The opioid fentanyl is becoming an increasingly popular drug of abuse across the United States. With a potency up to 100 times greater than the common opioid morphine, fentanyl use can easily lead to overdoses. This is especially true as fentanyl is increasingly found mixed into other illicit drugs without users’ knowledge. However, there exists an antidote for opioid overdoses called naloxone. Naloxone is a pure antagonist at μ-opioid receptors in the brain and produces little known side-effects. Recently, the FDA has approved naloxone delivery devices designed for individuals without medical training, making naloxone layperson friendly. Under today’s policy, naloxone is a prescription medication. This means physicians must write a prescription for take-home naloxone or issue a standing order allowing other healthcare professionals to distribute naloxone. However, there are little federal laws governing naloxone as most of the statutes discussing naloxone access and administration are determined by individual states. For example, only some states allow physicians to prescribe naloxone to non-patients. Additionally, many states have differing laws regarding criminal liabilities for physicians who prescribe the drug and for laypersons who administer the drug. In the U.S. there exists a dilemma with naloxone, as topics ranging from public policy to insurance coverage are controversial. With increasing information on fentanyl and naloxone being published, the U.S. is currently looking into the idea of making naloxone more accessible as a way to reduce overdose deaths.

Many dietary supplements being promoted for weight loss contain caffeine-or ephedra-related alkaloids to increase energy and suppress appetite. People may be unaware that supplements can contain caffeine, even if caffeine is not listed as an ingredient. Commonly used herbal dietary supplement ingredients, such as guarana, are natural sources of caffeine. Additions of these natural sources of caffeine to dietary supplements have increased in recent years. We describe a case of possible caffeine-induced seizure in a patient taking an over-the-counter weight loss supplement. A previously healthy 38-year-old female experienced blurring of vision and a new onset grand mal seizure. The patient had a 2-month history of taking the dietary supplement, Zantrex-3™. Zantrex-3™ is advertised as a weight loss supplement, which may provide rapid weight loss and extreme energy in one "power packed pill." Zantrex-3™ is a proprietary blend containing niacin, caffeine, and various herbs. After presenting to the hospital emergency room, the patient's chemistry panel, with the exception of potassium (2.9 mEq/L), was within normal limits. An electroencephalogram (EEG) was unremarkable. The magnetic resonance imaging (MRI) showed possible atrophy in the right frontal lobe. Findings from follow-up MRI and EEG ordered as an outpatient were within normal limits. After discontinuation of Zantrex-3™, the patient has experienced no further seizure activity.

Indiana University-Purdue University Indianapolis (IUPUI) / Deaths due to prescription painkillers and heroin have quickly become national, state, and local public health concerns. Studies using data from Medical Examiners or Coroner Offices throughout the United States have been conducted and are contributing to the understanding of this epidemic. However, the analysis of these fatalities are specific to the communities where the study was conducted and cannot be assumed that the decedents in one community are similar to decedents in another community. Many local governments and agencies throughout the U.S. are aware that this problem exists in their communities, but are not prepared to adequately respond to and intervene in these fatalities as an analysis of those who have died has rarely been conducted. This dissertation is a replication study of longitudinal epidemiological analyses of opiate related fatalities that was implemented in a location where an analysis of opiate-related fatalities had not been conducted, Marion County, Indiana. The purpose of the dissertation was twofold: (1) to describe the demographic characteristics of the decedents using publicly available data from the Marion County Coroner’s Office to be used in informing future preventative efforts to decrease opiate-related fatalities in Marion County and (2) to inform other communities on how to conduct a similar analysis in their own community. This dissertation describes the methods of the replication study, provides descriptive results of the people who died from opiate-related overdoses, and: (a) Report the types of opiates identified in blood toxicology reports and (b) Present the histories of opiate-related decedents as reported in the Deputy Coroner Field Officer’s Reports (DCFOR). Additionally, analysis was conducted to determine if decedent characteristics deferred depending on the type of opiate fatality based on the toxicology in 1) heroin alone, 2) painkillers alone, and 3) heroin and painkillers combined.

The crisis of overdose deaths in British Columbia (BC) continues into its seventh year. This thesis applies a human security lens to a mixed methods computer-assisted discourse analysis on a corpus of public-facing documents from drug enforcement organizations in BC, and one from community-run harm reduction organizations in BC. Analysis uses a “What is the Problem Represented to Be”? (WPR) approach to analyze conflicting conceptual logics and answer the question “What human security problems are constructed in Harm Reduction and Enforcement discourses surrounding the crisis of overdose deaths in British Columbia?” Conclusion: Both corpora construct different problematizations. Whereas enforcement discourses emphasize criminality and proximal substance use harms, harm reduction discourses look at enforcement as a structural threat to people who use drugs. / Graduate / 2023-08-17

Fentanyl is a potent narcotic analgesic that leads to countless overdoses each year. Past studies have shown that fentanyl use has been growing substantially in counties within Florida. However, little research has been done to quantify and analyze rates of fentanyl overdose within Orange County, particularly over multiple year periods of time. The goal of this study is to provide information and analysis on the rates of fentanyl overdose within Orange County, Florida from 2019 to 2021, and to explore demographic factors that correlate with fentanyl overdose. It is hypothesized that the rate of fentanyl overdoses will have significantly increased yearly from 2019 to 2021. Additionally, it is expected that a significant portion (20+%) of decedents will have other drugs identified by the Medical Examiner within their systems. Lastly, it is predicted that there will be a statistically significant difference in fentanyl overdose rates between demographic groups.

