We present a case of malignant arrhythmias associated with hypocalcemia and subsequent cardiac arrest in a 20-year-old woman due to ingestion of 3.1 g mesoridazine in a suicide attempt. There were unexplained alterations in serum electrolytes preceding the cardiac arrest. The patient subsequently recovered and was transferred to a psychiatric hospital. Despite the paucity of data on the potential cardiotoxicity associated with mesoridazine overdose, this case demonstrates that malignant arrhythmias and cardiac arrest occur; consequently, these patients probably require constant ECG monitoring.

No description available.

Purpose of review: Overdose deaths have increased significantly over the last 5 years. This review analyzes the severity and nature of the epidemic, its impact on society, factors driving the increase in mortality, special populations disproportionately affected, and solutions to decrease overdose deaths. A thorough understanding of opioid overdose rates and deaths position the reader to respond most effectively in their sphere of influence. Recent findings: Final statistics for 2017 show a continued worsening of the epidemic. Recent studies focus on the evolving role of synthetic fentanyl, risk factors for fatal overdose, variation of mortality across demographic and socioeconomic regions, and the effectiveness of harm reduction strategies such as naloxone. Summary: The national overdose death rate continues to rise unabated with a 9.6% increase during 2017, with an estimated cost over $550 billion in 2019. There are, however, effective strategies to identify and treat individuals at risk for a fatal overdose. The root cause of addiction is the brain’s response to despair, social stressors, and societal structural inequities. It is unlikely we will see a significant decrease in addiction and its consequences until these root causes are addressed. Additional research is needed on the role of social determinants in addiction, strategies to treat incarcerated individuals, the role of suicidal ideation in fatal overdose, and risk factors, and frequency of non-fatal overdose.

No description available.

BACKGROUND: It is well known that those taking chronic opioid pain medications often become tolerant to the medications and require escalating doses over time (Drewes, 2017). No objective method to identify tolerance currently exists. OBJECTIVE: The objective of this study is to determine the usability and feasibility of a wearable biosensor technology to determine a transition point between opioid naivety and tolerance. METHODS: Participant’s were recruited in the Emergency Department setting and were being admitted with a treatment plan that includes opioid analgesics. Participants were instructed to wear the sensor at all times and to ‘tag’ the sensor when opioid pain medications were administered. This data was analyzed for trends and changes in sensor data before and after opioid administration. Research staff also conducted formative interviews during and after hospital admission to gather information on the participants’ perception of the wearable biosensor and of opioid tolerance. RESULTS: The sample included 17 participants who received, on average, 21.2 morphine equivalents per day during admission. Over 90% of participants stated that they would wear the sensor again, and 70% would even wear two. Data analysis from the E4 biosensor indicated a difference between baseline physiological signaling and post-opioid administration. CONCLUSIONS: In this study, feasibility of wearable mHealth technology was assured, and the preliminary findings of the biosensor data suggest that the features from activity data at different axes can predict opioid use. Future studies will evaluate the development of tolerance among these participants. / 2021-06-17T00:00:00Z

BACKGROUND: Naloxone, an opioid antagonist, offers a powerful tool for preventing opioid overdose deaths. Because studies have shown opioid overdose education and naloxone distribution (OEND) programs to be a safe, feasible, and effective intervention, several policymakers and public health agencies have advocated for broader access to this life-saving medication. Community health centers (CHCs) are a promising location for expanding naloxone access. This investigation examined the experience of CHC-based HIV primary care teams with a variety of overdose education and naloxone access (OENA) strategies in order to inform future dissemination efforts. METHODS: A mixed methods study was conducted with eight CHCs located in Massachusetts communities experiencing high opioid overdose fatality rates. Individual and group interviews with 29 clinic staff members; clinic and participant surveys; and document review were used to elucidate the OENA strategies. The Consolidated Framework for Implementation Research guided the data collection process and subsequent analysis, which revealed several factors supporting or hindering implementation of OENA activities in CHC primary care settings. RESULTS: Operating in a facilitative state policy environment, the CHCs utilized a mix of approaches to OENA: providing clinic-based services, issuing prescriptions, utilizing pharmacy standing orders, and making referrals to existing community-based OEND programs. With prescribers having limited time and competing priorities, nurses, health educators, and other staff played a prominent role in OENA. Pharmacies also served as important access points for patients and community residents. Several strategies were used to engage patients, including active outreach, partnerships with external organizations, and efforts to destigmatize substance use disorders. Clinic staff participation was enhanced through leadership support for harm reduction approaches, ongoing training, peer modeling, and information sharing. CONCLUSIONS: This study demonstrated that OENA can be integrated into CHC primary care services, adapted to the clinic context, and modified as needed. Successful implementation required a systems-level response, grounded in a team-based care model and a consideration of patient needs. The process for naloxone reimbursement needs to be determined to minimize CHC or patient barriers and ensure sustainability. Clinic training and technical assistance plans should be customized according to the staff members’ potential roles and their stage of readiness.

