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Pharmacology & Therapeutics May 2022Overdose deaths are often viewed as the leading edge of the opioid epidemic which has gripped the United States over the past two decades (Skolnick, 2018a). This... (Review)
Review
Overdose deaths are often viewed as the leading edge of the opioid epidemic which has gripped the United States over the past two decades (Skolnick, 2018a). This emphasis is perhaps unsurprising because opioid overdose is both the number-one cause of death for individuals between 25 and 64 years old (Dezfulian et al., 2021) and a significant contributor to the decline in average lifespan (Dowell et al., 2017). Exacerbated by the COVID 19 pandemic, it was estimated there were 93,400 drug overdose deaths in the United States during the 12 months ending December 2020, with more than 69,000 (that is, >74%) of these fatalities attributed to opioid overdose (Ahmad et al., 2021). However, the focus on mortality statistics (Ahmad et al., 2021; Shover et al., 2020) tends to obscure the broader medical impact of nonfatal opioid overdose. Analyses of multiple databases indicate that for each opioid-induced fatality, there are between 6.4 and 8.4 non-fatal overdoses, exacting a significant burden on both the individual and society. Over the past 7-8 years, there has been an alarming increase in the misuse of synthetic opioids ("synthetics"), primarily fentanyl and related piperidine-based analogs. Within the past 2-3 years, a structurally unrelated class of high potency synthetics, benzimidazoles exemplified by etonitazene and isotonitazene ("iso"), have also appeared in illicit drug markets (Thompson, 2020; Ujvary et al. 2021). In 2020, it was estimated that over 80% of fatal opioid overdoses in the United States now involve synthetics (Ahmad et al., 2021). The unique physicochemical and pharmacological properties of synthetics described in this review are responsible for both the morbidity and mortality associated with their misuse as well as their widespread availability. This dramatic increase in the misuse of synthetics is often referred to as the "3rd wave" (Pardo et al., 2019; Volkow and Blanco, 2020) of the opioid epidemic. Among the consequences resulting from misuse of these potent opioids is the need for higher doses of the competitive antagonist, naloxone, to reverse an overdose. The development of more effective reversal agents such as those described in this review is an essential component of a tripartite strategy (Volkow and Collins, 2017) to reduce the biopsychosocial impact of opioid misuse in the "synthetic era".
Topics: Adult; Analgesics, Opioid; Drug Overdose; Humans; Middle Aged; Naloxone; Opiate Overdose; United States; COVID-19 Drug Treatment
PubMed: 34637841
DOI: 10.1016/j.pharmthera.2021.108019 -
Expert Opinion on Drug Metabolism &... 2023Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes... (Review)
Review
INTRODUCTION
Paracetamol is one of the most used medicines worldwide and is the most common important poisoning in high-income countries. In overdose, paracetamol causes dose-dependent hepatotoxicity. Acetylcysteine is an effective antidote, however despite its use hepatotoxicity and many deaths still occur.
AREAS COVERED
This review summarizes paracetamol overdose and toxicity (including mechanisms, risk factors, risk assessment, and treatment). In addition, we summarize the epidemiology of paracetamol overdose worldwide. A literature search on PubMed for poisoning epidemiology and mortality from 1 January 2017 to 26 October 2022 was performed to estimate rates of paracetamol overdose, liver injury, and deaths worldwide.
EXPERT OPINION
Paracetamol is widely available and yet is substantially more toxic than other analgesics available without prescription. Where data were available, we estimate that paracetamol is involved in 6% of poisonings, 56% of severe acute liver injury and acute liver failure, and 7% of drug-induced liver injury. These estimates are limited by lack of available data from many countries, particularly in Asia, South America, and Africa. Harm reduction from paracetamol is possible through better identification of high-risk overdoses, and better treatment regimens. Large overdoses and those involving modified-release paracetamol are high-risk and can be targeted through legislative change.
Topics: Humans; Acetaminophen; Drug Overdose; Acetylcysteine; Chemical and Drug Induced Liver Injury; Cost of Illness
PubMed: 37436926
DOI: 10.1080/17425255.2023.2223959 -
Emergency Medicine Journal : EMJ Jul 2001Overdoses of tricyclic antidepressants are among the commonest causes of drug poisoning seen in accident and emergency departments. This review discusses the... (Review)
Review
Overdoses of tricyclic antidepressants are among the commonest causes of drug poisoning seen in accident and emergency departments. This review discusses the pharmacokinetics, clinical presentation and treatment of tricyclic overdose.
