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Daly C, Griffin E, Corcoran P, Webb RT, Ashcroft DM, Perry IJ, Arensman E. A national case fatality study of drugs taken in intentional overdose. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102609. [PMID: 31884324 DOI: 10.1016/j.drugpo.2019.102609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intentional drug overdose (IDO) has been linked with marked increases in premature mortality risk due to suicide, accidents and other causes, yet little is known about how case fatality risk varies according to the type of drug/s taken. This study aimed to examine the incidence of IDO, to identify the predictors of fatal IDO and to establish which drugs are linked with greater risk of a fatal outcome. METHODS Data from the National Self-Harm Registry, and the National Drug-Related Deaths Index, 2007-2014, were used to calculate incidence, examine overdose characteristics and estimate case fatality risk ratios. RESULTS We examined 63,831 non-fatal and 364 fatal IDOs (incidence: 148.8 and 1.01 per 100,000 respectively). Compared to non-fatal IDOs, fatal cases were more often male (55.2% vs. 42.0%), older in age (median 44 vs. 35 years), and more frequently involved multiple drugs (78.3% vs. 48.5%). Tricyclic antidepressants were associated with a 15-fold increased risk of death and opioids a 12-fold increased risk, relative to the reference category (non-opioid analgesics). While the risk of fatal outcome was higher for males than females, the elevation in risk was greater in females when tricyclic antidepressants or opioids were taken. CONCLUSION Male gender, increasing age and multiple drug use were associated with fatal IDO outcome. Tricyclic antidepressants and opioids were associated with a significantly increased risk of death following intentional overdose. Clinicians need to consider the case fatality risk of drugs when determining treatment for patients at risk of or those who have previously harmed themselves.
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Affiliation(s)
- Caroline Daly
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland.
| | - Eve Griffin
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Roger T Webb
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom; Division of Psychology & Mental Health, Centre for Mental Health and Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom; Division of Pharmacy & Optometry, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Ivan J Perry
- School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation, Room 4.28, Western Gateway Building, Western Road, Cork, Ireland; School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland; Australian Institute for Suicide Research and Prevention, Room 1.48 Psychology Building (M24), Griffith University Messines Ridge Road, Mount Gravatt, Queensland 4122, Australia
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Brenes F, Henriquez F. Hispanics, Addictions, and the Opioid Epidemic: Brief Report. HISPANIC HEALTH CARE INTERNATIONAL 2019; 18:40-43. [PMID: 31747797 DOI: 10.1177/1540415319888437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Opioid addiction is a public health concern. Opioid overdose death rates account for one third to a half of all global substance-related deaths. Opioid mortality rates increased nearly fivefold in the United States between 1999 and 2016. Recent research has found health care disparities in the United States among minority populations with opioid use disorder, particularly Hispanics. Current literature also suggests that a number of social and cultural factors, including the stigma linked to mental illness and treatment in the Hispanic culture, may further negatively contribute to the problem. This brief report pays close attention to the opioid epidemic in the United States and addresses issues related to the crisis among Hispanics. Recommendations for clinical practice, research, and health care policy are also discussed.
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Marotta PL, Hunt T, Gilbert L, Wu E, Goddard-Eckrich D, El-Bassel N. Assessing Spatial Relationships between Prescription Drugs, Race, and Overdose in New York State from 2013 to 2015. J Psychoactive Drugs 2019; 51:360-370. [PMID: 31056042 PMCID: PMC6847245 DOI: 10.1080/02791072.2019.1599472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/08/2018] [Indexed: 10/26/2022]
Abstract
Over the last decade, New York State has experienced one of the greatest increases in opioid overdose deaths in the United States, particularly from heroin and synthetic opioids. This study investigated spatial patterns in the distribution of county-level rates of overdose deaths in New York State and associations between prescriptions for opioid pain relievers, race, and overdose deaths from 2013-2015. Global and local Moran's I tests for spatial autocorrelation examined Bayesian smoothed rates of overdose for clusters of counties with high and low rates of overdose mortality. Getis Ord* analyses identified local hotspots of high and low clusters of overdose. Model performance indicators selected the best-fitting spatial regression model to examine associations between prescriptions for opioid pain relievers, race/ethnicity (non-Hispanic White, Black, and Hispanic) after adjusting for spatial dependence in the data. Socio-demographic characteristics of clusters were examined. Findings suggest rates of opioid overdose deaths are clustered in New York. Rates of prescription opioids were associated with rates of overdose from any opioid, prescription pain relievers, and synthetic opioids. Greater populations of African Americans were associated with greater rates of heroin overdose death rates. Findings from this study inform public health opioid overdose prevention interventions and policies.
