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Care of opiate users: maintenance treatment
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
Where heroin is used by injection, the preferred route for heavy users because of the relative efficiency of this method of delivery, the health risks encountered include deep vein thrombosis, pulmonary embolus and sepsis both local and systemic. Where injecting equipment is shared, there are the attendant risks of transmission of bloodborne viruses, with an estimated 20–70% of injecting drug users being positive for hepatitis C antibodies.2 Although the proportion of injecting drug users who have evidence of hepatitis B and HIV is lower, the risk is nevertheless significant. General unwanted side-effects of heroin use include low salivary flow, leading to severe dental decay, severe constipation and adverse effects on pregnancy outcomes. Death associated with heroin use is common, with injecting drug users experiencing approximately 14 times the mortality rate compared with their non-drug using peers.3 Death is usually the result of coma and respiratory depression from heroin overdose, often in conjunction with other respiratory and CNS depressants such as alcohol, other opiates and benzodiazepines.
The solution is the problem
Published in J. Michael Ryan, COVID-19, 2020
Another common way that police officers criminalize citizens is by regarding victims as potential perpetrators. During his class, a police academy instructor asked his students, Is a call about a heroin overdose a call for help or a crime call? Can be both. If drugs are on the scene, then it is a crime call. If they already used them, it is a call for help. But be aware if he gets Narcan they will resist and fight, and so it is a crime call.The presumptions revealed in this example, particularly with regards to viewing a physiological response to a prescription treatment as a catalyst for a potential criminal act, demonstrate how a call for help can likely result in an arrest – a particularly disturbing policing practice that is commonly observed today. Police are trained to construct people as worthy and unworthy of assistance, framed by racial and classed assumptions that supersede any larger health or safety goals believed to be the objectives of police work during the pandemic.
Homeless Healthcare
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
Regarding dependence on heroin and other opioids, replacement therapy has been shown to be highly effective [27]. As well as reducing illicit opioid use, it is beneficial in reducing associated risk behaviours and criminal activity. Opioid overdose prevention programmes, which train people at risk and their contacts to recognise overdose and administer naloxone to reverse the effects, have been shown to reduce heroin overdose-related deaths [53]. Educating patients who misuse opiates regarding the risk factors for drug overdoses should also be a health promotion priority (see box below).
The onset and severity of acute opioid toxicity in heroin overdose cases: a retrospective cohort study at a supervised injecting facility in Melbourne, Australia
Published in Clinical Toxicology, 2022
Nathan C. Stam, Shelley Cogger, Jennifer L. Schumann, Anthony Weeks, Amanda Roxburgh, Paul M. Dietze, Nicolas Clark
There is a paucity of information relating to the direct toxicological effects that occur in heroin overdose cases at the time of the overdose event, including the typical clinical and physiological features associated with more severe levels of acute opioid toxicity. A key reason for this is that the majority of heroin overdose cases occur in the community rather than in a clinical setting that enables the identification, assessment, and monitoring of acute opioid toxicity at the time that an overdose occurs. The differentiation and description of opioid toxicity features associated with heroin overdose events are important because it provides evidence to inform public health and harm reduction strategies in order to reduce the frequency and severity of adverse outcomes resulting from heroin overdose. In this study, we aimed to differentiate the severity of acute opioid toxicity and describe both the clinical and physiological features associated with heroin overdose events in a cohort of witnessed overdose cases.
The role of take-home naloxone in the epidemic of opioid overdose involving illicitly manufactured fentanyl and its analogs
Published in Expert Opinion on Drug Safety, 2019
Hong K. Kim, Nicholas J. Connors, Maryann E. Mazer-Amirshahi
Several factors limit the impact of THN programs on preventing overdose deaths. Fentanyl causes life-threatening ventilatory depression within approximately 2 min after intravenous administration, whereas DAM can take up to 10 min [108]. Heroin overdose victims can survive up to 20 min before succumbing to a fatal overdose [135]. Therefore, there is only a very narrow window for a layperson to intervene. According to the CDC, 44% of overdose fatalities reported from 11 of the 32 states and the District of Columbia that participate in the ESOOS program occurred when bystanders were present. But only 0.8% to 4% of the decedents received naloxone administered by a layperson [136]. It is unclear from the CDC’s report whether the decedents were suspected to be dead when the bystanders discovered them, resulting in the low naloxone administration rate, or if the decedents did not respond to naloxone due to delayed or inadequate dose. Several other studies also documented that opioid overdose frequently occurs when the person is alone and that, even when bystanders are present, only a small number of overdose victims/decedents receive naloxone [137,138].
Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment
Published in Clinical Toxicology, 2018
Nathan C. Stam, Jennifer L. Pilgrim, Olaf H. Drummer, Karen Smith, Dimitri Gerostamoulos
Heroin overdose is a major public health concern and the leading cause of death for people who use heroin [1,2]. Non-fatal heroin overdose is a far more common occurrence than fatal heroin overdose, with only 3.1% of all heroin overdose events in Australia resulting in death [3]. A recent report from a medically supervised injecting center in Sydney, Australia revealed an overdose rate of 12.7 heroin overdoses per 1000 injections, or on average, one overdose for every 80 injections of heroin [4]. Heroin overdose is a problem because it is associated with the rapid onset of opioid-induced ventilatory impairment that can lead to hypoxia and hypercapnia secondary to central nervous system depression, the loss of airway reflexes, respiratory failure and pulmonary aspiration [5–10].