RESUMEN
BACKGROUND: Opioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs. METHODS: The research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups. DISCUSSION: Findings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341.
Asunto(s)
Fentanilo , Reducción del Daño , Ensayos Clínicos Controlados Aleatorios como Asunto , Tiras Reactivas , Fentanilo/orina , Fentanilo/efectos adversos , Humanos , Ohio , Naloxona/administración & dosificación , Sobredosis de Droga/prevención & control , Sobredosis de Droga/orina , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/orina , Trastornos Relacionados con Opioides/diagnóstico , Analgésicos Opioides/orina , Analgésicos Opioides/efectos adversos , Antagonistas de Narcóticos , Sobredosis de Opiáceos/prevención & control , Sobredosis de Opiáceos/epidemiología , Estudios Multicéntricos como Asunto , Servicios Urbanos de Salud , Drogas Ilícitas/orinaRESUMEN
Shortening analgesic onset has been researched and it has been documented that prewarming epidural medications to body temperature (37°C) prior to administration increases medication efficacy. Our double-blind randomized controlled trial was designed to investigate if a lower degree of prewarming in providers' pockets could achieve similar results without the need of a bedside incubator. A total of 136 parturients were randomized into either the pocket-warmed group or the room temperature group to receive 10 mL of 0.125% bupivacaine with 2 µg/mL fentanyl epidural bolus at either the 27.8 ±1.7°C or 22.1 ±1.0°C temperatures, respectively. Primary outcome, time to analgesic onset (verbal rating scale pain score ≤ 3) was recorded in 0-, 5-, 10-, 15-, 20-, 30-, and 60-minutes intervals. It was observed that the pocket-warming group (n = 64) and room temperature group (n = 72) had no significant difference of analgesic onset time (median 8 vs. 6.2 minutes; p = 0.322). The incidence of adverse events such as hypotension, fever (≥ 38°C), nausea, vomiting, and number of top-off epidural boluses, as well as patient satisfaction rates and mode of delivery, were not significantly different between the groups as well. Further research is warranted to confirm these findings and explore the impact of different temperatures on analgesic onset time as well as the logistical issues associated with their clinical implementations.
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Analgesia Epidural , Bupivacaína , Fentanilo , Humanos , Femenino , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Analgesia Epidural/métodos , Bupivacaína/administración & dosificación , Adulto , Método Doble Ciego , Embarazo , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efectos adversos , Anestésicos Locales/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QTC values of the patients or being monitored. However, the effect of fentanyl on QTC, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QTC. METHODS: This is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QTC value was calculated. Primary outcomes were QTC prolongation, defined as an increase in the QTC to ≥ 500 ms or any increase in QTC by ≥ 60 ms. RESULTS: The study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QTC value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QTC prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period. CONCLUSION: Fentanyl prolonged the QTC value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QTC-prolonging effect should be considered when using fentanyl in patients at risk of torsades.
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Analgésicos Opioides , Electrocardiografía , Servicio de Urgencia en Hospital , Fentanilo , Humanos , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Masculino , Femenino , Estudios Prospectivos , Adulto , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/administración & dosificación , Electrocardiografía/efectos de los fármacos , Persona de Mediana Edad , Síndrome de QT Prolongado/inducido químicamente , Anciano , Adulto Joven , Administración IntravenosaRESUMEN
The aim of this study is to determine if extended-release, bioabsorbable, subcutaneous naltrexone (NTX) implants can mitigate respiratory depression after an intravenous injection (IV) of fentanyl. Six different BIOabsorbable Polymeric Implant Naltrexone (BIOPIN) formulations, comprising combinations of Poly-d,l-Lactic Acid (PDLLA) and/or Polycaprolactone (PCL-1 or PCL-2), were used to create subcutaneous implants. Both placebo and naltrexone implants were implanted subcutaneously in male dogs. The active naltrexone implants consisted of two doses, 644 mg and 1288 mg. A challenge with IV fentanyl was performed in 33 male dogs at 97-100 days after implantation. Following the administration of a 30 µg/kg intravenous fentanyl dose, the placebo cohort manifested a swift and profound respiratory depression with a ~50% reduction in their pre-dose respiratory rate (RR). The BIOPIN NTX-implanted dogs were exposed to escalating doses of intravenous fentanyl (30 µg/kg, 60 µg/kg, 90 µg/kg, and 120 µg/kg). In contrast, the dogs implanted with the BIOPIN naltrexone implants tolerated doses up to 60 µg/kg without significant respiratory depression (<50%) but had severe respiratory depression with fentanyl doses of 90 µg/kg and especially at 120 µg/kg. Bioabsorbable, extended-release BIOPIN naltrexone implants are effective in mitigating fentanyl-induced respiratory depression in male canines at about 3 months after implantation. This technology may also have potential for mitigating fentanyl-induced respiratory depression in humans.