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Affiliation(s)
- Phillip L Marotta
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
| | - Tim Hunt
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
| | - Louisa Gilbert
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
| | - Elwin Wu
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
| | - Dawn Goddard-Eckrich
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University , New York , NY , USA
- Social Intervention Group, Columbia University , New York , NY , USA
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Hill R, Dewey WL, Kelly E, Henderson G. Oxycodone-induced tolerance to respiratory depression: reversal by ethanol, pregabalin and protein kinase C inhibition. Br J Pharmacol 2018; 175:2492-2503. [PMID: 29574756 PMCID: PMC5980627 DOI: 10.1111/bph.14219] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Oxycodone, a prescription opioid, is a major drug of abuse, especially in the USA, and contributes significantly to opioid overdose deaths each year. Overdose deaths result primarily from respiratory depression. We have studied respiratory depression by oxycodone and have characterized how tolerance develops on prolonged exposure to the drug. We have investigated the role of PKC in maintaining tolerance and have examined whether ethanol or pregabalin reverses oxycodone-induced tolerance. EXPERIMENTAL APPROACH Respiration was measured in male CD-1 mice by whole-body plethysmography. Mice were preinjected with oxycodone then implanted with mini-pumps (s.c.) delivering 20, 45 or 120 mg·kg-1 ·day-1 oxycodone for 6 days and subsequently challenged with oxycodone (3 mg·kg-1 , i.p.) or morphine (10 mg·kg-1 , i.p.) to assess the level of tolerance. KEY RESULTS Oxycodone-treated mice developed tolerance to oxycodone and cross tolerance to morphine-induced respiratory depression. Tolerance was less with 20 mg·kg-1 ·day-1 than with 45 or 120 mg·kg-1 ·day-1 oxycodone treatment. At doses that do not depress respiration, ethanol (0.3 g·kg-1 ), pregabalin (20 mg·kg-1 ) and calphostin C (45 μg·kg-1 ) all reversed oxycodone-induced tolerance resulting in significant respiratory depression. Reversal of tolerance was less in mice treated with oxycodone (120 mg·kg-1 ·day-1 ). In mice receiving ethanol and calphostin C or ethanol and pregabalin, there was no greater reversal of tolerance than seen with either drug alone. CONCLUSION AND IMPLICATIONS These data suggest that oxycodone-induced tolerance is mediated by PKC and that reversal of tolerance by ethanol or pregabalin may be a contributory factor in oxycodone overdose deaths.