OBJECTIVE: To study the association between benzodiazepine prescribing patterns including dose, type and dosing schedule and the risk of drug overdose death among US veterans receiving opioid analgesics. DESIGN: Case-cohort study SETTING: Veterans Health Administration (VHA), 2004 through 2009. PARTICIPANTS: US veterans, primarily male, who received opioid analgesics between 2004 and 2009. All veterans who died of a drug overdose (n = 2,400) while receiving opioid analgesics and a random sample of veterans (n = 420,386) who received VHA medical services and opioid analgesics were included in the study. Main outcome measure: Drug overdose death, defined as any intentional, unintentional or indeterminate poisoning death caused by any medication or drug, determined by cause of death information from the National Death Index. RESULTS: Twenty seven percent of veterans who received opioid analgesics also received benzodiazepines during the study period. Approximately half of the drug overdose deaths (n=1,185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of drug overdose death increased based on benzodiazepine prescription history: formerly prescribed vs. not prescribed (adjusted hazard ratio [HR]=2.33, 95% confidence interval [CI]: 2.05-2.64); currently prescribed vs. not prescribed (HR=3.86, CI:3.49-4.26). Risk of drug overdose death increased as daily benzodiazepine dose increased. When compared to clonazepam, temazepam was associated with a decreased drug overdose death risk (HR=0.63, CI: 0.48-0.82). Benzodiazepine dosing schedule was not associated with drug overdose death risk. CONCLUSIONS: Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of drug overdose death in a dose-response fashion.

The number of opioid-related overdose deaths in the United States has quadrupled since 1999. For this reason, in October 2017 President Donald Trump declared the opioid epidemic a public health emergency. Massachusetts is particularly affected by the opioid epidemic as evident in an opioid-related death rate that is double the national rate. Naloxone is a prescription medication that works antagonistically to bind opioid receptors and rapidly reverses and blocks the effects of opioids. This drug is widely used to revive patients who are experiencing an opioid overdose. Prior research on the topic of attitudes toward naloxone prescriptions and dispensing has focused primarily on three groups of people: patients, prescribers, and pharmacists. However, in recent years there has been an expansion of the role of the pharmacy technician in healthcare administration, such as in the administration of vaccines. Thus, there is a lack of research centered on the role of pharmacy technicians in the dispensing of naloxone. The aim of this study was to investigate the attitudes and perceptions of pharmacy technicians in the dispensing of naloxone across Massachusetts. This goal was accomplished by purposively sampling CVS pharmacies in 13 municipalities across the state, with 7 municipalities having an opioid-related death rate per 100,000 people greater than the state average and 6 municipalities having an opioid-related death rate per 100,000 people less than the state average. These municipalities were termed High-Risk Municipalities and Low-Risk Municipalities, respectively. Three CVS pharmacies were sampled within each municipality, yielding a total sample size of 39 CVS pharmacies with 21 from High-Risk Municipalities and 18 from Low-Risk Municipalities. Pharmacy technicians working in each pharmacy were administered a survey pertaining to their attitudes and perceptions on naloxone dispensing. The results of this study demonstrated that there was a significant difference between technicians working in High-Risk Municipalities and Low-Risk Municipalities regarding the percentage of patients who they believed could benefit from naloxone. Specifically, 67% of participants in Low-Risk Municipalities indicated that less than 25% of patients could benefit from having a naloxone kit available whereas 67% of participants in High-Risk Municipalities indicated that greater than 50% of patients could benefit (Mann-Whitney U significance level = 0.001). This result is critical, especially considering the fact that there was no significant difference between both groups of technicians on their perceptions of patients who used illicit opioids or prescription opioids. In addition, unsolicited feedback from participants revealed several common themes among technicians working in both groups, including the belief that patients could benefit from a reduced cost of naloxone and that both technicians and patients may be unaware that naloxone can benefit individuals taking prescription opioids rather than just people who inject drugs. Future studies could investigate whether participant characteristics, such as years of experience working in the pharmacy may have influenced the results. Also, future research could be directed toward determining if there might be a relationship between syringe sales and naloxone sales in High-Risk Municipalities.