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Implantes Absorbibles , Fentanilo , Naltrexona , Antagonistas de Narcóticos , Insuficiencia Respiratoria , Perros , Animales , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Masculino , Naltrexona/administración & dosificación , Naltrexona/farmacología , Insuficiencia Respiratoria/inducido químicamente , Insuficiencia Respiratoria/prevención & control , Proyectos Piloto , Antagonistas de Narcóticos/administración & dosificación , Antagonistas de Narcóticos/farmacología , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Preparaciones de Acción RetardadaRESUMEN
BACKGROUND: The ongoing overdose crisis in Canada has prompted efforts to increase access to a "safer supply" of prescribed alternatives to the unregulated drug supply. While safer supply programs predominantly distribute hydromorphone tablets, the Safer Alternatives for Emergency Response (SAFER) program in Vancouver, Canada offers a range of prescribed alternatives, including fentanyl patches. However, little is known about the effectiveness of fentanyl patches as safer supply. Drawing on the perspectives and experiences of program participants, we sought to qualitatively evaluate the effectiveness of the SAFER fentanyl patch program in meeting its intended aims, including reducing risk of overdose by decreasing reliance on the unregulated drug supply. METHODS: As part of a larger mixed-methods evaluation of SAFER, semi-structured qualitative interviews were conducted with 17 fentanyl patch program participants between February 2022 and April 2023. Thematic analysis of interview data focused on program engagement, experiences, impacts, and challenges. RESULTS: The flexible program structure, including lack of need for daily dispensation, the extended missed dose protocol, and community pharmacy patch distribution fostered engagement and enhanced autonomy. Improved management of withdrawal symptoms and cravings due to steady transdermal dosing led to reduced unregulated drug use and overdose risk. Participants also experienced economic benefits and improvements in overall health and quality of life. However, skin irritation and patch adhesion issues were key barriers to program retention. CONCLUSION: Our findings demonstrate the value of including fentanyl patch safer supply in the substance use continuum of care and offer insights for innovations in delivery of this intervention.
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Sobredosis de Droga , Fentanilo , Parche Transdérmico , Fentanilo/administración & dosificación , Fentanilo/provisión & distribución , Fentanilo/efectos adversos , Humanos , Sobredosis de Droga/prevención & control , Femenino , Masculino , Adulto , Canadá , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/provisión & distribución , Trastornos Relacionados con Opioides/prevención & control , Investigación Cualitativa , Colombia Británica , Persona de Mediana Edad , Entrevistas como Asunto , Evaluación de Programas y Proyectos de SaludRESUMEN
Opioid-associated brain injury may involve selective regions, including the hippocampi alone, globi pallidi, and cerebellar hemispheres. Opioid-associated amnestic syndrome, for example, is one clinical correlate of hippocampal injury as manifest by MRI abnormality. When all three regions are involved in what may be a more fulminant injury, the syndrome is termed "cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER)", initially described in 2019. Until now, to our knowledge, there have been no histopathologic correlates to the imaging findings specifically in CHANTER syndrome. Here, for the first time, we present histopathologic findings of the post-mortem brain from a patient who died from complications of CHANTER syndrome following fentanyl intoxication. These observations included microhemorrhage, reactive and necrotic vasculature, eosinophilic neuronal necrosis, axonal swelling and spheroids, and frank infarction. The findings support previous experimental models implicating both hypoxic-ischemic and cytotoxic mechanisms in the tissue damage associated with CHANTER syndrome, though further work is needed to better characterize the exact cellular pathways involved to develop targeted treatments.
