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Drug Overdoses during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
If the patient is still conscious, she will likely provide the most accurate information on drugs taken. Notably, drug overdoses are usually premeditated. Frequently, the patient will recall estimates of how many pills were taken of which substances. Family members significant, if present at the time of clinical evaluation, they should be able to provide corroborative information (i.e., presence of medicine bottles, known prescriptions, patient statements, etc.). Toxicology samples for drug screens should be collected with frequency (i.e., every hour or two) to provide serial evaluation. Toxicology screens should be ordered as soon as possible to determine (1) what substances were ingested, (2) whether or not levels are rising or falling, and (3) whether or not levels are toxic or approaching toxicity. However, a generalized treatment plan may be undertaken before toxicology results are available.
The Opioid Crisis and Relief
Published in Eldo E. Frezza, The Moral Distress Syndrome Affecting Physicians, 2020
Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015, more than half a million people died from drug overdoses (1).
Gastroenterology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
Drug overdose: Paracetamol: Saturation of conjugation reactions → P450 oxidation to NABQI → glutathione consumptionAspirinIron sulphate (zone 1 necrosis)
Poisoning in older adults: characterization of exposures reported to the Dutch Poisons Information Center
Published in Clinical Toxicology, 2022
Saskia J. Rietjens, Joyce E. M. van der Heijden, Dylan W. de Lange
In 23% of the patients exposed to medication, the drugs were taken intentionally (n = 152) (Table 2). In intentional drug overdose, most commonly involved medication was: oxazepam (n = 32 exposures), paracetamol (n = 30), oxycodone (n = 15), lorazepam (n = 12), temazepam (n = 11), zolpidem (n = 9), quetiapine (n = 9) and citalopram (n = 7) (see also Table 3). The median age of the patients intentionally exposed to medication was 73 years old (IQR: 69–79; range: 66–94). The majority of the patients who were intentionally exposed to medication were advised to be evaluated by a physician (n = 43, 28%) or to be observed in hospital (n = 54, 36%), whereas (from a pure toxicological point of view) in 36% (n = 55) observation at home or in nursing home was advised.
Housing Instability, Structural Vulnerability, and Non-Fatal Opioid Overdoses Among People Who Use Heroin in Washington Heights, New York City
Published in Behavioral Medicine, 2022
R. E. Pérez-Figueroa, D. J. Obonyo, S. Santoscoy, H. L. Surratt, H. M. Lekas, C. F. Lewis, J. S. Lyons, S. C. Amesty
More than 69,000 people died of drug overdoses in 2018, making it a leading cause of injury-related death in the US.1 Although the vast majority of drug overdoses involved more than one substance, nearly seven out of ten overdose deaths involve opioids; almost half of opioid-related deaths are due to fentanyl or other synthetic opioids besides methadone. Evidence suggests that opioid-related overdose is a leading cause of death among homeless individuals in the US.2,3 Housing instability is a persistent and striking problem in the nation. On any given night, almost 600,000 people in the US are homeless, taking a terrible toll on morbidity and mortality.4 More than 78,000 New York City (NYC) residents were homeless in 2019,5 and each day, more than four homeless individuals die as a result of an opioid-related overdose.6 Washington Heights (WH) is a neighborhood in the northern portion of Manhattan with high rates of poverty, unemployment, and residents with more difficulties paying rent compared to the average of NYC.7 The majority of the population in WH are people of color (more than 80%): primarily Latinx (69%) and Black (7%).8 Limited information exists on the burden of non-fatal opioid overdoses and its association with housing instability in WH, despite evidence suggesting that opioid overdose rates in WH are among the highest in NYC.6 This information is critical to inform targeted public health responses.
Coroner county systems are associated with a higher likelihood of unclassified drug overdoses compared to medical examiner county systems
Published in The American Journal of Drug and Alcohol Abuse, 2022
Alina Denham, Tarsha Vasu, Paloma Avendano, Andrew Boslett, Michael Mendoza, Elaine L. Hill
Our main independent variable was the MDI system type: coroner or ME. We obtained additional state MDI system characteristics from the CDC (13). These characteristics include the level of qualification needed for the coroner or ME (i.e., must be a qualified doctor, must receive training, or must be a qualified pathologist), whether autopsies must be performed by a pathologist, and whether the state requires coroners to have training. In addition, we included indicators for six circumstances surrounding a death that by state law require coroner or ME involvement. To select these, we conducted a thematic analysis of state law excerpts (13). We included circumstances that were most common and drug overdose relevant: (1) any injury, (2) drug or poisoning death, (3) sudden death, (4) criminal or unknown intent, (5) violent death (including homicide, suicide and firearm injury), and (6) death unattended by a physician. Additionally, we created indicators for the type of state MDI system: centralized, decentralized county-based and decentralized district-based. Centralized systems are likely better equipped to conduct high-quality medical death investigations due to pooling of resources.