimination half-life (<5 hours) were reported with hemodialysis. The workgroup assessed gabapentin and pregabalin as "dialyzable" for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Severe toxicity, mortality, and sequelae were rare in cases receiving ECTR and in historical controls receiving standard care alone. No clear clinical benefit from ECTR could be identified although major knowledge gaps were acknowledged, as well as costs and harms of ECTR. The EXTRIP workgroup suggests against performing ECTR in addition to standard care rather than standard care alone (weak recommendation, very low quality of evidence) for gabapentinoid poisoning in patients with normal kidney function. If decreased kidney function and coma requiring mechanical ventilation are present, the workgroup suggests performing ECTR in addition to standard care (weak recommendation, very low quality of evidence).
Topics: Drug Overdose; Frailty; Gabapentin; Humans; Poisoning; Pregabalin; Renal Dialysis
PubMed: 34799138
DOI: 10.1053/j.ajkd.2021.06.027 -
Drug and Alcohol Dependence Sep 2021Non-fatal opioid-related overdoses have increased significantly over the past two decades and there have been increasing reports of brain injuries and/or neurocognitive... (Review)
Review
BACKGROUND
Non-fatal opioid-related overdoses have increased significantly over the past two decades and there have been increasing reports of brain injuries and/or neurocognitive impairments following overdose events. Limited preclinical research suggests that opioid overdoses may cause brain injury; however, little is known about such injuries in humans. The purpose this systematic review is to summarize existing studies on neurocognitive impairments and/or brain abnormalities associated with an opioid-related overdose in humans.
METHODS
PubMed, Web of Science, Ovid MEDLINE and PsyINFO were searched, without year restrictions, and identified 3099 articles. An additional 24 articles were identified by reviewing references. Articles were included if they were published in English, reported study findings in humans, included individuals 18 years of age or older, and reported an objective measure of neurocognitive impairments and/or brain abnormalities resulting from an opioid-related overdose. Six domains of bias (selection, performance, attrition, detection (two dimensions) and reporting were evaluated and themes were summarized.
RESULTS
Seventy-nine journal articles, published between 1973-2020, were included in the review. More than half of the articles were case reports (n = 44) and there were 11 cohort studies, 18 case series, and 6 case-control studies. All of the studies were categorized as at-risk of bias, few controlled for confounding factors, and methodological differences made direct comparisons difficult. Less than half of the studies reported toxicology results confirming an opioid-related overdose; 64.6 % reported brain MRI results and 27.8 % reported results of neuropsychological testing. Only two studies had within subject comparative data to document changes in the brain possibly associated with an overdose. Despite these limitations, existing publications suggest that brain injuries and neurocognitive impairments are associated with opioid overdose. Additional research is needed to establish the incidence of overdose-related brain injuries and the potential impact on functioning, as well as engagement in treatment of substance use disorders.
CONCLUSIONS
Respiratory depression is a defining characteristic of opioid overdose and prolonged cerebral hypoxia may cause brain injuries and/or neurocognitive impairments. The onset, characteristics, and duration of such injuries is variable and additional research is needed to understand their clinical implications.
Topics: Adolescent; Adult; Analgesics, Opioid; Brain; Drug Overdose; Humans; Opiate Overdose; Substance-Related Disorders
PubMed: 34271512
DOI: 10.1016/j.drugalcdep.2021.108838 -
Substance Abuse Treatment, Prevention,... Nov 2021There are preliminary indications that the trajectory of drug overdose-related deaths in North America has been exacerbated due to the novel coronavirus disease pandemic... (Review)
Review
The impact of the novel coronavirus disease (COVID-19) pandemic on drug overdose-related deaths in the United States and Canada: a systematic review of observational studies and analysis of public health surveillance data.
BACKGROUND
There are preliminary indications that the trajectory of drug overdose-related deaths in North America has been exacerbated due to the novel coronavirus disease pandemic (COVID-19). As such, the impact of COVID-19 on drug overdose-related deaths was examined through a systematic review of the literature and percentage change analyses of surveillance data.
METHODS
Systematic searches in electronic databases were conducted, a topical issue brief and bibliography were reviewed, reference lists of included studies were searched and expert consultations were held to identify studies (Registration # CRD42021230223). Observational studies from the United States and Canada were eligible for inclusion if drug overdose-related deaths were assessed in quantitative or qualitative analyses onwards from at least March 2020. In addition, percentage changes comparing drug overdose-related deaths in the second annual quarter (Q2 2020 [April to June]) with the first annual quarter (Q1 2020 [January to March]) were generated using national and subnational data from public health surveillance systems and reports from jurisdictions in the United States and Canada.
RESULTS
Nine studies were included in the systematic review, eight from the United States and one from Canada. The maximum outcome assessment period in the included studies extended until September 2020. Drug overdose-related deaths after the onset of COVID-19 were higher compared with the months leading up to the pandemic in 2020 and the comparative months in 2019. In additional percentage change analyses, drug overdose-related deaths increased by 2 to 60% in jurisdictions in the United States and by 58% in Canada when comparing Q2 2020 with Q1 2020.
CONCLUSIONS
Drug overdose-related deaths increased after the onset of COVID-19. The current situation necessitates a multi-pronged approach, encompassing expanded access to substance use disorder treatment, undisrupted access to harm reduction services, emphasis on risk reduction strategies, provision of a safe drug supply and decriminalization of drug use.
Topics: COVID-19; Canada; Drug Overdose; Humans; Pandemics; Public Health Surveillance; SARS-CoV-2; United States
PubMed: 34844624
DOI: 10.1186/s13011-021-00423-5