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Edema Encefálico , Humanos , Masculino , Edema Encefálico/patología , Edema Encefálico/inducido químicamente , Edema Encefálico/diagnóstico por imagen , Autopsia , Analgésicos Opioides/efectos adversos , Fentanilo/efectos adversos , Adulto , Síndrome , Resultado Fatal , Persona de Mediana EdadRESUMEN
BACKGROUND: Dexmedetomidine has acceptable clinical utility for inducing sedation during flexible bronchoscopy. Reducing its dose may not only ameliorate its cardiovascular side effects, but also maintain its clinical usefulness. METHODS: Patients between 18 and 65 years were randomized to either dexmedetomidine (0.75 µg/kg) or the midazolam-fentanyl group (0.035 mg/kg midazolam and 25 mcg fentanyl). The primary outcome measure was the composite score. Other parameters noted were: oxygen saturation, hemodynamic variables, Modified Ramsay Sedation Score, Numerical Rating Scale (NRS) for pain intensity and distress, Visual Analog Scale score for cough, rescue medication doses, ease of doing bronchoscopy, and patient response 24 hours after bronchoscopy. RESULTS: In each arm, 31 patients were enrolled. The composite score at the nasopharynx was in the ideal category in 26 patients in dexmedetomidine and 21 in the midazolam-fentanyl group (P=0.007). At the tracheal level, the corresponding values were 24 and 16 (P=0.056). There was no significant difference between the 2 groups regarding the secondary outcome measures except hemodynamic parameters. The mean heart rate in the dexmedetomidine and midazolam-fentanyl groups, respectively, was as follows: at 10 minutes after start of FB (90.10±14.575, 104.35±18.48; P=0.001), at the end of FB (98.39±18.70, 105.94±17.45; P=0.016), and at 10 minutes after end of FB (89.84±12.02, 93.90±13.74; P=0.022). No patient developed bradycardia. Two patients (P=0.491) in the dexmedetomidine group developed hypotension. CONCLUSION: Low-dose dexmedetomidine (0.75 µg/kg single dose) appears to lead to a better composite score compared with the midazolam-fentanyl combination.
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Broncoscopía , Dexmedetomidina , Fentanilo , Hipnóticos y Sedantes , Midazolam , Humanos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/efectos adversos , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Midazolam/administración & dosificación , Midazolam/efectos adversos , Broncoscopía/métodos , Masculino , Femenino , Método Doble Ciego , Persona de Mediana Edad , Estudios Prospectivos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Adulto , Anciano , Adulto Joven , Frecuencia Cardíaca/efectos de los fármacos , Sedación Consciente/métodos , Hemodinámica/efectos de los fármacos , Adolescente , Dimensión del Dolor/métodosRESUMEN
Transitioning a patient with chronic pain from a fentanyl patch to a buprenorphine patch has not been well described in the literature. Even after a patient removes their fentanyl patch, the residual fentanyl in the skin continues to be absorbed for hours. Due to the risk of precipitated withdrawal when initiating buprenorphine, this transition is a more challenging opioid rotation to plan safely. We report a case of a patient who had been using a fentanyl patch for over 10 years and was successfully rotated directly to a buprenorphine patch.
