Incidence Of Overdose Research Articles

Bridging the gap: An environmental scan of post-overdose program features and evaluation measures.

Prior overdose incident is a predictor of future non-fatal and fatal overdoses. Therefore, the period immediately following a non-fatal overdose is critical for engaging with survivors; however, they often do not access or receive services immediately after experiencing an overdose. To efficiently reach this high-risk population and provide survivors with services, novel interventions including post-overdose outreach programs have been developed. Using PRISMA guidelines, we conducted an environmental scan of the academic and gray literature on post-overdose programs to identify key features and measures used to evaluate post-overdose programs. Using the Donabedian quality framework we then analyzed the frequency of measures by type of initiating stakeholder. Of the 36 studies included for final extraction, 14 were descriptive studies, ten were evaluation studies, eight studies identified facilitators and barriers, and four were program design toolkits. Initiator entity types included emergency departments (EDs; n = 10), public health agencies (n = 5), community-based organizations (n = 4), emergency medical services (EMS) (n = 4), law enforcement agencies (n = 4), and some combination or unknown (n = 9). We identified six key features of post-overdose programs across the literature: program theory, team composition, identifying and contacting clients, service provision, public private partnerships, and referrals. We extracted 223 operationalized measures, of which we analyzed 173 and categorized them as client experience (n = 2), structural (n = 12), process (n = 69), and outcome measures (n = 90). Public health agency-initiated programs reported all the experience-related measures (n = 2) and the most outcome measures (n = 23). Programs initiated by EDs reported the most process measures (n = 20), whereas community-based agencies reported the most structural measures (n = 12). Only two of the 223 measures related to stigma. There are six common features across all post-overdose programs and different initiating organization types had differing foci for their evaluation measures. The key features and evaluation measure clusters identified in this environmental scan can help inform future post-overdose programs assess the comprehensiveness of their evaluations, inform funding agencies on the range of existing measures (and gaps) to consider, and support evaluators in study design.

The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis.

This study aimed to estimate the strength of association between prescriptions of glucose-dependent insulinotropic polypeptide (GIP) and/or glucagon-like peptide-1 receptor agonists (GLP-1 RA) and the incidence of opioid overdose and alcohol intoxication in patients with opioid use disorder (OUD) and alcohol use disorder (AUD), respectively. This study also aimed to compare the strength of the GIP/GLP-1 RA and substance use-outcome association among patients with comorbid type 2 diabetes and obesity. A retrospective cohort study analyzing de-identified electronic health record data from the Oracle Cerner Real-World Data. About 136 United States of America health systems, covering over 100 million patients, spanning January 2014 to September 2022. The study included 503 747 patients with a history of OUD and 817 309 patients with a history of AUD, aged 18 years or older. The exposure indicated the presence (one or more) or absence of GIP/GLP-1 RA prescriptions. The outcomes were the incidence rates of opioid overdose in the OUD cohort and alcohol intoxication in the AUD cohort. Potential confounders included comorbidities and demographic factors. Patients with GIP/GLP-1 RA prescriptions demonstrated statistically significantly lower rates of opioid overdose [adjusted incidence rate ratio (aIRR) in OUD patients: 0.60; 95% confidence interval (CI) = 0.43-0.83] and alcohol intoxication (aIRR in AUD patients: 0.50; 95% CI = 0.40-0.63) compared to those without such prescriptions. When stratified by comorbid conditions, the rate of incident opioid overdose and alcohol intoxication remained similarly protective for those prescribed GIP/GLP-1 RA among patients with OUD and AUD. Prescriptions of glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonists appear to be associated with lower rates of opioid overdose and alcohol intoxication in patients with opioid use disorder and alcohol use disorder. The protective effects are consistent across various subgroups, including patients with comorbid type 2 diabetes and obesity.

Risk Factors and Pharmacist Intervention to Reduce the Incidence of Overdose of Etoricoxib Drug in Outpatient Polyclinic

Risk Factors and Pharmacist Intervention to Reduce the Incidence of Overdose of Etoricoxib Drug in Outpatient Polyclinic

Risk and protective factors associated with posttraumatic stress disorder among layperson responders to opioid overdose incidents.

