Opioid overdoses are increasing and several efforts are being made to reduce this problem. One potential solution is overdose education and naloxone distribution. Project ASSERT began distributing naloxone in conjunction with its overdose education program in 2009. Project ASSERT’s overdose education and naloxone distribution program trained opioid users in recognition, risk factors, and response to overdoses, as well as how to use nasal naloxone kits. Opioid users that had received overdose education only were compared with those that received overdose education and naloxone kits. The goal was to determine if there were any differences in occurrence of nonfatal overdoses, overdose response, illicit opioid use, and opioid agonist treatment. This retrospective study involved phone-surveying patients from a hospital billing list. It was obtained through Project ASSERT and contained the names of patients that had received overdose education only or overdose education and naloxone distribution from January 2011 to February 2012. Questions were asked about the respondents’ naloxone kits, overdose history since their Project ASSERT visit, response to the last witnessed overdose, 30-day substance use, and overdose risk knowledge. Chi-square tests were used to compare the groups. 51 out of 415 eligible were successfully surveyed from March 2012 to October 2012. The surveys occurred on average 11.8 months after their Project ASSERT visit. 73% (37) had naloxone kits and most kept them where they lived (12). There were 9 successful overdose reversals reported. 76% (39) of the respondents did not overdose in the intervening period. There was no statistical difference between the two groups in overdose occurrence, 19% trained with naloxone versus 29% trained without naloxone (p=0.45). 16 out of 19 (84%) of the naloxone group properly responded to an overdose, whereas 3 out of 8 (38%) of those trained without naloxone properly responded (p=.03). There was no statistical difference in illicit opioid use (p=1.0) and opioid agonist treatment (p=.53), 36% of the group trained with naloxone versus 35% of the group trained without naloxone, and 49% of those trained with naloxone versus 36% of those trained without naloxone, respectively. In studying the association between overdose education only and overdose education and naloxone distribution, it was found that there is not an increase in overdose and illicit opioid use. There also is no reduction in seeking for opioid agonist treatment. However, it was found that having naloxone kits does increase proper response to overdose. This is a promising result that could have an impact in reducing opioid overdose deaths.

No description available.

This thesis examines three main themes; depression, suicidality, and non-fatal overdose involving pharmaceutical and over-the-counter (OTC) medications. At any given time depression affects approximately one in every twenty adults in Australia. People with depression are at elevated risk of attempted and completed suicide compared to those without. Medication overdose is a frequently chosen method of suicidal behaviour, and accounts for one in ten suicide deaths and close to nine out of ten non-fatal episodes of suicidal behaviour for which hospital treatment is sought. The study reported here had six primary aims; (i) to quantify medication overdose presentations over a 12-month period to the Emergency Department (ED) of a major metropolitan public hospital in Melbourne, Australia, (ii) to describe the medication overdose patient group, including comparison with two other relevant types of presentation, illicit drug overdose, and actual or potential self-harm by means other than overdose, (iii) to explore the relationship between depression, suicidal ideation and medication overdose, (iv) to identify the medications typically used in overdose and their means of acquisition, (v) to explore patient experiences of emergency care following a medication overdose, and (vi) to comment on the feasibility of introducing a brief intervention within the ED with the intention of addressing the issue of medication overdose. Three data sources were employed: computerised ED records, interviews with a sub-sample of patients attending the ED following a medication overdose, and observation of ED processes in relation to these cases. / One of the most important findings of the study was the large contribution made by benzodiazepine medications to the overall medication overdose statistics. When considered in conjunction with the patient interview data, it appeared that many patients included in the study were prescribed benzodiazepines in a manner that contradicts current national prescribing guidelines. The problem of medication overdose could be partially addressed by working with doctors to ensure the appropriateness of their prescribing practices, to encourage them to more closely monitor the treatment progress of at-risk patients, and to increase awareness of other evidence-based forms of treatment for depression and anxiety.

