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: Methamphetamine-related deaths have been rising along with those involving synthetic opioids, mostly fentanyl and fentanyl analogs (FAs). However, the extent to which methamphetamine involvement in deaths differs from those changes occurring in synthetic opioid involvement is unknown.: To determine the patterns and temporal changes in methamphetamine-related deaths with and without other drug involvement.: Data from all methamphetamine-related deaths in West Virginia from 2013 to 2018 were analyzed. Quasi-Poisson regression analyses over time were conducted to compare the rates of change in death counts among methamphetamine and fentanyl//FA subgroups.: A total of 815 methamphetamine-related deaths were analyzed; 572 (70.2%) were male and 527 (64.7%) involved an opioid. The proportion of methamphetamine only deaths stayed relatively flat over time although the actual numbers of deaths increased. Combined fentanyl/FAs and methamphetamine were involved in 337 deaths (41.3%) and constituted the largest increase from 2013 to 2018. The modeling of monthly death counts in 2017-2018 found that the average number of deaths involving fentanyl without methamphetamine significantly declined (rate of change -0.025, < .001), while concomitant fentanyl with methamphetamine and methamphetamine only death counts increased significantly (rate of change 0.056 and 0.057, respectively, < .001).: Fentanyl and FAs played an increasingly significant role in methamphetamine-related deaths. The accelerating number of deaths involving fentanyl/FAs and methamphetamine indicates the importance of stimulants and opioids in unintentional deaths. Comprehensive surveillance efforts should continue to track substance use patterns to ensure that appropriate prevention programs are undertaken.

La douleur chronique non-cancéreuse (DCNC) est un problème de santé qui touche environ une personne sur cinq au Canada. Elle est associée à une dégradation de la qualité de vie physique et mentale et occasionne des coûts économiques importants. Pour lutter contre la DCNC, les opioïdes ont été largement recommandés et prescrits malgré l’absence de preuves de leur efficacité à long terme, entraînant une augmentation des surdoses. Ces surdoses mais surtout celles causées par le fentanyl illicite ont fait naître une crise sanitaire, la crise des opioïdes. Pour juguler cette crise, des lignes directrices ont été émises pour encadrer de façon plus stricte la prescription d’opioïdes pour la DCNC. Cependant ces mesures peuvent constituer des barrières d’accès aux traitements pour les personnes vivant avec de la DCNC. Il est donc important de garantir un accès sécuritaire aux opioïdes à ceux qui en ont besoin pour fonctionner tout en limitant l’accès inapproprié qui alimente la crise des opioïdes. L’objectif de cette thèse était d’identifier les personnes susceptibles de bénéficier d’une utilisation efficace et sécuritaire des opioïdes à long terme et de mieux comprendre la douleur et les difficultés d’accès au traitement chez les personnes utilisatrices de drogues (PUD). Une première étude, visant à identifier les prédicteurs de l’efficacité des opioïdes à long terme, n’a pas permis de faire ressortir des caractéristiques des personnes susceptibles d’en bénéficier. Deux autres études ont permis d’étudier le nomadisme médical (doctor shopping), un indicateur d’utilisation problématique d’opioïdes, qui consiste à obtenir des ordonnances qui se chevauchent de plusieurs médecins et à les faire dispenser dans différentes pharmacies. Les résultats ont montré que cette pratique est rare chez les personnes vivant avec de la DCNC mais qu’elle peut être associée à la survenue de surdose. Les caractéristiques des personnes à risque de faire du nomadisme médical ont été identifiées permettant ainsi un meilleur suivi. Enfin, une dernière étude a montré que la DCNC est très fréquente chez les PUD et qu’une proportion importante de cette population a recours à des drogues illicites pour soulager leur douleur, courant ainsi le risque de faire une surdose. Ces études montrent la nécessité d’une médecine