Class of 2015 Abstract / Objectives: Evaluate prescriber knowledge on naloxone use for opioid overdose reversals in intravenous drug users. Interview prescribers on their perceptions about intravenous drug users, syringe access programs, and other related topics. Subjects: Prescribers and medical professionals in the State of Arizona. Methods: Medical facilities were contacted by email, fax, or telephone requesting for prescribers to complete the survey and return by email or fax, or call to schedule a face-to-face appointment. The respondents of the survey were kept anonymous and were permitted to answer the survey in free text. Surveys were sent to the 68 selected medical facilities at least twice during the study period. Results: All of the six respondents were male, of the respondents had at least 11 years experience, with two having >30 years. A majority practiced in rehab centers or worked with drug abuse patients, however the number of patients treated per week by respondent varies from 10-320. Also of note five of the six respondents had a family member or relative with an addiction to opioids. The respondents seem to be in support of a naloxone distribution program however it is difficult to draw any conclusions since the number of responses was low. Conclusions: It appears that prescribers have a favorable perception of naloxone use and support harm reduction strategies, however response rate was too low to make any definitive conclusions.

Title: Drug Related Crimes and Overdoses during the COVID-19 Pandemic Format: Poster Authors: Janaya Colbert, Kristin Mahan, MA, Jill D. Stinson, PhD Department of Psychology, College of Arts & Sciences, East Tennessee State University, Johnson City, TN The COVID-19 pandemic affected many aspects of life, including restricting many people to their homes. During the lockdown, more people were isolated inside, which may have resulted in varying levels of drug and substance-related crimes, as well as overdose deaths. Increases in substance misuse may be associated with stress regarding COVID-19, but these events may be less often officially reported during the lockdown. An increase in substance use may also be associated with an increase in overdose deaths. In the present study, we will compare trends of drug and substance related outcomes before and during the pandemic in Tennessee, and differentiate effects between rural and urban counties. Data for this project were obtained from the Tennessee Bureau of Investigation’s (TBI) online incident-based reporting system and the County Health Rankings and Roadmaps online database. Variables of interest include all 95 Tennessee counties, number of driving under the influence (DUI) cases, number of drug/narcotic violation cases, and number of overdose deaths. In 2019, there were 19,556 reported DUI cases and in 2020, there were 17,578 reported DUI cases in Tennessee. In 2019, there were 50,618 reported drug/narcotic violations and in 2020, there were 49,875 reported drug/narcotic violations. In 2019 there were 4,776 reported overdose deaths and 5,097 reported overdose deaths in 2020. Utilizing 2x2 factorial ANOVAs, we will analyze the relationships between county type (i.e., urban vs. rural) and report year (i.e., 2019 vs. 2020) for each outcome of interest. Our hypotheses include: (a) there will be differences between urban and rural counties on the rates of drug and substance related outcomes (i.e., DUI cases, drug/narcotic violation cases, overdose deaths) pre- and mid-pandemic; (b) drug-related crimes and DUI cases decreased during the pandemic when compared to the previous year due to lockdown procedures and decreased ability to access substances; and (c) overdose deaths increased from pre- to mid- pandemic. Anticipated results will help examine how the COVID-19 pandemic has affected rates of drug and substance related crimes, which can help inform prevention and treatment strategies in the future. Additionally, potential discrepancies between rural and urban counties may highlight prevention and treatment disparities for those struggling with substance misuse, which can inform resource allocation within Tennessee.