Fatal and nonfatal overdoses involving opioids have increased to crisis levels in recent years. Laypersons have been increasingly tasked with responding to these events by administering naloxone, performing rescue breaths/cardiopulmonary resuscitation, and calling for medical assistance. However, little is known about the development of posttraumatic stress disorder (PTSD) related to opioid overdose responding among laypersons. To this end, we sought to determine the factors associated with PTSD stemming from responding to an opioid overdose event. From April 2021 to October 2021, structured interviews were conducted with layperson responders who had responded to an opioid overdose. Participants were administered structured diagnostic interviews, Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and completed validated self-report measures. In total, 101 layperson adults who responded to an opioid overdose were recruited for the present study (Mage: 34, 65% identified as women, 79% as White, and 11% as Hispanic/Latino). Of the 80 participants who completed the Clinician-Administered PTSD Scale for DSM-5, 100% met Criteria A for PTSD related to overdose responding, and over one quarter (27.5%) met current PTSD diagnosis criteria related to overdose responding. Current PTSD related to overdose responding was associated with depression symptoms, generalized anxiety symptoms, and presence of law enforcement or professional first responders during the most distressing overdose responding event. Responding to opioid overdoses is traumatizing for many and results in a considerable burden of PTSD among layperson responders. As such, we call for trauma-informed interventions that cater to the unique experiences of layperson opioid overdose responders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Risk and Protective Factors Associated With Posttraumatic Stress Disorder Among Layperson Responders to Opioid Overdose Incidents

Supplemental Material for Risk and Protective Factors Associated With Posttraumatic Stress Disorder Among Layperson Responders to Opioid Overdose Incidents

Proof of Concept for High-Dose Cannabidiol Pretreatment to Antagonize Opioid Induced Persistent Apnea.

Using a mouse equivalent of FDA-approved cannabidiol (CBD) dosing, we found high dose CBD affects opioid induced persistent apnea (OIPA), the principal cause of opioid related fatalities. CBD pretreatment mitigated respiratory depression from fentanyl in awake mice and significantly delayed OIPA onset in anesthetized mice, effective as the opioid antagonist naloxone. The powerful effect of CBD pretreatment on OIPA suggests a novel therapeutic strategy to reduce fatal opioid overdose incidence.

Medications for Opioid Use Disorder after Entering Residential Treatment: Evidence from Louisiana Medicaid.

Policies have attempted to increase the use of medication for opioid use disorder (MOUD) during an admission to a residential treatment program, but little is known about the association of residential admission with subsequent MOUD use. In a cohort study of Louisiana Medicaid beneficiaries age 18-64 with diagnosed opioid use disorder (OUD), weekly MOUD use and overdose for 20 weeks before and after an admission to residential treatment was analyzed using comparative interrupted time series regression. Participants with residential treatment admission between January 1, 2018, and December 31, 2020 (N = 12,222) were compared against a demographically similar group of people with OUD without residential treatment during the study period. The samples with residential treatment were largely male (61.9%), White (47.2%), and aged 30 to 39 years (41.4%). At baseline, people admitted to residential treatment were much less likely to use MOUD than the comparison group (4.2% lower, CI: 3.8%, 4.5%, P < 0.01). After admission, use of any MOUD initially increased by 3.1% (P < 0.01) relative to the comparison group, which reverted to the counterfactual trend by 20 weeks. Post-admission MOUD use differed widely by medication. Overdose incidence was highest in the weeks right before admission, but otherwise, it did not change during the study period. Admission to residential treatment for OUD was associated with a temporary increase in MOUD use. Policy initiatives should focus on both boosting use of MOUD during residential treatment and sustaining access to MOUD in outpatient care in the weeks following discharge.

