ABC of poisoning: opioids (original) (raw)
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USE OF NALOXONE FOR REVERSAL OF PICTURES OF OPIOID POISONING (Atena Editora)
USE OF NALOXONE FOR REVERSAL OF PICTURES OF OPIOID POISONING (Atena Editora), 2022
Introduction: The consumption of illegal substances is notably a global public health problem. From this, opioid intoxication is, for example, the main cause of drug-related deaths in Austria. In this sense, the administration of Naloxone appears as a tool to combat toxic situations triggered by the use of substances of an opioid nature, given its antagonistic effect on the receptors of this class. Goals: to analyze the effects of using Naloxone as an intervention tool in cases of opioid intoxication. Methods: This is an integrative literature review, in the PubMed database, based on the descriptors: “naloxone” and “opioid intoxication ” in the last five years. Seven scientific articles were selected, all written in English and carried out in humans, and articles that did not fit the goals of the present study were excluded. Results: Naloxone was a significant intervening agent in the absolute majority of cases of opioid intoxication. Select exceptions were observed in which patients required endotracheal intubation and mechanical ventilation due to respiratory failure relatively refractory to large doses of Naloxone. However, the use of opioid antagonist medication has been proven to be the safest and most efficient method of reversing intoxication, with great results even as a treatment for cases of alcohol dependence. Conclusion: the use of naloxone to reverse opioid intoxication conditions proved to be safe and efficient, but with some adverse effects when using high doses of this opioid receptor antagonist. It is concluded that the administration of naloxone, in adequate doses, is a useful tool in overdose or acute opioid intoxication.
Identifying and assessing the risk of opioid abuse in patients with cancer: an integrative review
Substance Abuse and Rehabilitation, 2016
Background: The misuse and abuse of opioid medications in many developed nations is a health crisis, leading to increased health-system utilization, emergency department visits, and overdose deaths. There are also increasing concerns about opioid abuse and diversion in patients with cancer, even at the end of life. Aims: To evaluate the current literature on opioid misuse and abuse, and more specifically the identification and assessment of opioid-abuse risk in patients with cancer. Our secondary aim is to offer the most current evidence of best clinical practice and suggest future directions for research. Materials and methods: Our integrative review included a literature search using the key terms "identification and assessment of opioid abuse in cancer", "advanced cancer and opioid abuse", "hospice and opioid abuse", and "palliative care and opioid abuse". PubMed, PsycInfo, and Embase were supplemented by a manual search. Results: We found 691 articles and eliminated 657, because they were predominantly non cancer populations or specifically excluded cancer patients. A total of 34 articles met our criteria, including case studies, case series, retrospective observational studies, and narrative reviews. The studies were categorized into screening questionnaires for opioid abuse or alcohol, urine drug screens to identify opioid misuse or abuse, prescription drug-monitoring programs, and the use of universal precautions. Conclusion: Screening questionnaires and urine drug screens indicated at least one in five patients with cancer may be at risk of opioid-use disorder. Several studies demonstrated associations between high-risk patients and clinical outcomes, such as aberrant behavior, prolonged opioid use, higher morphine-equivalent daily dose, greater health care utilization, and symptom burden.
Cancer patients’ first treatment episode with opioids: a pharmaco-epidemiological perspective
2006
Goal: The factors underlying the choice of opioids for cancer patients in primary care are largely unknown. Our aim was to describe cancer patients' first treatment episode with opioids in relation to disease characteristics and clinical course. Patients and methods: During 1997 and 1998, a populationbased cohort of 4,006 incident cancer patients from a Danish county was identified. The patients were followed up from diagnosis to death or until 31 December 2003, and data on their use of opioids were obtained from a prescription database. Main results: Eventually, 54% of the cancer patients became incident users of opioids. Opioid treatment was initiated close to the diagnosis date in 20% of the patients. Most incident users (57%) were not terminal when they began using opioids, and 44% survived the first treatment episode. Of those who died, 70% received opioids in their terminal phase. The incidence rates of new opioid users were inversely related to the 5-year cancer survival period. A weak opioid was the first choice in 64% of the non-terminal users and in 43% of the terminal ones. No statistically significant differences in opioid use were found between men and women. Conclusions: Opioid use in cancer patients was not confined to the terminal course. Treatment with opioids should be viewed as a dynamic condition, with patients shifting between periods of use and non-use. The aggressiveness of the cancer and the presence of metastases were characteristics found to be strong determinants of opioid use.
BMJ, 2010
Objective To investigate the effect of opiate substitution treatment at the beginning and end of treatment and according to duration of treatment. Design Prospective cohort study. Setting UK General Practice Research Database Participants Primary care patients with a diagnosis of substance misuse prescribed methadone or buprenorphine during 1990-2005. 5577 patients with 267 003 prescriptions for opiate substitution treatment followed-up (17 732 years) until one year after the expiry of their last prescription, the date of death before this time had elapsed, or the date of transfer away from the practice. Mainoutcome measures Mortality rates and rate ratios comparing periods in and out of treatment adjusted for sex, age, calendar year, and comorbidity; standardised mortality ratios comparing opiate users' mortality with general population mortality rates. Results Crude mortality rates were 0.7 per 100 person years on opiate substitution treatment and 1.3 per 100 person years off treatment; standardised mortality ratios were 5.3 (95% confidence interval 4.0 to 6.8) on treatment and 10.9 (9.0 to 13.1) off treatment. Men using opiates had approximately twice the risk of death of women (morality rate ratio 2.0, 1.4 to 2.9). In the first two weeks of opiate substitution treatment the crude mortality rate was 1.7 per 100 person years: 3.1 (1.5 to 6.6) times higher (after adjustment for sex, age group, calendar period, and comorbidity) than the rate during the rest of time on treatment. The crude mortality rate was 4.8 per 100 person years in weeks 1-2 after treatment stopped, 4.3 in weeks 3-4, and 0.95 during the rest of time off treatment: 9 (5.4 to 14.9), 8 (4.7 to 13.7), and 1.9 (1.3 to 2.8) times higher than the baseline risk of mortality during treatment. Opiate substitution treatment has a greater than 85% chance of reducing overall mortality among opiate users if the average duration approaches or exceeds 12 months. Conclusions Clinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality.
Commentary: “Ockham’s Razor” Doesn’t Apply to “Opioid” Overdose Death
Journal of Biosciences and Medicines, 2021
Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are polysubstance overdose deaths. And since many of the substances involved in a polysubstance Overdose Death (POD) are Central Nervous System (CNS) depressants, many of which can cause overdose death themselves, or synergistically with opioids, it is somewhat puzzling that prescription opioids have been singled out as the cause of these deaths-without reference to PSA. This is particularly puzzling in light of the fact that the issues of PSA and POD have been recognized and discussed in the literature since at least the 1960's and before. We therefore here consider the question: are we facing an "opioid" crisis or, instead, a "polysubstance crisis"? And we wonder if the issue has been oversimplified , to the detriment of the individuals affected, and to society more broadly. There is a need for an "agnostic" respiratory stimulant that can reverse polysubstance-induced respiratory depression.