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Analgésicos Opioides , Buprenorfina , Dolor Crónico , Fentanilo , Parche Transdérmico , Humanos , Buprenorfina/administración & dosificación , Buprenorfina/efectos adversos , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Dolor Crónico/tratamiento farmacológico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Administración Cutánea , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Tratamiento de Sustitución de Opiáceos , FemeninoRESUMEN
We conduct this research with a two-fold aim: providing a quantitative analysis of the opioid epidemic in the United States (U.S.), and exploring the impact of the COVID-19 pandemic on opioid-related mortality. The duration and persistence of the opioid epidemic lends itself to the need for an overarching analysis with extensive scope. Additionally, studying the ramifications of these concurrent severe public health crises is vital for informing policies to avoid preventable mortality. Using data from CDC WONDER, we consider opioid-related deaths grouped by Census Region spanning January 1999 to October 2022 inclusive, and later add on a demographic component with gender-stratification. Through the lens of key events in the opioid epidemic, we build an interrupted time series model to reveal statistically significant drivers of opioid-related mortality. We then employ a counterfactual to approximate trends in the absence of COVID-19, and estimate excess opioid-related deaths (defined as observed opioid-related deaths minus projected opioid-related deaths) associated with the pandemic. According to our model, the proliferation of fentanyl contributed to sustained increases in opioid-related death rates across three of the four U.S. census regions, corroborating existing knowledge in the field. Critically, each region has an immediate increase to its opioid-related monthly death rate of at least 0.31 deaths per 100,000 persons at the start of the pandemic, highlighting the nationwide knock-on effects of COVID-19. There are consistent positive deviations from the expected monthly opioid-related death rate and a sizable burden from cumulative excess opioid-related deaths, surpassing 60,000 additional deaths nationally from March 2020 to October 2022, â¼70% of which were male. These results suggest that robust, multi-faceted measures are even more important in light of the COVID-19 pandemic to prevent overdoses and educate users on the risks associated with potent synthetic opioids such as fentanyl.
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COVID-19 , Epidemia de Opioides , Pandemias , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , Estados Unidos/epidemiología , Masculino , Femenino , Trastornos Relacionados con Opioides/mortalidad , Trastornos Relacionados con Opioides/epidemiología , SARS-CoV-2 , Analgésicos Opioides/efectos adversos , Fentanilo/efectos adversos , Sobredosis de Droga/mortalidad , Sobredosis de Droga/epidemiologíaRESUMEN
Orthognathic surgery has a high incidence of postoperative nausea (PON) and vomiting (POV), delaying mobility initiation and postoperative recovery. Bleeding is another risk associated with this surgical procedure. We aimed to compare total intravenous anesthesia (TIVA) and volatile anesthesia in patients undergoing orthognathic surgery in terms of postoperative nausea and vomiting (PONV) incidence and hemodynamic changes. This retrospective study included 82 patients who underwent bilateral sagittal split ramus osteotomies at Saga University Hospital between April 2016 and April 2021. We compared the effects of TIVA and volatile anesthesia on PONV onset after surgery, acute postoperative hemodynamic changes (blood pressure and heart rate), and factors contributing to PONV. PON was significantly lower in the TIVA group than in the volatile anesthesia group. The total dose of fentanyl contributed to the onset of POV, while the onset of PON was associated with low volumes of fluid infusion and urine in the TIVA and volatile anesthesia groups, respectively. Furthermore, post-extubation hemodynamic change was significantly smaller in the TIVA group than in the volatile anesthesia group. Therefore, TIVA could have a reduced risk of PONV and hemodynamic changes in patients undergoing orthognathic surgery. Employing TIVA could mitigate perioperative complications and enhance patient safety.
