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Epidemiologic Reviews Jan 2020The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids...
The opioid overdose epidemic is typically described as having occurred in 3 waves, with morbidity and mortality accruing over time principally from prescription opioids (1999-2010), heroin (2011-2013), and illicit fentanyl and other synthetic opioids (2014-present). However, the increasing presence of synthetic opioids mixed into the illicit drug supply, including with stimulants such as cocaine and methamphetamine, as well as rising stimulant-related deaths, reflects the rapidly evolving nature of the overdose epidemic, posing urgent and novel public health challenges. We synthesize the evidence underlying these trends, consider key questions such as where and how concomitant exposure to fentanyl and stimulants is occurring, and identify actions for key stakeholders regarding how these emerging threats, and continued evolution of the overdose epidemic, can best be addressed.
Topics: Analgesics, Opioid; Central Nervous System Stimulants; Drug Overdose; Female; Humans; Male; Public Health; United States
PubMed: 33511987
DOI: 10.1093/epirev/mxaa011 -
Supportive Care in Cancer : Official... Aug 2021Adolescents and young adults (AYAs) are at increased risk for negative opioid-related outcomes, including misuse and overdose. High-quality cancer care requires adequate...
Adolescents and young adults (AYAs) are at increased risk for negative opioid-related outcomes, including misuse and overdose. High-quality cancer care requires adequate pain management and often includes opioids for tumor- and/or treatment-related pain. Little is known about opioid use and misuse in children and AYAs with cancer, and we therefore conducted a systematic review of the literature using PRISMA guidelines to identify all relevant studies that evaluated opioid use and/or misuse among this population. Eleven studies were identified that met our inclusion criteria. The range of opioid use among the studies was 12-97%, and among the five studies that reported opioid misuse or aberrant behaviors, 7-90% of patients met criteria. Few studies reported factors associated with opioid misuse but included prior mental health and/or substance use disorders, and prior opioid use. In summary, opioid use is highly variable among children and AYAs with cancer; however, the range of use varies widely depending on the study population, such as survivors or end-of-life cancer patients. Few studies have examined opioid misuse and/or aberrant behaviors, and future research is needed to better understand opioid use and misuse among children and AYAs with cancer, specifically those who will be cured of their cancer and may subsequently experience adverse opioid-related outcomes.
Topics: Adolescent; Analgesics, Opioid; Cancer Pain; Child; Drug Overdose; Female; Humans; Male; Opioid-Related Disorders; Pain Management; Young Adult
PubMed: 33462726
DOI: 10.1007/s00520-020-05980-2 -
Current Neuropharmacology Oct 2021Both prescription and over-the-counter (OTC) drugs recently emerged among novel psychoactive substances (NPS) being reported as ingested for recreational purposes. Among...
BACKGROUND
Both prescription and over-the-counter (OTC) drugs recently emerged among novel psychoactive substances (NPS) being reported as ingested for recreational purposes. Among them, benzydamine (BZY), normally prescribed as an OTC anti-inflammatory drug, is reportedly being diverted and recreationally used.
OBJECTIVE
The aim of this study was to investigate how the misuse of BZY has been reported, illustrating its psychotropic molecular mechanism, and studying its psychopathological effects.
METHODS
We firstly conducted a systematic review of the literature concerning the abuse of BZY and its effects. For data gathering purposes, both PRISMA and PROSPERO guidelines were followed. All research methods were approved by PROSPERO (identification code CRD42020187266). Second, we analysed BZY-related data from the European Monitoring Agency (EMA) Adverse Drug Reactions (ADRs) database recorded during 2005-2020 regarding its abuse.
RESULTS
Eleven articles, published during 1997-2019, were included in our systematic review, including five case reports, four surveys, and two retrospective case series analyses. While nine articles dealt with the recreational use of BZY, two described an oral overdose of the drug. When specified, dosages of BZY consumed ranged from 500 to 1500mg. The EMA dataset contained three cases of BZY abuse.
CONCLUSION
Results from the systematic review showed BZY might be diverted for typical hallucinogenic properties occurring at high dosages. Healthcare professionals should be warned about a possible misuse/abuse of a commonly prescribed anti-inflammatory drug and be vigilant when prescribing it. Physicians working in emergency units should know that psychotic symptoms may be related to BZY abuse.
Topics: Anti-Inflammatory Agents; Benzydamine; Humans; Psychotic Disorders; Retrospective Studies
PubMed: 33441070
DOI: 10.2174/1570159X19666210113151136 -
Journal of Pain Research 2020Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature.... (Review)
Review
PURPOSE
Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl-associated deaths using case studies and case series in peer-reviewed published literature.
METHODS
Four electronic databases including Embase, Medline (via Ovid), Scopus and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively.
RESULTS
Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, <1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 µg/mL.
CONCLUSION
Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths.
PubMed: 33324089
DOI: 10.2147/JPR.S280462 -
The International Journal on Drug Policy Apr 2021Adult drug courts are growing in popularity within the Unites States, but the quality of substance use treatment within drug court programs and the impact of drug courts...
BACKGROUND
Adult drug courts are growing in popularity within the Unites States, but the quality of substance use treatment within drug court programs and the impact of drug courts on health and substance use treatment outcomes is largely unknown. We appraised the quality of United States adult drug court process evaluations and the inclusion of measures of substance use treatment quality.
METHODS
We systematically reviewed the adult drug court evaluations between 2008 and 2018 in accordance with recommended strategies for systematic gray literature search. We appraised evaluation quality using the Evidence for Policy and Practice Information and Coordination Center tool for process evaluations. We extracted recommended measures of substance use treatment quality, including measures related to screening and monitoring, diagnosis, service availability, service utilization, and outcomes.