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In recent years, the opioid epidemic in the United States has garnered attention on a federal and local level due to the increasing number of fatal overdoses. This study aimed to explore the experiences of parents who have an adult child who has passed away from an opioid overdose. This study used the Double ABC-X model of family stress theory. Bonadaptation versus maladaptation of each parent was discussed across a multitude dimensions. Qualitative semi-structured interviews were conducted with six parents living in the state of Maryland who each had an adult child, age 18+, die from an opioid overdose 2 or more years prior to the study. Data was analyzed using thematic analysis. Themes that emerged were as follows: the grieving process, support vs. stigma, experiences with state and local services, parental guilt, shame, and unanswered questions, coping mechanisms, and post-mortem life changes. While overall adaptation levels varied among participants, all participants reported positive and negative outcomes related to their experience of grief and loss. Implications for clinical practice and intervention are discussed. Researchers also make recommendations for future research. / Master of Science / This study aimed to explore the experiences of parents who have had an adult child pass away from an opioid overdose. The study utilized Family Stress theory, a theory which focuses on how families respond and adapt after a crisis occurs, for this research. The following themes emerged from interviews with parents: the grieving process itself, support vs. stigma, experiences with state and local services, parental guilt, shame, and unanswered questions, coping mechanisms, and post-mortem life changes. While adaptation varied among participants, participants reported both positive and negative outcomes related to their experiences of grief and loss.

This exploratory research assesses the relationship between unintentional fatal overdoses and hospitality environments, with a special focus on the Central Florida region, due to its high annual tourism rates. Multiple methodologies are used to determine the frequency of unintentional fatal overdoses across five calendar years in hotels and motels, analyze statistical significance between location of death and other demographic factors, geographically depict locations of overdoses, and analyze the role that hospitality staff plays in preventing or responding to fatal overdoses on their properties. Upon analyzing overdose data from the District Nine Medical Examiner’s Office Medical Examiner, it was found that 8.4% of unintentional overdose deaths occurred in a hotel or motel in Orange County, and 10.7% of unintentional overdose deaths occurred in a hotel or motel in Osceola County. Geospatial analysis revealed distinct patterns in overdose locations and frequencies, which were congregated in specific geographic areas. Semi-structured interviews were conducted at hotel/motel locations across Orange and Osceola Counties, where hospitality management was interviewed about their experiences, their roles, current procedures, and reservations they would have with implementing programs to reduce fatal overdose. Thematic analysis of the interviews revealed five emerging themes among hospitality management: reluctance in getting involved, “see something, say something,” support for harm reduction and prevention, experiences with drug use, and role of property type. With very minimal existing literature on the topic, this study establishes hotels and motels as locations where overdoses happen and identifies different ways to approach the opioid epidemic that can be used to reduce overdose mortality in hotels and motels while considering the roles and opinions of hospitality staff.

Escalonamento com controle de overdose (EWOC-PH, escalation with overdose control proporcional hazards) é um método bayesiano com controle de overdose que estima a dose máxima tolerada (MTD, maximum tolerated dose) assumindo que o tempo que um paciente leva para apresentar toxicidade segue o modelo de riscos proporcionais. Neste trabalho analisamos quais são as consequências em adotarmos um método que se baseia no modelo de riscos proporcionais quando o tempo até toxicidade segue o modelo de chances de sobrevivência proporcionais. A fim de buscar responder se teríamos uma superestimativa ou uma subestimativa da MTD foram feitas simulações em que consideramos dados de chances de sobrevivência proporcionais e aplicação do método EWOC-PH para analisarmos a MTD. Como uma extensão do método EWOC-PH, propomos o método EWOC-POS que assume que os tempos seguem o modelo de chances de sobrevivência proporcionais. / Escalation with overdose control proportional hazards is a Bayesian method with overdose control that estimates the maximum tolerated dose (MTD) assuming that the time a patient takes to show toxicity follows the proportional hazards model. In this work, we analyse the consequences of adopting a method based on the proportional hazard model when the time until toxicity follows the proportional survival model. In order to seek to answer if we would have an overestimate or an underestimate of MTD, simulations were performed in which we considered proportional odds survival data and application of the EWOC-PH method. As an extension of the EWOC-PH method, we propose the EWOC-POS method which assumes that time until toxicity follows the proportional odds survival model.

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