personnalisée tenant compte des caractéristiques et situations individuelles afin de prescrire le bon médicament à la bonne personne. En somme, ces résultats ont permis d’accroître les connaissances scientifiques sur l’utilisation des opioïdes pour la DCNC. / Chronic non-cancer pain (CNCP) is a health problem that affects about one in five people in Canada. CNCP is associated with a deterioration of physical and mental health-related quality of life and incurs significant economic costs. To better manage CNCP, opioids have been widely recommended and prescribed despite the lack of evidence on their long-term effectiveness, leading to an increase in opioid overdoses. These overdoses but mainly those caused by illicit fentanyl have led to the opioid crisis. To address this crisis, guidelines have been issued to tighten the prescribing of opioids for CNCP. However, these measures can exacerbate barriers of access to treatment for people living with CNCP. Therefore, it is important to ensure safe access to opioids for those who need this medication to improve function while reducing inappropriate access that contributes to the opioid crisis. The aim of this thesis was to identify the characteristics of patients who may benefit from effective and safe long-term opioid therapy and to better understand pain and treatment access difficulties among people who use drugs (PWUD). An initial study, which aimed at examining predictors of long-term opioid efficacy, failed to identify characteristics of those likely to benefit from opioid therapy. Two other studies investigated doctor shopping, an indicator of problematic opioid use, which consists of obtaining overlapping prescriptions from several doctors and pharmacies. The results showed that this practice is rare among people living with CNCP but may be associated with the occurrence of opioid overdose. The characteristics of people at high-risk to engage in opioid doctor shopping were identified, thus allowing better monitoring. Finally, a last study showed that CNCP is very frequent among PWUD and that a significant proportion of this population uses illicit drugs to relieve their pain, which can increase the risk of overdose. These studies show the need for personalized medicine considering individual characteristics and specific situations to prescribe the right drug to the right person. In summary, these results have increased the scientific knowledge about the long-term opioid use in CNCP.

Accidental drug poisoning has tripled in Sweden since the start of the 21st century, and statistically the country has had one of the highest overdose death rates in Europe. To reverse an opioid overdose, which is the main cause of drug related death, the antidote naloxone has the capacity of breaking the effect, and it is widely recommended as a safe drug with limited side effects. Police forces around the world have started to use naloxone and there is proven connection between its introduction and a reduced number of drug related deaths. However, Swedish police has not started to use or, as far as we know, investigate use of naloxone despite proven benefits. Since police sometimes are the first to arrive at the scene of an overdose, naloxone in a police context is important to study. This survey had its origin in the Theory of Planned Behavior, in accordance with the research instruments Opioid Overdose Knowledge Scale (OOKS), Opioid Overdose Attitude Scale (OOAS) and Naloxone-Related Risk Compensation Beliefs (NaRRC-B). This quantitative study had the purpose to measure and create knowledge about Swedish police officers' attitudes towards introducing and administering naloxone in police work, as well as their general knowledge regarding the antidote. The participants agreed that Swedish police officers should be equipped with naloxone to be able to save more lives (mean value = 3,9). The demonstrated benefits significantly outweigh the disadvantages of a possible implementation of naloxone within the Swedish police. Hence, it is essential that the Swedish Police Authority further investigates whether the use of naloxone can be a new working method to save more lives.