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Anestesia General , Anestesia Intravenosa , Procedimientos Quirúrgicos Ortognáticos , Náusea y Vómito Posoperatorios , Humanos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Anestesia Intravenosa/efectos adversos , Anestesia Intravenosa/métodos , Anestesia General/efectos adversos , Anestesia General/métodos , Náusea y Vómito Posoperatorios/epidemiología , Náusea y Vómito Posoperatorios/etiología , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Procedimientos Quirúrgicos Ortognáticos/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Cirugía Ortognática/métodos , Adulto Joven , Anestesia por Inhalación/efectos adversos , Anestesia por Inhalación/métodos , Hemodinámica/efectos de los fármacos , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/efectos adversos , Osteotomía Sagital de Rama Mandibular/efectos adversos , Osteotomía Sagital de Rama Mandibular/métodos , Fentanilo/administración & dosificación , Fentanilo/efectos adversosRESUMEN
This study aimed to compare the effects of intrathecal dexmedetomidine, fentanyl and magnesium sulfate added to ropivacaine on the onset and duration of sensory and motor blocks in lower abdominal surgery. This double-blind randomized clinical trial included 90 patients scheduled for lower abdominal surgery at Vali-Asr Hospital in Arak, Iran. The enrolled patients were randomly divided into three equal groups and then underwent spinal anesthesia. The first group received 10 µg of dexmedetomidine, the second group received 50 µg of fentanyl, and the third group received 200 mg of 20% magnesium sulfate intrathecally in addition to 15 mg of 0.5% ropivacaine. In the dexmedetomidine group, the mean arterial blood pressure was lower than the other two groups (P = 0.001). Moreover, the time to onset of sensory block (P = 0.001) and the mean duration of sensory block (P = 0.001) were shorter and longer, respectively, in the dexmedetomidine group than in the other two groups. In the dexmedetomidine group, the mean time to onset of motor block (P = 0.001) and the mean duration of motor block (P = 0.001) were lower and higher than in the other two groups, respectively. There was no significant difference in visual analog scale score, heart rate, administered opioid, and drug side effects among the three groups. Dexmedetomidine caused early sensory and motor blocks while prolonging the duration of sensory and motor blocks compared with the other two groups. In addition, dexmedetomidine reduced mean arterial blood pressure in patients. Based on the findings of this study, it is recommended that dexmedetomidine can be used in order to enhance the quality of sensory and motor block in patients.
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Dexmedetomidina , Fentanilo , Sulfato de Magnesio , Ropivacaína , Humanos , Dexmedetomidina/administración & dosificación , Dexmedetomidina/farmacología , Masculino , Sulfato de Magnesio/farmacología , Sulfato de Magnesio/administración & dosificación , Femenino , Ropivacaína/farmacología , Ropivacaína/administración & dosificación , Fentanilo/administración & dosificación , Fentanilo/farmacología , Fentanilo/efectos adversos , Persona de Mediana Edad , Adulto , Método Doble Ciego , Abdomen/cirugía , Amidas/administración & dosificación , Amidas/farmacologíaRESUMEN
BACKGROUND Colonoscopy is the predominant invasive procedure for Crohn disease (CD) patients. Opioids and propofol carry risks of respiratory and cardiovascular complications. This study aimed to evaluate whether substituting fentanyl with ketamine or lidocaine could diminish propofol usage and minimize adverse events. MATERIAL AND METHODS In total, 146 patients with CD scheduled for elective colonoscopy were assigned to anesthesia with fentanyl (n=47), ketamine (n=47), or lidocaine (n=55). Propofol was administered to achieve sufficient anesthesia. Measured outcomes in each group included propofol consumption, hypotension and desaturation incidents, adverse event types, consciousness recovery time, abdominal pain intensity, Aldrete scale, and Post Anaesthetic Discharge Scoring System (PADSS). RESULTS Patients administered fentanyl needed significantly more propofol (P=0.017) than those on ketamine, with lidocaine showing no notable difference (P=0.28). Desaturation was significantly less common in the ketamine and lidocaine groups than fentanyl group (P<0.001). The ketamine group experienced milder reductions in mean arterial (P=0.018) and systolic blood pressure (P<0.001). Recovery metrics (Aldrete and PADSS scores) were lower for fentanyl (P<0.001), although satisfaction and pain levels were consistent across all groups (P=0.797). Dizziness occurred less frequently with lidocaine than fentanyl (17.2%, P=0.018) and ketamine (15.1%, P=0.019), while metallic taste incidents were more prevalent in the lidocaine group (13.5%, P=0.04) than fentanyl group. CONCLUSIONS Using ketamine or lidocaine instead of fentanyl in anesthesia for colonoscopy in patients with CD significantly lowers propofol use, reduces desaturation events, maintains blood pressure more effectively, without increasing hypotension risk, and accelerates recovery, without negatively impacting adverse events or patient satisfaction.