An individual-based dynamic model to assess interventions to mitigate opioid overdose risk

BackgroundIllicit opioid overdose continues to rise in North America and is a leading cause of death. Mathematical modeling is a valuable tool to investigate the epidemiology of this public health issue, as it can characterize key features of population outcomes and quantify the broader effect of structural and interventional changes on overdose mortality. The aim of this study is to quantify and predict the impact of key harm reduction strategies at differing levels of scale-up on fatal and nonfatal overdose among a population of people engaging in unregulated opioid use in Toronto.MethodsAn individual-based model for opioid overdose was built featuring demographic and behavioural variation among members of the population. Key individual attributes known to scale the risk of fatal and nonfatal overdose were identified and incorporated into a dynamic modeling framework, wherein every member of the simulated population encompasses a set of distinct characteristics that govern demographics, intervention usage, and overdose incidence. The model was parametrized to fatal and nonfatal overdose events reported in Toronto in 2019. The interventions considered were opioid agonist therapy (OAT), supervised consumption sites (SCS), take-home naloxone (THN), drug-checking, and reducing fentanyl in the drug supply. Harm reduction scenarios were explored relative to a baseline model to examine the impact of each intervention being scaled from 0% use to 100% use on overdose events.ResultsModel simulations resulted in 3690.6 nonfatal and 295.4 fatal overdoses, coinciding with 2019 data from Toronto. From this baseline, at full scale-up, 290 deaths were averted by THN, 248 from eliminating fentanyl from the drug supply, 124 from SCS use, 173 from OAT, and 100 by drug-checking services. Drug-checking and reducing fentanyl in the drug supply were the only harm reduction strategies that reduced the number of nonfatal overdoses.ConclusionsWithin a multi-faceted harm reduction approach, scaling up take-home naloxone, and reducing fentanyl in the drug supply led to the largest reduction in opioid overdose fatality in Toronto. Detailed model simulation studies provide an additional tool to assess and inform public health policy on harm reduction.

Compared the Effectiveness of Intraperitoneal Bupivacaine with Lung Recruitment Maneuver Versus Normal Saline with Lung Recruitment Maneuver in Reducing Shoulder Pain After Laparoscopic Surgery: A Double-Blind Randomized Controlled Trial.

Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain. The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery. The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05. The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups. The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain.

Trends in and characteristics of drug overdose morbidity among pregnant and postpartum individuals in California, 2010-2018.

Fatal drug overdoses among pregnant and postpartum individuals have risen dramatically over the past 10 years. Trends in and characteristics of nonfatal drug overdoses in this population, however, remain unknown, despite the importance of this outcome for maternal and infant health. We used statewide, longitudinally-linked hospital and emergency department administrative claims data from California to characterize the incidence, trends, drug type involvement, and sociodemographic disparities in pregnancy-associated drug overdose between 2010 and 2019. Generalized linear models accounting for multiple deliveries per individual were used to test for trends; descriptive statistics were used for other study analyses. Of California individuals with a live delivery between 2010 and 2018, approximately 0.2% had a pregnancy-associated drug overdose. Nonfatal overdoses were nearly 60 times more common than fatal overdoses. Incidence of overdoses involving stimulants increased in frequency, while incidence of overdoses involving sedative/hypnotic drugs and psychotropic medications decreased in frequency. Risk of overdose was substantially higher among delivering individuals who were young, non-Hispanic Black, Medicaid patients, or who lived in non-metropolitan areas. Ongoing public health surveillance of and clinical interventions to reduce pregnancy-associated nonfatal drug overdose events are critical for prevention efforts.

A Framework for Developing and Assessing Custom Case Definitions: A Demonstration Applied to Opioid Overdose in Maryland.

Public health epidemiologists monitor data sources for disease outbreaks and other events of public health concern, but manual review of records to identify cases of interest is slow and labor-intensive and may not reflect evolving data practices. To automatically identify cases from electronic data sources, epidemiologists must use "case definitions" or formal logic that captures the criteria used to identify a record as a case of interest. To establish a methodology for development and evaluation of case definitions. A logical evaluation framework to approach case definitions will allow jurisdictions the flexibility to implement a case definition tailored to their goals and available data. Case definition development is explained as a process with multiple logical components combining free-text and categorical data fields. The process is illustrated with the development of a case definition to identify emergency medical services (EMS) call records related to opioid overdoses in Maryland. The Maryland Department of Health (MDH) installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE), which began capturing EMS call records in ESSENCE in 2019 to improve statewide coverage of all-hazards health issues. We describe a case definition evaluation framework and demonstrate its application through development of an opioid overdose case definition to be used in MDH ESSENCE. We show the iterative process of development, from defining how a case can be identified conceptually to examining each component of the conceptual definition and then exploring how to capture that component using available data. We present a framework for developing and qualitatively assessing case definitions and demonstrate an application of the framework to identifying opioid overdose incidents from MDH EMS data. We discuss guidelines to support jurisdictions in applying this framework to their own data and public health challenges to improve local surveillance capability.

