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Sheehan J, Reynolds A, O'Donnell MM, O'Donohoe R, Tubridy N. Reversible amnesia following opiate overdose: CHANTER syndrome. Pract Neurol 2023; 23:350-351. [PMID: 37068933 DOI: 10.1136/pn-2023-003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Julie Sheehan
- General Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Audrey Reynolds
- General Medicine, St Vincent's University Hospital, Dublin, Ireland
| | | | - Rory O'Donohoe
- General Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Tubridy
- Neurology, St Vincent's University Hospital, Dublin, Ireland
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Application of an Existing Syndromic Surveillance System to Quantify Possible Cases of Opioid-associated Amnestic Syndrome in Massachusetts. J Addict Med 2022; 16:684-688. [PMID: 35678426 DOI: 10.1097/adm.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In recent years, an opioid-associated amnestic syndrome (OAS) was identified in Massachusetts through elicited reporting by health care providers (traditional surveillance, TS). Whether OAS occurs more frequently and with a wider spatiotemporal distribution in Massachusetts remains unclear. We compared the frequency and spatiotemporal characteristics of emergency department (ED) visits for possible OAS (pOAS) using a pre-existing syndromic surveillance system (SyS) with OAS cases captured through TS. METHODS SyS was queried for Massachusetts ED visits in 15- to 55-year-olds with a chief complaint text and discharge codes for memory loss in association with codes for opioid use (pOAS). SyS data were extracted for 2016-2020, whereas TS was conducted for 2012-2018. Cases identified by SyS and TS were stratified by demographic and spatiotemporal variables. RESULTS TS ascertained 22 reported cases of OAS (18 males) between 2012 and 2018, ranging from 0 to 5 annually. No identified OAS patients presented between January and March or in western Massachusetts. Between 2016 and 2020, SyS identified 82 ED visits (49 males) with pOAS, ranging from 13 to 22 per year. Over the 5-year period, at least 2 ED visits for pOAS occurred during each month of the year (24 total during January, February, or March) and at least 1 visit occurred in each county except 2, with the second largest number (11) in Berkshire County (at the western border of Massachusetts), where no cases were ascertained through TS. CONCLUSIONS Although OAS is a relatively rare condition, use of SyS in Massachusetts suggests a broader and more frequent spatiotemporal distribution than previously indicated from TS.
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Winstanley EL, Mahoney JJ, Castillo F, Comer SD. Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review. Drug Alcohol Depend 2021; 226:108838. [PMID: 34271512 PMCID: PMC8889511 DOI: 10.1016/j.drugalcdep.2021.108838] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-fatal opioid-related overdoses have increased significantly over the past two decades and there have been increasing reports of brain injuries and/or neurocognitive impairments following overdose events. Limited preclinical research suggests that opioid overdoses may cause brain injury; however, little is known about such injuries in humans. The purpose this systematic review is to summarize existing studies on neurocognitive impairments and/or brain abnormalities associated with an opioid-related overdose in humans. METHODS PubMed, Web of Science, Ovid MEDLINE and PsyINFO were searched, without year restrictions, and identified 3099 articles. An additional 24 articles were identified by reviewing references. Articles were included if they were published in English, reported study findings in humans, included individuals 18 years of age or older, and reported an objective measure of neurocognitive impairments and/or brain abnormalities resulting from an opioid-related overdose. Six domains of bias (selection, performance, attrition, detection (two dimensions) and reporting were evaluated and themes were summarized. RESULTS Seventy-nine journal articles, published between 1973-2020, were included in the review. More than half of the articles were case reports (n = 44) and there were 11 cohort studies, 18 case series, and 6 case-control studies. All of the studies were categorized as at-risk of bias, few controlled for confounding factors, and methodological differences made direct comparisons difficult. Less than half of the studies reported toxicology results confirming an opioid-related overdose; 64.6 % reported brain MRI results and 27.8 % reported results of neuropsychological testing. Only two studies had within subject comparative data to document changes in the brain possibly associated with an overdose. Despite these limitations, existing publications suggest that brain injuries and neurocognitive impairments are associated with opioid overdose. Additional research is needed to establish the incidence of overdose-related brain injuries and the potential impact on functioning, as well as engagement in treatment of substance use disorders. CONCLUSIONS Respiratory depression is a defining characteristic of opioid overdose and prolonged cerebral hypoxia may cause brain injuries and/or neurocognitive impairments. The onset, characteristics, and duration of such injuries is variable and additional research is needed to understand their clinical implications.