Topics: Anti-Arrhythmia Agents; Antidepressive Agents, Tricyclic; Cardiovascular Diseases; Drug Overdose; Humans; Inactivation, Metabolic; Sodium Bicarbonate; Sorption Detoxification
PubMed: 11435353
DOI: 10.1136/emj.18.4.236 -
Journal of Addiction Medicine 2014Community-based opioid overdose prevention programs (OOPPs) that include the distribution of naloxone have increased in response to alarmingly high overdose rates in... (Review)
Review
Community-based opioid overdose prevention programs (OOPPs) that include the distribution of naloxone have increased in response to alarmingly high overdose rates in recent years. This systematic review describes the current state of the literature on OOPPs, with particular focus on the effectiveness of these programs. We used systematic search criteria to identify relevant articles, which we abstracted and assigned a quality assessment score. Nineteen articles evaluating OOPPs met the search criteria for this systematic review. Principal findings included participant demographics, the number of naloxone administrations, percentage of survival in overdose victims receiving naloxone, post-naloxone administration outcome measures, OOPP characteristics, changes in knowledge pertaining to overdose responses, and barriers to naloxone administration during overdose responses. The current evidence from nonrandomized studies suggests that bystanders (mostly opioid users) can and will use naloxone to reverse opioid overdoses when properly trained, and that this training can be done successfully through OOPPs.
Topics: Community Mental Health Services; Drug Overdose; Humans; Naloxone; Narcotic Antagonists; Narcotics; Opioid-Related Disorders; Program Evaluation
PubMed: 24874759
DOI: 10.1097/ADM.0000000000000034 -
International Journal of Environmental... Jan 2023Drug 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... (Review)
Review
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.
Topics: Humans; United States; Drug Overdose; Substance-Related Disorders; Public Health; Epidemics; Cost-Effectiveness Analysis; Analgesics, Opioid
PubMed: 36673987
DOI: 10.3390/ijerph20021230 -
The Lancet. Public Health Mar 2022
Topics: Drug Overdose; Humans; Opiate Overdose; Opioid Epidemic
PubMed: 35247347
DOI: 10.1016/S2468-2667(22)00043-3 -
The Mount Sinai Journal of Medicine,... 1997The differential diagnosis of all patients with altered mental status must include drug toxicity. In particular, intentional or unintentional overdosing and/or poisoning... (Review)
Review
The differential diagnosis of all patients with altered mental status must include drug toxicity. In particular, intentional or unintentional overdosing and/or poisoning are common emergency department presenting complaints. A comprehensive approach to managing these patients must incorporate aggressive information gathering, a careful physical examination looking for toxic syndromes, and diagnostic testing. Proper decontamination is the key to effective management, as is the use of specific antidotes when indicated.
Topics: Antidotes; Decontamination; Drug Overdose; Emergencies; Humans; Poisoning
PubMed: 9293729
DOI: No ID Found -
Annals of Internal Medicine Apr 1999Acute heroin overdose is a common daily experience in the urban and suburban United States and accounts for many preventable deaths. Heroin acts as a pro-drug that... (Review)
Review
Acute heroin overdose is a common daily experience in the urban and suburban United States and accounts for many preventable deaths. Heroin acts as a pro-drug that allows rapid and complete central nervous system absorption; this accounts for the drug's euphoric and toxic effects. The heroin overdose syndrome (sensitivity for diagnosing heroin overdose, 92%; specificity, 76%) consists of abnormal mental status, substantially decreased respiration, and miotic pupils. The response of naloxone does not improve the sensitivity of this diagnosis. Most overdoses occur at home in the company of others and are more common in the setting of other drugs. Heroin-related deaths are strongly associated with use of alcohol or other drugs. Patients with clinically significant respiratory compromise need treatment, which includes airway management and intravenous or subcutaneous naloxone. Hospital observation for several hours is necessary for recurrence of hypoventilation or other complications. About 3% to 7% of treated patients require hospital admission for pneumonia, noncardiogenic pulmonary edema, or other complications. Methadone maintenance is an effective preventive measure, and others strategies should be studied.
Topics: Drug Overdose; Heroin; Heroin Dependence; Humans; Naloxone; Narcotic Antagonists; United States
PubMed: 10189329
DOI: 10.7326/0003-4819-130-7-199904060-00019 -
American Journal of Public Health Apr 2022
Topics: Drug Overdose; Humans; Opiate Overdose; Opioid Epidemic
PubMed: 35349307
DOI: 10.2105/AJPH.2022.306816 -
Journal of Urban Health : Bulletin of... Jun 2003Drug overdose is a major cause of premature death and morbidity among heroin users. This article examines recent research into heroin overdose to inform interventions... (Review)
Review
Drug overdose is a major cause of premature death and morbidity among heroin users. This article examines recent research into heroin overdose to inform interventions that will reduce the rate of overdose death. The demographic characteristics of overdose cases are discussed, including factors associated with overdose: polydrug use, drug purity, drug tolerance, routes of administration, and suicide. Responses by heroin users at overdoses are also examined. Potential interventions to reduce the rate of overdose and overdose-related morbidity are examined in light of the emerging data in this field.
Topics: Australia; Drug Overdose; Evidence-Based Medicine; Heroin Dependence; Humans; Research; Risk Factors
PubMed: 12791795
DOI: 10.1093/jurban/jtg022