Implementation and evaluation of interprofessional overdose review team recommendations following intentional or accidental overdose events.

Drug overdose death rates in the United States remain high despite efforts to mitigate this risk. Many communities and hospitals across the country have implemented overdose review teams, including local overdose fatality review teams or postoverdose intervention programs, to address the opioid crisis. The goal of most of these teams is to identify missed opportunities or patient-specific interventions to prevent future opioid overdose fatalities. Few overdose review teams review a combination of both fatal and nonfatal overdose events. The Veterans Affairs Tennessee Valley Healthcare System implemented a novel overdose review team (ORT) that collaboratively reviews all overdose incidents regardless of fatality, intent, or substance involved. This practice description characterizes reported facility overdose events and patient-specific risk-mitigation strategies recommended by the ORT, highlights the implementation rate and time to implementation of ORT recommendations, and discusses potential areas for process improvement. This practice highlights the potential impact of a pharmacist-led, interdisciplinary ORT following accidental or intentional overdose events involving any substance or medication. Key patient-specific interventions implemented following ORT recommendations included overdose prevention education and naloxone distribution, prescribing of medications for opioid use disorder and/or alcohol use disorder, reducing medication supply to limit lethal means access, and facilitation of mental health and/or substance use disorder specialty appointments. Further research to evaluate clinical outcomes related to specific ORT interventions should be considered.

How digital technology can contribute to timely and effective recognition and response to opioid overdose events

AbstractObjectivesTo discuss novel approaches in the development early detection, response and interventions of drug overdoses.Rationale There is an urgent need to research and develop novel strategies to rapidly and accurately detect, respond, and treat them with the ultimate goal of reducing drug deaths secondary to fatal drug overdose incidents. This should be additional to supporting communities and networks able to intervene utilizing novel public health approaches.Methods We will describe technologies and associated systems that are able to accelerate detection and result in a timely response to potential overdose with effective and timely intervention to these occurrences using digital technologies and therapeutics. This will be contextualised around novel public health approaches.ResultsWe will describe 11 protypes as part of a £5 million UK inititiative. The themes will include:–Use of discrete digital technology for easy use by people who use drugs in clinical and non-clinical settings–Simple alert / responder pathways that created effective responses to potentially fatal overdose events– Enhance innovative therapeutics as antidotes to overdose episodes–Novel public health approaches ConclusionThe use of remote monitoring devices like wearables and smartphone applications, paired with artificial intelligence and innovative therapeutics is an emerging field of research. This needs to be balanced around novel public health approaches.Disclosure of InterestNone Declared

Opioid Use and Overdose Patterns in Puerto Rico in 2020-2022: A Retrospective Descriptive Study

The opioid epidemic is a recent global phenomenon affecting the United States and its affiliated territories, including Puerto Rico. There is a considerable gap in knowledge on how this epidemic has affected Puerto Rico. This gap can hinder the capabilities of healthcare workers to deliver appropriate treatment and preventative strategies to vulnerable groups. This descriptive study aims to describe opioid use and overdose in Puerto Rico during 2020-2022. This study analyzed data gathered by the Puerto Rico mental health and addiction subdivision of the Public Health Department (Administración de Servicios de Salud y Contra la Adicción; ASSMCA). Some of the noteworthy trends in this study include that most participants who suffered an overdose were overwhelmingly male and in the age group of 35-44 years old. Furthermore, most cases occurred in large metropolitan areas and happened in open spaces during the 12 pm-5:59 pm period. These findings emphasize the need for targeted interventions that consider the sociodemographic characteristics and geographical variations in drug use and overdose incidents in Puerto Rico.

Characterizing opioid overdose hotspots for place-based overdose prevention and treatment interventions: A geo-spatial analysis of Rhode Island, USA

ObjectiveExamine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. MethodsWe conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. ResultsWe identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). ConclusionNeighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths.