RESULTS
Our search identified 112 evaluations. Process measures were included within 68 evaluations, 45% of which had poor data reliability. We found that less than 10% of evaluations reported substance use treatment quality measures related to service utilization, overdose, and mortality, while more than 75% contained criminal justice measures, including program graduation (completion of criminal justice proceedings) and participant recidivism.
CONCLUSIONS
We found low uptake of measures of substance use treatment quality. The absence of data call into question the ability of drug courts to stem harmful substance use related health outcomes.
Topics: Adult; Criminal Law; Humans; Pharmaceutical Preparations; Recidivism; Reproducibility of Results; Substance-Related Disorders; United States
PubMed: 33310636
DOI: 10.1016/j.drugpo.2020.103050 -
Basic & Clinical Pharmacology &... Jan 2021Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk...
Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-a-go-go-channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.
Topics: Adolescent; Adult; Analgesics, Opioid; Animals; Antipsychotic Agents; Arrhythmias, Cardiac; Autopsy; Cause of Death; Consciousness; Drug Interactions; Drug Overdose; Female; Forensic Toxicology; Humans; Hypotension; Male; Methadone; Middle Aged; Morphine; Opioid-Related Disorders; Quetiapine Fumarate; Respiratory Insufficiency; Risk Assessment; Risk Factors
PubMed: 33245632
DOI: 10.1111/bcpt.13480 -
Journal of General Internal Medicine Dec 2020Many clinicians are reevaluating the use of long-term opioid therapy (LTOT) for chronic pain in response to the opioid crisis and calls from organizations including the...
BACKGROUND
Many clinicians are reevaluating the use of long-term opioid therapy (LTOT) for chronic pain in response to the opioid crisis and calls from organizations including the Centers for Disease Control & Prevention to limit prescribing of high-dose opioids. However, this practice change is occurring largely in the absence of data regarding patient outcomes. A 2017 systematic review found inconclusive evidence on the impact of LTOT dose reduction and discontinuation on pain severity and function, quality of life, withdrawal symptoms, substance abuse, and adverse effects. This rapid systematic review provides an updated evidence synthesis of patient outcomes following LTOT dose reduction including serious harms such as overdose and suicide.
METHODS
We systematically searched numerous bibliographic databases from January 2017 (the end search date of the 2017 systematic review) through May 2020. One reviewer used prespecified criteria to assess articles for inclusion, evaluate study quality, abstract data, and grade strength of evidence, with a second reviewer checking.
RESULTS
We included 49 studies-1 systematic review, 34 studies included in that systematic review, and 14 new studies. We prioritized evidence synthesis of 19 studies with the most applicability to the Veteran population and outpatient settings. Among these studies, improvements in mean pain scores were common among patients tapering opioids while participating in intensive multimodal pain interventions and mostly unchanged with less intensive or nonspecific co-interventions. Our confidence in these findings is low due to methodological limitations of the studies. Observational data suggests that serious harms such as opioid overdose and suicidal ideation can occur following opioid dose reduction or discontinuation, but the incidence of these harms at the population level is unknown.
DISCUSSION
The net balance of benefits and harms of LTOT dose reduction for patients with chronic pain is unclear. Clinicians should closely monitor patients during the tapering process given the potential for harm.
Topics: Analgesics, Opioid; Chronic Pain; Drug Overdose; Drug Tapering; Humans; Quality of Life
PubMed: 33145689
DOI: 10.1007/s11606-020-06253-8 -
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 -
PloS One 2020To systematically review the literature in order to evaluate the effects of health coaching on patients' reduction of opioid usage and opioid discontinuation. In...
PURPOSE
To systematically review the literature in order to evaluate the effects of health coaching on patients' reduction of opioid usage and opioid discontinuation. In addition, this systematic review investigated the effects of health coaching on pain intensity, physical function, and quality of life.
METHODS
Four electronic databases (PubMed, Embase, Scopus, and PsychINFO) were searched from inception to December 2019. Randomized controlled trials assessing the effects of health coaching interventions in adult patients currently using opioids were included. We considered trials if they included any of the four defined key constructs of health coaching adopted in this review: motivational interviewing, positive psychology, the transtheoretical model, and self-determination theory Independent reviewers screened and selected studies, extracted data, and assessed risk of bias using Revised Cochrane risk-of-bias tool for randomized trials (RoB2) and quality of evidence using Grading, Recommendation, Assessment, Development, and Evaluation (GRADE). The review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) databased as CRD42019136201. It was not possible to perform a meta-analysis due to heterogeneity between included trials.
RESULTS
Eleven studies met our inclusion criteria (n = 4,516 participants). No study assessed all four constructs of health coaching. All eleven studies utilized only one of the constructs, brief motivational interviewing. Thus, we reported our results in terms of motivational interviewing. There is conflicting and very low quality of evidence that brief motivational interviewing may or may not be more effective than education to reduce opioid usage. There is very low quality of evidence that brief motivational interviewing is more effective than educational monthly diaries to reduce opioid use. There is very low to low quality of evidence that brief motivational interviewing is not more effective than no behavioral intervention to reduce opioid use at 6 months follow-up, treatment as usual (TAU) to improve overdose risk behaviors, and TAU to improve physical and psychological health.
CONCLUSION
There is no direct evidence related to the effect of health coaching on opioid reduction. There is limited, low quality evidence to conclude brief motivational interviewing reduces opioid usage in opioid-dependent patients. Future research should focus on the impact of high theoretical health coaching interventions on opioid usage.
Topics: Analgesics, Opioid; Health Promotion; Humans; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic
PubMed: 33119705
DOI: 10.1371/journal.pone.0241434