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Colonoscopía , Enfermedad de Crohn , Fentanilo , Ketamina , Lidocaína , Propofol , Humanos , Ketamina/efectos adversos , Ketamina/administración & dosificación , Fentanilo/efectos adversos , Fentanilo/administración & dosificación , Propofol/efectos adversos , Propofol/administración & dosificación , Lidocaína/efectos adversos , Lidocaína/administración & dosificación , Masculino , Femenino , Colonoscopía/métodos , Adulto , Persona de Mediana Edad , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/administración & dosificación , Anestesia/métodos , Anestesia/efectos adversosAsunto(s)
Relación Dosis-Respuesta a Droga , Hipnóticos y Sedantes , Unidades de Cuidados Intensivos , Propofol , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sedación Consciente/métodos , Sedación Consciente/efectos adversos , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Propofol/administración & dosificación , Propofol/efectos adversos , Propofol/análogos & derivadosRESUMEN
BACKGROUND: To determine if marijuana legalization was associated with reduced opioid mortality. STUDY DESIGN: The United States (US) opioid mortality trend during the 2010-2019 decade was compared in states and District of Columbia (jurisdictions) that had implemented marijuana legalization with states that had not. Acceleration of opioid mortality during 2020, the first year of the coronavirus disease 2019 (COVID-19) pandemic, was also compared in recreational and medicinal-only legalizing jurisdictions. METHODS: Joinpoint methodology was applied to the Centers for Disease Control and Prevention WONDER data. Trends in legalizing jurisdictions were cumulative aggregates. RESULTS: The overall opioid and fentanyl death rates and the percentage of opioid deaths due to fentanyl increased more during 2010-2019 in jurisdictions that legalized marijuana than in those that did not (pairwise comparison p = 0.007, 0.05, and 0.006, respectively). By 2019, the all-opioid and fentanyl death rates were 44 and 50 percent greater in the legalizing than in the nonlegalizing jurisdictions, respectively. When the COVID-19 pandemic hit in 2020, jurisdictions that implemented recreational marijuana legalization before 2019 had significantly greater increases in both overall opioid and fentanyl death rates than jurisdictions with medicinal-only legalization. For all-opioids, the mean (95 percent confidence interval) 2019-to-2020 increases were 46.5 percent (36.6, 56.3 percent) and 29.1 percent (20.2, 37.9 percent), respectively (p = 0.02). For fentanyl, they were 115.6 percent (80.2, 151.6 percent) and 55.4 percent (31.6, 79.2 percent), respectively (p = 0.01). CONCLUSIONS: During the past decade, marijuana legalization in the US was associated at the jurisdiction level with a greater acceleration in opioid death rate. An even greater increase in opioid mortality occurred in recreational-legalizing jurisdictions with the onset of the COVID-19 pandemic. Marijuana legalization is correlated with worsening of the US opioid epidemic.