Association of Drugs for Sale on the Internet and Official Health Indicators: Darknet Parsing and Correlational Study.

Studying illicit drug circulation and its effects on population health is complicated due to the criminalization of trade and consumption. Illicit drug markets have evolved with IT, moving digital to the "darknet." Previous research has analyzed darknet market listings and customer reviews. Research tools include public health surveys and medical reports but lack neutral data on drugs' spread and impact. This study fills this gap with an analysis of the volume of drugs traded on the darknet market. We aimed to use the dark web data and officially published indicators to identify the most vulnerable regions of Russia and the correlations between the pairs of variables to measure how illicit drug trade can affect population well-being. We web-parsed the Hydra darknet drug marketplace using Python code. The dataset encompassed 3045 individual sellers marketing 6721 unique products via 58,563 distinct postings, each representing specific quantities sold in different Russian regions during 2019. In the second stage, we collected 31 variables from official sources to compare officially collected data with darknet data about amounts and types of selling drugs in every 85 regions of Russia. The health-related data were obtained from official published sources-statistical yearbooks. Maps, diagrams, correlation matrixes, and applied observational statistical methods were used. In 2019, a minimum of 124 kilograms of drugs circulated daily in small batches on the Russian darknet. Cannabis dominated the market, being 10 times more prevalent than opiates, and cannabis products' higher availability in the region is correlated with a lower incidence of opiate overdoses. The "grams of opiates in the region" variable is significantly correlated with drug overdose deaths (r=.41; P=.003), HIV-positive cases due to drug use (r=.51; P=.002), and drug court convictions in Russia (r=.39; P=.004). The study identified significant correlations between opiate sales on the darknet and higher rates of HIV among injection drug users (r=.47; P=.003). Conversely, regions with higher cannabis sales exhibited significant negative correlations with indicators of harmful drug use (r=-.52; P=.002) and its prevalence (r=-.49; P=.001). These findings suggest regional variations in drug sales on the darknet may be associated with differing public health outcomes. These indicators accurately reflect regional drug issues, though some official statistics may be incomplete or biased. Our findings point to varying levels of risk associated with different types of drugs sold on the darknet, but further research is needed to explore these relationships in greater depth. The study's findings highlight the importance of considering regional variations in darknet drug sales when developing public health strategies. The significant correlations between drug sales data and public health indicators suggest that region-specific interventions could be more effective in addressing the diverse challenges posed by illicit drug use.

Epidemiological Aspects of Opioid Poisoning in Northern Iran: A Registry-Based Clinical Study.

Opioids are a class of drugs that are commonly used to manage pain due to their analgesic and sedative effects. However, the high consumption of opioids in the community has led to an increase in the incidence of overdoses and poisonings caused by various types of these drugs, whether intentional or unintentional. Therefore, comprehending the epidemiological features of patients experiencing opioid poisoning is crucial. We decided to investigate various epidemiological aspects of patients with opioid poisoning in the Mazandaran province, located in northern Iran, during the period of 2020 to 2021. The present investigation was conducted as a descriptive cross-sectional study, wherein we collected data on patients registered in the Mazandaran Registry Center of Opioid Poisoning (MRCOP) who had a history of using any kind of opioid. We collected information on various parameters, including patient demographics, the type of opioid consumed, the mode of consumption, and clinical outcomes. A total of 240 patients were initially registered at the registry center. However, 17 cases were excluded with personal consent, and eventually, a total of 223 patients were included in the investigation. The majority of the patients 70.9% (n = 158) were male, and the average age was 34.4 ± 16.55 years. The most common cause of poisoning reported in our study was intentional, which was mainly due to a suicide attempt. Furthermore, the most prevalent type of opioid consumed was methadone. The most frequently observed symptoms of poisoning among the patients were drowsiness, a decreased level of consciousness, and reduced arterial oxygen saturation levels. Based on the results of our study, several factors were found to be significant in methadone poisoning, including addiction, age, gender, suicide attempt, and a history of psychiatric disorder. These findings highlight the need for public education and awareness campaigns on the risks associated with opioid use, particularly methadone.