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Made available in DSpace on 2011-05-04T12:42:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Os medicamentos são um instrumento terapêutico importante no cuidado à saúde do idoso. No entanto, devido a motivos financeiros, estima-se que um quarto dos indivíduos deste grupo populacional subutiliza os tratamentos prescritos. A subutilização é uma forma de não adesão, que ocorre quando o indivíduo não faz uso dos medicamentos prescritos ou reduz as doses ou a freqüência de uso, comportamento que pode levar a hospitalizações, incapacidades e morte. Os objetivos deste trabalho foram estimar a prevalência e identificar a influência defatores sócio-demográficos, econômicos, relativos à saúde, à percepção de capital social e ao sistema de saúde na subutilização por motivos financeiros entre idosos residentes em duas comunidades localizadas no Estado de Minas Gerais, Brasil (Região Metropolitana de Belo Horizonte - RMBH e Bambuí). A prevalência da subutilização para indivíduos acima de 60 anos, residentes na Região Metropolitana de Belo Horizonte, foi de 12,9 por cento, estando independentemente associada à filiação a plano privado de saúde, à freqüência com que o profissional de saúde esclareceu sobre a saúde / tratamento, à auto-avaliação de saúde, ao número de condições crônicas, à percepção de coesão ao bairro de moradia e ao número de contatos sociais. Já para o subgrupo de mulheres acima de 70 anos, a prevalência da subutilização foi de 11,4 por cento para aquelas que residem na RMBH e de 5,4 por cento para as residentes da cidade de Bambuí. Os fatores independentemente associados à subutilização na RMBH foram a autoavaliação de saúde, a capacidade funcional e a percepção de ajuda. Em Bambuí, os fatores independentemente associados à subutilização foram a percepção de coesão ao bairro de moradia e a percepção do ambiente físico. Os resultados evidenciam uma situação de risco para indivíduos em piores condições de saúde e confirmam a importância dos aspectos sócio-econômicos para a subutilização pormotivos financeiros. Além disso, indicam também que a determinação dessa subutilização está ligada à qualidade da comunicação médico-paciente e ao contexto social no qual o indivíduo está inserido, sendo este último aspecto especialmente relevante para as mulheres idosas. / Cost-related medication nonadherence (CRN) is an important and recognized issue for older people. Recent studies have documented that up to one-quarter of seniors reported underusing prescription medicines due to financial barriers. This behavior, which includes unfilled prescriptions, reduced frequency or lowered dosage of prescription medicines, is associated with increased risk of declining health and higher rates of hospitalization in the elderly population. The aim of this study was to estimate the prevalence of cost-related medication nonadherence and to evaluate the associations between CRN with socio-demographic and economic status, health related characteristics and perceived social capital and health system characteristics among elderly individuals residing in two communities located in Minas Gerais State, Brazil (Greater Metropolitan Belo Horizonte and Bambuí). The prevalence of CRN among elderly individuals (age ≥ 60) was 12.9%. Health plan coverage, frequencies of physician-patient dialogue about health/treatment, self-rated health, multiple comorbidities, perception of attachment to the neighbourhood and social contacts were the variables most strongly related to CRN. For elderly women (age ≥ 70) residing in the GMBH, the prevalence of CRN was 11.4% and for those residing in Bambuí, this rate was 5.4%. Among GMBH residents in poor or very poor health status, any ADL limitation and no perception of help had the strongest effect on the likelihood of CRN. In contrasting, a high perception of attachment to the neighborhood and a high perception of physical environment significantly decreased the likelihood of CRN among Bambuí residents. Our results suggest that the pronounced risk of cost-related underuse among elderly in poor health is especially worrisome. Additionally, our results also suggest adherence problems within this population are due to a communication gap between seniors and physicians in respect to treatment and to the lack of health plan coverage. Social capital explains to some extent adherence problems within this population, especially for older women.

Opioid overdose is a growing epidemic plaguing the United States. Overdose related death has risen from 16,849 in 1999 to 69,029 in 2018. Almost 7 out of 10 of these deaths were due to opioids with 47% being caused by fentanyl or other synthetic opioids. There is a strong need to reduce the amount of overdose-related deaths. Indirect methods should be a first priority, and include counseling and care. For some individuals, this treatment option is unavailable because the drug user may not have the desire or economic means to pursue it. In this case, a more direct preventative approach is needed. This paper presents a novel method of detecting poor peripheral oxygenation, a biomarker linked to opioid overdose. A wristwatch near-infrared spectroscopy device (NIRS) was developed. SPICE simulations were conducted to confirm proper operation of electrical systems. The device was fabricated on a printed circuit board and mounted to a 3D printed enclosure. Absorbance of green, red and infrared (IR) light were measured. Additionally, peripheral capillary oxygen saturation (SpO2) modulation index and changes in concentration of oxyhemoglobin and deoxyhemoglobin were calculated from raw data. A brachial occlusion test was performed to mimic the effects of opioid overdose on peripheral oxygenation. A statistically significant difference (p < 0.05) was observed between pre-occlusion and during-occlusion groups in two subjects for measurement of peak-to-peak values of green raw data, red raw data, IR raw data, oxyhemoglobin concentration change, and deoxyhemoglobin concentration change. Peak-to-peak was observed as a consistent indicator of poor peripheral oxygenation and could serve as a useful metric in the detection of opioid overdose.