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Affiliation(s)
- Rob Hill
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
| | - William L Dewey
- Department of Pharmacology and ToxicologyVirginia Commonwealth UniversityRichmondVA23298‐0613USA
| | - Eamonn Kelly
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
| | - Graeme Henderson
- School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolBS8 1TDUK
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Abstract
Drugs related to morphine represent not only large range of important therapeutic applications for the relief of moderate to severe pain but also give rise to a relatively large series of novel opioids that mimic the action of this naturally occurring analgesic. Most of these are based on fentanyl structures that are much more potent, and dangerous, than fentanyl itself. This publication reviews reports of fatalities attributed to 15 novel opioids with the view to assessing mortality associated with their misuse as well as reviewing published analytical procedures that would be able to detect these and other novel opioids. These drugs include reports of deaths to acetylfentanyl, acrylfentanyl, butr(yl)fentanyl, carfentanil, 2- and 4-fluorofentanyls, 4-fluorobutyrfentanyl, 4-fluoroisobutyrfentanyl, furanylfentanyl, α- and 3-methylfentanyls, 4-methoxyfentanyl, ocfentanil, as well as AH-7921, U-47700 and MT-45. Most of these cases reporting a drug-caused death involved other drugs in addition to the opioid. No obvious minimum fatal concentration was discerned for any of the opioids for which details were provided, however, the more potent members required detection limits well under 1 ng/mL and often even well below 0.1 ng/mL requiring use of the most sensitive mass spectral detection procedures, particularly when screening specimens using a non-targeted mode. Four other novel opioids have been reported in admissions to hospitals include 4-chloroisobutryfentanyl, cyclopentylfentanyl and tetrahydrofuranfentanyl, all of which are likely to have the potential to cause death. It is also likely that other analogues will appear with time.
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Affiliation(s)
- Olaf H. Drummer
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Southbank, Victoria, Australia
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Brown R, Riley MR, Ulrich L, Kraly EP, Jenkins P, Krupa NL, Gadomski A. Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity. Drug Alcohol Depend 2017; 178:348-354. [PMID: 28692945 DOI: 10.1016/j.drugalcdep.2017.05.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prescription Drug Monitoring programs (PDMPs) are intended to reduce opioid prescribing and aberrant drug-related behavior thereby reducing morbidity and mortality due to prescription opioid overdose. Expansion of the New York (NY) State's PDMP in 2013 included the institution of the I-STOP law that mandated clinicians to consult the statewide PDMP database to review the patient's prescription history prior to prescribing opioids. METHODS Trends in prescription opioid distribution, prescribing, and prescription opioid and heroin overdose morbidity in NY were analyzed using time series. A Chow test was used to test the difference in trends before and after the implementation of I-STOP. RESULTS The results indicated that: 1) the number of opioid prescriptions appears to be declining following the implementation of the I-STOP, 2) however, supply chain data shows that the total quantity of opioids in the supply chain increased, 3) statewide trends in inpatient and emergency department visits for prescription opioid overdose increased from 2010 to the third quarter of 2013 where the slope leveled off following I-STOP, but this change in slope was not significant, 4) visits for heroin overdose started escalating in 2010 and continued to increase through the second quarter of 2016. The overall significance of these findings show a small impact of PDMPs on prescription opioid overdose morbidity in NY in the context of the increasing national trend during this time period. CONCLUSIONS Prescription opioid morbidity leveled off following the implementation of a mandated PDMP although morbidity attributable to heroin overdose continued to rise.
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Affiliation(s)
- Richard Brown
- Bassett Healthcare Network, Psychiatry,1 Atwell Rd., Cooperstown, NY 13326, USA.
| | - Moira R Riley
- Bassett Healthcare Network, Research Institute,1 Atwell Rd., Cooperstown, NY 13326, USA,.
| | - Lydia Ulrich
- Colgate University, Upstate Institute, 13 Oak Dr., Hamilton, NY 13346, USA
| | - Ellen Percy Kraly
- Colgate University, Geography and Environmental Studies, 13 Oak Dr., Hamilton, NY 13346, USA.
| | - Paul Jenkins
- Bassett Healthcare Network, Research Institute,1 Atwell Rd., Cooperstown, NY 13326, USA,.
| | - Nicole L Krupa
- Bassett Healthcare Network, Research Institute,1 Atwell Rd., Cooperstown, NY 13326, USA,.
| | - Anne Gadomski
- Bassett Healthcare Network, Research Institute,1 Atwell Rd., Cooperstown, NY 13326, USA,.