Association between household opioid prescriptions and risk for overdose among family members not prescribed opioids.

Prescription opioids have contributed to the rise in opioid-related overdoses and deaths. The presence of opioids within households may increase the risk of overdose among family members who were not prescribed an opioid themselves. Larger quantities of opioids may further increase risk. To determine the risk of opioid overdose among individuals who were not prescribed an opioid but were exposed to opioids prescribed to other family members in the household, and evaluate the risk in relation to the total morphine milligram equivalents (MMEs) present in the household. We conducted a cohort study using a large database of commercial insurance claims from 2001 to 2021. For inclusion in the cohort, we identified individuals not prescribed an opioid in the prior 90 days from households with two or more family members, and determined the total MMEs prescribed to other family members. Individuals were stratified into monthly enrollment strata defined by household opioid exposure and other confounders. A generalized linear model was used to estimate incidence rate ratios (IRRs) for overdose. Overall, the incidence of overdose among enrollees in households where a family member was prescribed an opioid was 1.73 (95% confidence interval [CI]: 1.67-1.78) times greater than households without opioid prescriptions. The risk of overdose increased continuously with the level of potential MMEs in the household from an IRR of 1.23 (95% CI: 1.16-1.32) for 1-100 MMEs to 4.67 (95% CI: 4.18-5.22) for >12,000 MMEs. The risk of overdose associated with household opioid exposure was greatest for ages 1-2 years (IRR: 3.46 [95% CI: 2.98-4.01]) and 3-5 years (IRR: 3.31 [95% CI: 2.75-3.99]). The presence of opioids in a household significantly increases the risk of overdose among other family members who were not prescribed an opioid. Higher levels of MMEs, either in terms of opioid strength or quantity, were associated with increased levels of risk. Risk estimates may reflect accidental poisonings among younger family members.

Overdose and mortality risk following a non-fatal opioid overdose treated by Emergency Medical Services in King County, Washington

BackgroundEmergency Medical Services (EMS) agencies respond to hundreds of thousands of acute overdose events each year. We conducted a retrospective cohort study of EMS patients who survived a prior opioid overdose in 2019–2021 in King County, Washington. MethodsA novel record linkage algorithm was applied to EMS electronic health records and the state vital statistics registry to identify repeat overdoses and deaths that occurred up to 3 years following the index opioid overdose. We measured overdose incidence rates and applied survival analysis techniques to assess all-cause and overdose-specific mortality risks. ResultsIn the year following the index opioid overdose, the overdose (fatal or non-fatal) incidence rate was 23.3 per 100 person-year, overdose mortality rate was 2.7 per 100 person-year, and all-cause mortality rate was 5.2 per 100 person-year in this cohort of overdose survivors (n=4234). Overdose incidence was highest in the first 30 days following the index overdose (43 opioid overdoses and 4 fatal overdoses per 1000 person-months), declined precipitously, and then plateaued from the third month onwards (10–15 opioid overdoses and 1–2 fatal overdoses per 1000 person-months). Overdose incidence rates, measured at 30 days, were highest among overdose survivors who were young, male, and experienced a low severity index opioid overdose, but these differences diminished when measured at 12 months. ConclusionsAmong EMS patients who survived an opioid overdose, the risk of subsequent overdose is high, especially in the weeks following the index opioid overdose. Non-fatal overdose may represent a pivotal time to connect patients with harm-reduction, treatment, and other support services.

Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods

ObjectiveThe last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a university hospital emergency department at two different periods of time to analyze potential differences in terms of patient characteristics, prescription profile, and treatment. MethodThis is a retrospective observational study of opioid overdose-related visits in two periods of time: 2009-2014 and 2018-2020. ResultsThe study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year). A comparison between the two period showed a decrease in the patients’ age (81.1 vs 74.0; p = 0.044) and an increase in the number of acute trauma-derived pain treatments at the expense of chronic pain treatments (p = 0.002). No differences were observed in the opioids involved. As regards symptoms, there was a decrease in the incidence of confusional syndromes (p = 0.026) and an increase in deaths. ConclusionsEmergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A change has also been observed in the profile of affected patients, with a higher number of cases where pain is derived from acute trauma.