Naloxone therapy for prescription and illicit opioid poisoning cases aged 50 + in the national poison data system, 2015-2020

CONTEXT

Older adults are less likely than younger adults to receive naloxone therapy. Given high rates of prescription opioid use/misuse and increasing illicit opioid use among older adults, factors associated with naloxone administration for older opioid poisoning cases need examination.

METHODS

We analyzed the 83,135 opioid-involved cases aged 50+ from the 2015-2020 National Poison Data System. Single-variable logistic regression was used to examine associations of naloxone administration with demographic factors, exposure site/reason, medical outcomes, management site/level of care, clinical effects, and other interventions. Multivariable logistic regression models were fit to examine associations of naloxone administration with different types of opioids.

RESULTS

Over the six years, the proportion of prescription opioid cases that received naloxone therapy increased steadily from 21.9% to 28.4%. The proportion of illicit opioid cases that received naloxone therapy was 51.9% in 2015 and 59.8% in 2020 with a high of 64.4% in 2019. In 2020, the death rate for illicit opioid cases without naloxone therapy was 31.4% compared to 2.3% for those with the therapy. Cases managed at healthcare facilities (HCF) had higher odds of receiving naloxone therapy. Among prescription opioid cases, naloxone therapy rates among older and female cases and those managed at non-HCF settings were especially low even for major medical outcomes. Cases involving oxycodone, morphine, methadone, prescription fentanyl, hydromorphone, oxymorphone, and other/unknown opioids had higher odds of naloxone administration.

DISCUSSION

Rates of naloxone therapy for older prescription opioid poisoning cases need improvement. While rates were higher among illicit opioid cases, the drop in 2020 and the sharp increase in deaths among illicit opioid cases without naloxone therapy confirm the importance of access to this life-saving intervention.

CONCLUSIONS

Increased naloxone co-prescribing and other means of facilitating access to naloxone are needed to prevent opioid poisoning deaths among older adults who use prescription opioids.

γ-Hydroxybutyrate (GHB) - Effects on Human Performance and Behavior

γ-Hydroxybutyrate (GHB) is a powerful central nervous system (CNS) depressant which has had a history of limited therapeutic use and, more recently, potential for abuse. GHB is a naturally occurring compound present in mammalian CNS and peripheral tissues, and a minor metabolite and precursor of γ-amino butyric acid. GHB is also an emerging recreational drug and has limited therapeutic potential. It is now a federally controlled substance. Since the substances γ-butyrolactone and 1,4-butanediol rapidly convert to GHB in vivo, they are abused as metabolic precursor drugs for GHB and are available in a wide variety of forms. GHB alters dopaminergic activity in the CNS, and its effects are primarily those of a CNS depressant. Following low doses, euphoria, relaxation, reduced inhibitions and sedation can be observed, while vomiting, sweating, severe respiratory depression, and unconsciousness are common with GHB intoxication. Tolerance to the effects of GHB develops with chronic use, and physical and psychological addiction can follow. This monograph reviews the chemistry of GHB and its precursor drugs, their reported medicinal and recreational uses, pharmacology, pharmacokinetics, metabolism, analytical methodology, and interpretation issues such as postmortem endogenous concentrations and specimen storage conditions. The manuscript concludes with a discussion of the effects GHB may have on human performance. Given the ability of GHB to induce sleep and unconsciousness, recreational use of GHB and its precursor drugs GBL and 1,4-butanediol has the potential of causing impairment in psychomotor and cognitive skills.