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Affiliation(s)
- Erin L. Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Department of Neuroscience, West Virginia University, Morgantown, WV, USA,Corresponding author at: West Virginia University, School of Medicine, Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, USA. (E.L. Winstanley)
| | - James J. Mahoney
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Department of Neuroscience, West Virginia University, Morgantown, WV, USA
| | - Felipe Castillo
- Columbia University, Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
| | - Sandra D. Comer
- Columbia University, Department of Psychiatry and New York State Psychiatric Institute, New York, NY, USA
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Zibbell JE, Peiper NC, Duhart Clarke SE, Salazar ZR, Vincent LB, Kral AH, Feinberg J. Consumer discernment of fentanyl in illicit opioids confirmed by fentanyl test strips: Lessons from a syringe services program in North Carolina. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 93:103128. [PMID: 33487527 DOI: 10.1016/j.drugpo.2021.103128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The United States (U.S.) continues to witness an unprecedented increase in opioid overdose deaths driven by precipitous growth in the supply and use of illicitly-manufactured fentanyls (IMF). Fentanyl's growing market share of the illicit opioid supply in the U.S. has led to seismic shifts in the composition of the country's heroin supply. The growth in fentanyl supply has transformed illicit opioid markets once offering heroin with fairly consistent purity and potency to a supply overpopulated with fentanyl(s) of inconsistent and unpredictable potency. In response, people who inject drugs (PWID) have developed a number of sensory strategies to detect fentanyl in illicit opioids. The current study examined the accuracy of sensory discernment strategies by measuring study participants' descriptions of the last opioid injected and checked with a fentanyl test strip (FTS) by that test's positive/negative result. The primary objective was to determine associations between FTS results and descriptions of the illicit opioid's physical appearance and physiological effects. METHODS Between September-October 2017, a total of 129 PWID were recruited from a syringe services program in Greensboro, North Carolina and completed an online survey about their most recent use of FTS. Participants were instructed to describe the appearance and effects associated with the most recent opioid they injected and tested with FTS. We conducted bivariate and multivariate analyses to determine differences in positive vs negative FTS results and the physical characteristics and physiological experiences reported. An exploratory analysis was also conducted to describe the types and bodily locations of unusual sensations experienced by PWID reporting positive FTS results. RESULTS For physical characteristics, 32% reported that the drug was white before adding water and 38% reported the solution was clear after adding water. For physiological effects compared to heroin, 42% reported a stronger rush, 30% a shorter high, 30% a shorter time to the onset of withdrawal symptoms, and 42% experienced unusual sensations. In the multivariable model adjusting for demographics and polydrug correlates, white color of drug before adding water, stronger rush, shorter time to withdrawal, and unusual sensations were significantly associated with a positive FTS result. The most common unusual sensations were pins and needles (51%), warming of the head and face (35%), and lightheadedness (30%), and the most common locations where sensations occurred were face and neck (61%), arms/legs (54%), and chest (37%). CONCLUSION We found positive FTS results were significantly associated with the physical characteristics and physiological effects described by PWID. Descriptions concerning physical appearance were consistent with law enforcement profiles of illicitly-manufactured fentanyl and physiological effects were concomitant with scientific and clinical medical literature on iatrogenic fentanyl use. Taken together, these findings suggest sensory strategies for detecting fentanyl in illicit opioids may be an effective risk reduction tool to help consumers navigate unpredictable markets more safely.
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Affiliation(s)
- Jon E Zibbell
- Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, RTI International, Research Triangle Park, NC, United States.
