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Darke S, Duflou J, Peacock A, Farrell M, Lappin J. Differences in heroin overdose deaths in Australia by age, 2020-2022: Disease and estimated survival times. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100217. [PMID: 38332901 PMCID: PMC10850106 DOI: 10.1016/j.dadr.2024.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Background The age of people who use illicit opioids has increased, with a clinical picture of accelerated ageing. The study aimed to determine, stratified by age: 1. The circumstances and characteristics of heroin-related toxicity deaths in Australia, 2020-2022; 2. The toxicological profile and autopsy findings; 3. The proportion of cases in which blood 6-acetyl morphine (6AM) was detected, as a measure of survival time. Methods Retrospective study of 610 cases of fatal heroin-related drug toxicity in Australia, 2020-2022. Cases were stratified as: <30 years, 30-39 years, 40-49 years, ≥50 years. Results Compared to the youngest group, those aged ≥50 years were more likely to have a history of chronic pain (12.4 v 3.3 %), to have their death attributed to combined drug toxicity/disease (20.1 v 3.3 %), and to have evidence of a sudden collapse (21.3 v 11.1 %). There were no differences in free morphine concentrations or glucuronide concentrations. Compared to the youngest group, however, the two older groups were significantly more likely to have 6AM present in blood, a proxy measure of a shorter survival time (52.0, 55.2 v 34.5 %). Compared to the youngest group, cases aged ≥50 years were more likely to be diagnosed with cardiomegaly (44.0 v 16.7 %), coronary artery disease (46.0 v 15.0 %), emphysema (35.0 v 5.1 %), hepatic steatosis (15.4 v 3.4 %), hepatic fibrosis (17.6 v 3.4 %), and cirrhosis (19.8 v 0.0 %). Conclusions Older cases of heroin overdose had more extensive heart, lung, and liver disease, and appeared more likely to have shorter survival times.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
| | - Johan Duflou
- National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Amy Peacock
- National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
- School of Psychiatry, University of New South Wales, NSW, Australia
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Zolopa C, Høj SB, Minoyan N, Bruneau J, Makarenko I, Larney S. Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map. Addiction 2022; 117:2168-2188. [PMID: 35072313 PMCID: PMC9544522 DOI: 10.1111/add.15813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
AIMS To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated. METHODS We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area. RESULTS Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15). CONCLUSIONS The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.
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Affiliation(s)
- Camille Zolopa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Stine B Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Social and Preventative Medicine, School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Iuliia Makarenko
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - Sarah Larney
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montréal, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
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Tas B, Kalk NJ, Lozano-García M, Rafferty GF, Cho P, Kelleher M, Moxham J, Strang J, Jolley CJ. Undetected Respiratory Depression in People with Opioid Use Disorder. Drug Alcohol Depend 2022; 234:109401. [PMID: 35306391 DOI: 10.1016/j.drugalcdep.2022.109401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Opioid-related deaths are increasing globally. Respiratory complications of opioid use and underlying respiratory disease in people with Opioid Use Disorder (OUD) are potential contributory factors. Individual variation in susceptibility to overdose is, however, incompletely understood. This study investigated the prevalence of respiratory depression (RD) in OUD treatment and compared this to patients with chronic obstructive pulmonary disease (COPD) of equivalent severity. We also explored the contribution of opioid agonist treatment (OAT) dosage, and type, to the prevalence of RD. METHODS There were four groups of participants: 1) OUD plus COPD ('OUD-COPD', n = 13); 2) OUD without COPD ('OUD', n = 7); 3) opioid-naïve COPD patients ('COPD'n = 13); 4) healthy controls ('HC'n = 7). Physiological indices, including pulse oximetry (SpO2%), end-tidal CO2 (ETCO2), transcutaneous CO2 (TcCO2), respiratory airflow and second intercostal space parasternal muscle electromyography (EMGpara), were recorded continuously over 40 min whilst awake at rest. Significant RD was defined as: SpO2%< 90% for > 10 s, ETCO2 per breath > 6.6 kPa, TcCO2 overall mean > 6 kPa, respiratory pauses > 10 s RESULTS: At least one indicator was observed in every participant with OUD (n = 20). This compared to RD episode occurrence in only 2/7 HC and 2/13 COPD participants (p < 0.05,Fisher's exact test). The occurrence of RD was similar in OUD participants prescribed methadone (n = 6) compared to those prescribed buprenorphine (n = 12). CONCLUSIONS Undetected RD is common in OUD cohorts receiving OAT and is significantly more severe than in opioid-naïve controls. RD can be assessed using simple objective measures. Further studies are required to determine the association between RD and overdose risk.
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Affiliation(s)
- B Tas
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK.
| | - N J Kalk
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - M Lozano-García
- Biomedical Signal Processing and Interpretation group, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST) & Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) & Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Barcelona, Spain
| | - G F Rafferty
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - Psp Cho
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, King's Health Partners, London SE5 9RS, UK
| | - M Kelleher
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - J Moxham
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
| | - J Strang
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK; South London & Maudsley NHS Foundation Trust, SE5 8AZ, UK
| | - C J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College, London SE1 1UL, UK
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Sunshine MD, Fuller DD. Automated Classification of Whole Body Plethysmography Waveforms to Quantify Breathing Patterns. Front Physiol 2021; 12:690265. [PMID: 34489719 PMCID: PMC8417563 DOI: 10.3389/fphys.2021.690265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022] Open
Abstract
Whole body plethysmography (WBP) monitors respiratory rate and depth but conventional analysis fails to capture the diversity of waveforms. Our first purpose was to develop a waveform cluster analysis method for quantifying dynamic changes in respiratory waveforms. WBP data, from adult Sprague-Dawley rats, were sorted into time domains and principle component analysis was used for hierarchical clustering. The clustering method effectively sorted waveforms into categories including sniffing, tidal breaths of varying duration, and augmented breaths (sighs). We next used this clustering method to quantify breathing after opioid (fentanyl) overdose and treatment with ampakine CX1942, an allosteric modulator of AMPA receptors. Fentanyl caused the expected decrease in breathing, but our cluster analysis revealed changes in the temporal appearance of inspiratory efforts. Ampakine CX1942 treatment shifted respiratory waveforms toward baseline values. We conclude that this method allows for rapid assessment of breathing patterns across extended data recordings. Expanding analyses to include larger portions of recorded WBP data may provide insight on how breathing is affected by disease or therapy.
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Affiliation(s)
- Michael D Sunshine
- Rehabilitation Science Ph.D. Program, University of Florida, Gainesville, FL, United States.,Department of Physical Therapy, University of Florida, Gainesville, FL, United States.,Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States.,McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States.,Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, United States.,McKnight Brain Institute, University of Florida, Gainesville, FL, United States
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