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Analgésicos Opioides , COVID-19 , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/prevención & control , Estados Unidos/epidemiología , Analgésicos Opioides/efectos adversos , Fentanilo/efectos adversos , Legislación de Medicamentos/tendencias , Trastornos Relacionados con Opioides/mortalidad , Trastornos Relacionados con Opioides/epidemiología , Pandemias , Sobredosis de Opiáceos/mortalidad , Sobredosis de Opiáceos/epidemiología , Marihuana MedicinalAsunto(s)
Analgésicos Opioides , Fentanilo , Humanos , Analgésicos Opioides/uso terapéutico , Fentanilo/uso terapéutico , Fentanilo/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Trastornos Relacionados con Opioides/tratamiento farmacológico , Tratamiento de Sustitución de Opiáceos/métodosRESUMEN
INTRODUCTION: In the United States, methamphetamine use is increasing and the context of its use has changed, with reports of illicitly manufactured fentanyl being mixed with methamphetamine (either deliberately or inadvertently). We explore risk-mitigating actions taken by people who use drugs to protect their health when using methamphetamine in that context. METHODS: We conducted qualitative interviews with 48 adults (18+) who used methamphetamine in the past three months at two sites in Nevada, USA and two sites in New Mexico, USA. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS: Respondents described two rationales for employing harm reduction strategies. First, to prevent harm from methamphetamine containing illicit fentanyl, and second, to maintain their general wellbeing while using methamphetamine. Regarding methamphetamine containing illicit fentanyl, our findings highlight how respondents employ primary strategies like buying from trusted sources and secondary strategies such as spotting and selective use of harm reduction tools (i.e., fentanyl test strips) to reduce risks. To maintain their general wellbeing, participants reduced their use of methamphetamine as reasonably as possible, and used other substances like marijuana and alcohol alongside methamphetamine to counter the unwanted side effects of methamphetamine (i.e., hallucinations and paranoia). Use of these harm reduction strategies varied within situational and social contexts, and respondents usually developed these strategies based on their lived experiences. CONCLUSION: Our findings uniquely demonstrate that people who use methamphetamine prioritize community driven, trust-based strategies within their social networks to mitigate risks in a fentanyl-contaminated drug environment. Additionally, our results indicate that harm reduction behaviors are influenced by multilevel risk environments, which include social, physical, economic, and political factors. Overall, these results highlight the potential for targeted interventions at the network level, which are responsive to complexities and shifts in drug market dynamics- such as illicit fentanyl in methamphetamine.
Asunto(s)
Trastornos Relacionados con Anfetaminas , Contaminación de Medicamentos , Fentanilo , Reducción del Daño , Metanfetamina , Humanos , Fentanilo/efectos adversos , Fentanilo/administración & dosificación , Metanfetamina/efectos adversos , Metanfetamina/administración & dosificación , Adulto , Femenino , Masculino , Trastornos Relacionados con Anfetaminas/prevención & control , Contaminación de Medicamentos/prevención & control , Persona de Mediana Edad , Adulto Joven , New Mexico , Nevada , Drogas Ilícitas , Investigación Cualitativa , Entrevistas como AsuntoRESUMEN
While treatment side effects may adversely impact patients, they could also potentially function as indicators for effective treatment. In this study, we investigated whether and how side effects can trigger positive treatment expectations and enhance treatment outcomes. In this pre-registered trial (DRKS00026648), 77 healthy participants were made to believe that they will receive fentanyl nasal sprays before receiving thermal pain in a controlled experimental setting. However, nasal sprays did not contain fentanyl, rather they either contained capsaicin to induce a side effect (mild burning sensation) or saline (inert). After the first session, participants were randomized to two groups and underwent functional MRI. One group continued to believe that the nasal sprays could contain fentanyl while the other group was explicitly informed that no fentanyl was included. This allowed for the independent manipulation of the side effects and the expectation of pain relief. Our results revealed that nasal sprays with a side effect lead to lower pain than inert nasal sprays without side effects. The influence of side effects on pain was dependent on individual beliefs about how side effects are related to treatment outcome, as well as on expectations about received treatment. Functional MRI data indicated an involvement of the descending pain modulatory system including the anterior cingulate cortex and the periaqueductal gray during pain after experiencing a nasal spray with side effects. In summary, our data show that mild side effects can serve as a signal for effective treatment thereby influencing treatment expectations and outcomes, which is mediated by the descending pain modulatory system. Using these mechanisms in clinical practice could provide an efficient way to optimize treatment outcome. In addition, our results indicate an important confound in clinical trials, where a treatment (with potential side effects) is compared to placebo.