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Altaeva AZ, Galitskiy FA, Zhakupova TZ, Aidarkulov AS, Selivokhina NV, Zhunisov SS. [The morphofunctional features of the heart associated with acute morphine poisoning during the period of chronic drug intoxication]. Sud Med Ekspert 2016; 59:12-15. [PMID: 27239765 DOI: 10.17116/sudmed201659312-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to improve forensic medical diagnostics of the cases of death associated with morphine poisoning based on the investigation into the biochemical changes in blood and pericardial fluid as well as morphological changes in the myocardial structures. The studies were carried out with the use of thin-layer chromatography, colorimetric and morphological methods including hematoxylin and eosin, Lee's methylene blue, and van Gieson's picrofuscin staining. These techniques were supplemented by light and polarization microscopy. The study has demonstrated the presence of morphine in 99.16% of the blood and pericardial samples obtained in the cases of poisoning. The comparison of the results of biochemical and pathomorphological studies of the myocardium made it possible to evaluate the functional and morphological conditions of the heart in the case of acute morphine poisoning during the period of chronic drug intoxication.
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Affiliation(s)
- A Zh Altaeva
- Centre of Forensic Medicine, Kazakh Ministry of Justice, Almaty, Republic of Kazakhstan, 050000
| | - F A Galitskiy
- Astana Medical University, Kazakh Ministry of Health, Astana, Republic of Kazakhstan, 010000
| | - T Z Zhakupova
- Astana Medical University, Kazakh Ministry of Health, Astana, Republic of Kazakhstan, 010000
| | - A Sh Aidarkulov
- Centre of Forensic Medicine, Kazakh Ministry of Justice, Almaty, Republic of Kazakhstan, 050000
| | - N V Selivokhina
- Centre of Forensic Medicine, Kazakh Ministry of Justice, Almaty, Republic of Kazakhstan, 050000
| | - S S Zhunisov
- Centre of Forensic Medicine, Kazakh Ministry of Justice, Almaty, Republic of Kazakhstan, 050000
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Reducing Problematic Benzodiazepine Use Among Individuals Enrolled in Methadone Treatment Programs. J Addict Med 2016; 10:202-7. [DOI: 10.1097/adm.0000000000000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gill JR, Vincent GA, Toriello A, Nelson LS. An Underestimation of Heroin Deaths Due to the Use of "Acute Opiate Intoxication" on Death Certificates. Acad Forensic Pathol 2016; 6:114-121. [PMID: 31239879 PMCID: PMC6474517 DOI: 10.23907/2016.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/05/2016] [Accepted: 02/12/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Deaths due to drug intoxications in the United States have increased. Public health agencies track the specific intoxicants using death certificate data in order to develop and focus prevention strategies. Criteria used to decide what deaths need toxicological investigation and how these deaths are certified will affect this data. METHODS We retrospectively reviewed the investigative, autopsy, and toxicology reports of 118 fatal intoxications that were certified as "acute opiate intoxication." RESULTS Of the 113 decedents in whom morphine was detected, 84 were determined to involve heroin. For 61 of 84 heroin deaths, the heroin diagnosis was based upon the detection of diacetylmorphine, 6-acetylmorphine, and/or a lower blood codeine to morphine concentration. For 23 of 84 deaths, the determination was based upon morphine detection and illicit substances and/or paraphernalia at the scene. Of the 61 of 84 heroin deaths diagnosed by direct toxicology results, 33 of the 61 (54%) did not have illicit substances or paraphernalia at the scene. Toxicology identified 33 of 84 (39%) heroin fatalities that would not have been distinguished from morphine intoxication by the scene investigation. CONCLUSIONS The majority of deaths due to opioids can be further classified based upon the toxicological analysis and scene investigation. As heroin deaths may have no illicit substances/paraphernalia at the scene, investigators should not solely base their decision to perform an autopsy/toxicology on the scene absence of illicit drugs/paraphernalia. In our study sample, if toxicology testing were to be only performed when illicit substances/paraphernalia were found at the scene, a high portion of heroin deaths (39%) would have been missed.
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