Opioid drug related death is the topic of this thesis. Each of the published works submitted in this volume has investigated an aspect of opioid drug related death. The publications have been grouped into three sub-themes: i. Characteristics of opioid drug related deaths ii. Methadone-related deaths in and out of treatment iii. Improving the quality of treatment for opioid drug dependence: a focus on injectable opioid treatment The introduction and background (Chapter1) will briefly review-the-relevant literature on opioid drug death predating my own contribution to the field. The next chapter of the thesis, 'Publications' (Chapter 2), will comprise the body of published work being submitted for the degree of Doctor of Medicine. Each article is accompanied by text on the preceding page outlining my individual contribution to that research study. The thesis will conclude with a discussion of the published works (Discussion, Chapter 3) which summarises the chief findings and reflects on the international significance and impact of the work. Finally, the Conclusion (Chapter 4) will submit suggestions for areas of future research into opioid drug related death.

An investigation of the ratio of free to bound phenytoin in overdose cases was accomplished by three studies to answer these questions: 1. Will the free to bound ratio change with increasing total phenytoin concentration? 2. Will the free to bound ratio be altered with decreasing total protein concentration? 3. Do these results correlate with overdose cases? The results demonstrated that the ratio of free to bound phenytoin remains constant throughout the therapeutic range as long as a person has a normal total protein concentration. However, the free to bound ratio changes significantly when the total protein decreases by 25 per cent. This substantiates the importance of monitoring free and total phenytoin concentrations in hypoproteinemia.

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

published_or_final_version / Community Medicine / Master / Master of Public Health

Since the 1990s rates of prescription drug abuse and overdose have skyrocketed to unprecedented levels. As a result states have enacted and implemented new drug control policies in hopes of slowing and reversing this health epidemic. The goals of this study were to (a) determine the impact these state-based drug control policies have on prescription drug abuse and overdose and (b) deduce what leads some states to pass stricter policies than others. Results indicated that the prevalence of prescription drug overdose in 2008 largely impacted the future strength of a state’s drug control policy. States with higher rates of drug overdose and abuse in earlier years tended to develop tougher policy by 2013. In addition, states’ Prescription Drug Monitoring Programs (PDMPs) were found to be strongly related to the growth rate of prescription drug abuse in states. While not significantly differing from national trends at first, after about five years of PDMP operation, states began to see a slow or decrease in their rates of prescription drug abuse. Though much more can be done to combat prescription drug abuse and overdose, PDMPs that provide unsolicited reports to users and are accessible to law enforcement and are an effective step to begin to curb the problem.

Thesis (Ph.D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 172 pages. Includes Vita. Includes bibliographical references.

Poisonings account for 0.8% of emergency room visits each year. Our review of current toxicological resources revealed a gap in their ability to provide expedient calculations and recommendations, as they are broad in scope and time-consuming to read. Time is crucial in a toxicologic emergency. Delay in first dose can lead to life-threatening sequelae. To bridge the gap, we developed the Antidote Application (AA), a computational system that automatically provides patient-specific antidote treatment recommendation(s) and individualized dose calculation(s). We implemented 27 algorithms that describe FDA approved use and evidence-based practices found in primary literature for the treatment of common toxin exposure. The AA covers 29 antidotes recommended by Poison Control and toxicology experts, 31 toxins from 19 toxin classes, and over 200 toxic entities. We implemented the AA in two formats: a standalone downloadable application for offline use and an online web application. The AA represents a unique educational resource for the study of toxicology with the potential of being adopted for point of care decision support. The system also provides guidance for reporting toxic exposures regionally and nationally as required by accrediting bodies and some states. The AA system has the potential for reducing initial dose delays and medication errors. To the best of our knowledge, the AA is the first educational and decision support system in toxicology that provides patient-specific treatment recommendations and drug dose calculations. The downloadable and online Antidote Applications are publically available at http://www.met-hilab.org/files/antidote/antidote_application.jar and http://projects.met-hilab.org/antidote/ respectively.