Asunto(s)
Capsaicina , Fentanilo , Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Adulto , Fentanilo/efectos adversos , Fentanilo/uso terapéutico , Capsaicina/efectos adversos , Capsaicina/administración & dosificación , Resultado del Tratamiento , Adulto Joven , Rociadores Nasales , Dolor/tratamiento farmacológico , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Administración Intranasal , Dimensión del Dolor/métodos , Manejo del Dolor/métodosRESUMEN
A man in his late 40s with no known past medical history was unresponsive for an unknown period of time. Crushed pills and white residue were found on a nearby table. On presentation he was obtunded and unresponsive to verbal commands but withdrawing to painful stimuli. The initial urine drug screen was negative, but a urine fentanyl screen was subsequently positive with a level of 137.3 ng/mL. MRI of the brain showed reduced diffusivity and fluid attenuated inversion recovery (FLAIR) hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum and globus pallidus. Alternative diagnoses such as infection were considered, but ultimately the history and workup led to a diagnosis of fentanyl-induced leukoencephalopathy. Three days after admission the patient became able to track, respond to voice and follow basic one-step commands. The patient does not recall the mechanism of inhalation. While there are case reports of heroin-induced leukoencephalopathy following inhaled heroin use and many routes of fentanyl, this is the first reported case of a similar phenomenon due to fentanyl inhalation.
Asunto(s)
Fentanilo , Leucoencefalopatías , Imagen por Resonancia Magnética , Humanos , Fentanilo/efectos adversos , Masculino , Leucoencefalopatías/inducido químicamente , Leucoencefalopatías/diagnóstico por imagen , Adulto , Administración por Inhalación , Analgésicos Opioides/efectos adversos , Encéfalo/diagnóstico por imagen , Encéfalo/efectos de los fármacosRESUMEN
INTRODUCTION: The aims of this study were to investigate the independent risk factors associated with iatrogenic withdrawal syndrome in pediatric intensive care units (PICUs) and to establish receiver operator characteristic (ROC) curve to facilitate the diagnosis of iatrogenic withdrawal syndrome in clinical settings. METHODS: Pediatric patients who received analgesic and sedative medication at a tertiary hospital in the southern Zhejiang region of China between January 2016 and December 2022 were selected for the study. Clinical case data were retrospectively analyzed to gather information including age, gender, weight, total dose of analgesic and sedative medication, total treatment duration, average maintenance dose, and other relevant parameters. Medically induced withdrawal symptom scores were assessed using the Sophia Observation Scale for Withdrawal Symptoms (SOS). Univariate and multivariate logistic regression analyses were conducted on the above indicators to identify the risk factors for iatrogenic withdrawal, and an ROC curve was constructed. RESULTS: The study encompassed a total of 104 pediatric patients, comprising 47 patients in the SOS score ≥4 group and 57 patients in the SOS score ≤3 group. The incidence of iatrogenic withdrawal was 45.19%. Univariate analysis identified cumulative total dose of fentanyl, average daily dose of fentanyl, average daily dose of midazolam, and patient weight (p < 0.05) as factors associated with iatrogenic withdrawal syndrome. The logistic multiple regression analysis revealed that the average daily dose of fentanyl was an independent risk factor for the occurrence of iatrogenic withdrawal syndrome in critically ill children (p < 0.05). ROC curve analysis indicated an area under the curve of 0.711 (95% CI: 0.610-0.811) with sensitivity and specificity of 73.7% and 61.7%, respectively. CONCLUSION: The average daily maintenance dose of fentanyl holds significant clinical value in diagnosing and evaluating the prognosis of iatrogenic withdrawal syndrome and can provide a scientific foundation for enhancing sedative and analgesic management in clinical practice.