| | - Nicholas C Peiper
- Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Sarah E Duhart Clarke
- Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, RTI International, Research Triangle Park, NC, United States
| | - Zach R Salazar
- North Carolina Survivors Union, Greensboro, NC, United States
| | | | - Alex H Kral
- Center for Behavioral Health Epidemiology, Implementation, and Evaluation Research, RTI International, Research Triangle Park, NC, United States
| | - Judith Feinberg
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, United States
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Assessing Memory Loss in a Young Adult with Substance Use Disorder: Remember the Timing of Presentation. Harv Rev Psychiatry 2021; 29:246-250. [PMID: 32925309 DOI: 10.1097/hrp.0000000000000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barash JA, Whitledge J, Watson CJ, Boyle K, Lim C, Lev MH, DeMaria A, Ganetsky M. Opioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definition. J Neurol Sci 2020; 417:117048. [PMID: 32739497 DOI: 10.1016/j.jns.2020.117048] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE An opioid-associated amnestic syndrome (OAS) characterized by acute onset memory loss and bilateral hippocampal signal abnormalities on brain imaging in the setting of a history of opioid use, most notably fentanyl, has been reported. To date, however, there is no case definition to assist neurologists and other clinicians in identifying this syndrome. A multi-disciplinary collaboration of physicians, including neurologists, propose diagnostic criteria for OAS using cases that have been published in the medical literature or presented at conferences. METHODS Cases were classified as confirmed, probable, or possible based on brain imaging findings and history or analytical testing supporting opioid use. Published articles and presentations were identified by discussion with public health authorities and a systematic search of PubMed. Included were articles, abstracts or posters through November 2019 that presented case reports or case series of a new-onset amnestic syndrome associated with bilateral hippocampal injury on imaging and/or prior opioid or other substance use. The percentages of cases that would meet confirmed, probable, or possible criteria were calculated. RESULTS Twenty-three publications from all sources met criteria for inclusion, accounting for 40 unique cases. Based on the case definition of OAS, 50% (20/40) were confirmed, 25% (10/40) were probable and 25% (10/40) were possible. CONCLUSION The development of a validated, formal case definition for OAS can assist neurologists and other clinicians in evaluating patients with amnesia and a history of opioid use.
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Affiliation(s)
- Jed A Barash
- Department of Medicine, Soldiers' Home, Chelsea, MA, USA.
| | - James Whitledge
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - C James Watson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Katherine Boyle
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Chun Lim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alfred DeMaria
- Massachusetts Department of Public Health, Jamaica, Plain, MA, USA
| | - Michael Ganetsky
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Hong JS, Moran MT, Eaton LA, Grafton LM. Neurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00247-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Butler PM, Barash JA, Casaletto KB, Cotter DL, Joie RL, Geschwind MD, Rosen HJ, Kramer JH, Miller BL. An Opioid-Related Amnestic Syndrome With Persistent Effects on Hippocampal Structure and Function. J Neuropsychiatry Clin Neurosci 2019; 31:392-396. [PMID: 31177905 PMCID: PMC7469957 DOI: 10.1176/appi.neuropsych.19010017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P. Monroe Butler
- The Department of Neurology, University of California at San Francisco
| | - Jed A. Barash
- The Department of Neurology, University of California at San Francisco and Soldiers’ Home, Chelsea, Mass
| | | | - Devyn L. Cotter
- The Department of Neurology, University of California at San Francisco
| | - Renaud La Joie
- The Department of Neurology, University of California at San Francisco
| | | | - Howie J. Rosen
- The Department of Neurology, University of California at San Francisco
| | - Joel H. Kramer
- The Department of Neurology, University of California at San Francisco
| | - Bruce L. Miller
- The Department of Neurology, University of California at San Francisco
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Davies T. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662. [PMID: 30398630 DOI: 10.7326/l18-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Todd Davies
- Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia (T.D.)
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Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662-663. [PMID: 30398631 PMCID: PMC6464382 DOI: 10.7326/l18-0411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Uzoma B Duru
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Gauri Pawar
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | | | - Liv E Miller
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Indrani K Thiruselvam
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
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Abstract
Acute hippocampal injury represents a relatively rare cause of amnesia. Interestingly however, between 2012 and 2017, 18 patients were reported at hospitals in Massachusetts with sudden-onset amnesia in the setting of complete diffusion-weighted hyperintensity of both hippocampi on magnetic resonance imaging. Notably, 17 of the 18 patients tested positive for opioids or had a recorded history of opioid use. This observation suggests an association between opioids and acute hippocampal injury. With particular attention to the Massachusetts cluster and data on fentanyl and its congeners, the epidemiological and pathophysiological evidence that supports this hypothesis is presented, as are potential underlying mechanisms.
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Affiliation(s)
- Jed A Barash
- a Department of Medicine , Quigley Memorial Hospital, Soldiers' Home , Chelsea , MA , USA
| | - W Andrew Kofke
- b Department of Anesthesiology and Critical Care , University of Pennsylvania School of Medicine , Philadelphia , PA , USA
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12
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Barash JA, Ganetsky M, Boyle KL, Raman V, Toce MS, Kaplan S, Lev MH, Worth JL, DeMaria A. Acute Amnestic Syndrome Associated with Fentanyl Overdose. N Engl J Med 2018; 378:1157-1158. [PMID: 29562161 DOI: 10.1056/nejmc1716355] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Vinod Raman
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | - Alfred DeMaria
- Massachusetts Department of Public Health, Jamaica Plain, MA
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