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Inhalational Durg Abuse
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Jacob Loke, Richard Rowley, Herbert D. Kleber, Peter Jatlow
Opiate overdose victims with complicating pulmonary edema appear more acutely ill. Patients are usually cyanotic and frequently have a frothy white edema exuding from nostrils and mouth. On physical examination, diffuse bilateral crackles are present. On x-rays, there are typically bilateral, diffuse, fluffy acinar infiltrates extending almost to the periphery, though radiographic asymmetry may be present. Severe arterial hypoxemia and hypercapnia are noted. Clinical suspicion of pulmonary edema in a setting of opiate overdose should always be high. Therapy similar to that for uncomplicated opiate overdose, with a narcotic antagonist and supportive measures, is fundamental. However, endotracheal intubation with mechanical ventilation may be required and, in cases of gastric aspiration, the institution of positive end-expiratory pressure is often beneficial (Light and Dunham, 1975). The use of corticosteroids and prophylactic antibiotics may be indicated in this setting, although no prospective studies have been completed to confirm their utility. Patients with uncomplicated pulmonary edema frequently recover within 2-3 days.
You can Teach an Old Dog New Tricks
Published in Jenny Svanberg, The Psychology of Addiction, 2018
Opiate substitution prescriptions such as methadone and buprenorphine (Suboxone or Subutex) provide a vital way to stabilise a chaotic lifestyle focused on chasing the next fix, and also try to shift sensitisation to tolerance by prescribing the substitute drug in a scheduled and regular dosage. They are slow-onset and long-acting, so reduce the highs and crashes of heroin (Clinical Guidelines, 2017). A drug called naloxone blocks opiate receptors, and when administered reverses the effects of heroin, and can therefore reverse opiate overdose. National campaigns have ensured access and availability of this life-saving drug for people using heroin, so that those likely to be first on the scene at an overdose have a way of preventing it. Medicines have also been developed to address other symptoms associated with addictive behaviours, such as cravings and withdrawal symptoms, although a review of these is beyond the scope of this book.
Narcotic Addiction
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Mark S. Gold, Charles A. Dackis, A. L. C. Pottash, R. Bruce Lydiard
Because of the ability of cyclazocine to block the effects of other opiates,15 attempts were made to treat opiate addicts with it. Once adequate blood levels were obtained, exogenous narcotics did not produce euphoria.16 Later, a pure opiate antagonist, naloxone, was synthesized17 and used in an attempt to discourage former addicts from the use of opiates. This was unsuccessful, probably due to the short period of naloxone action within the body.18 Because of rapid turnover, an addict could experience euphoria within 24 hr of discontinuing naloxone, making it only a minor deterrent. This lead to the synthesis of a longer-acting, orally effective narcotic antagonist, naltrexone,19,20 which is currently being evaluated for efficacy in prophylaxis against relapse in recently detoxified addicts.13 Naloxone remains the mainstay of emergency opiate overdose treatment.
The impact of obesity in patients hospitalized with opioid/opiate overdose
Published in Substance Abuse, 2022
Paul Archibald, Kavitha Subramoney, Hind A. Beydoun, Ché Matthew Harris
The current study supports previous research indicating that patients with obesity have longer stays in the hospital and utilize more hospital resources.18,19 Our study is unique in that it identified obesity as a risk factor for these outcomes in patients presenting with opioid/opiate overdose. Patients in our study with obesity and opioid/opiate overdose had prolonged hospitalizations and higher hospital charges. Though observational studies cannot determine the causes of such findings, several factors should be considered, which may possibly explain higher hospital resource utilizations. First, patients with obesity and opioid/opiate overdose were sicker compared to those without obesity—suggested by higher respiratory failure and need for mechanical ventilation/intubation which requires critical care and prolonged hospitalizations. Additionally, obese patients hospitalized with opioid/opiate overdose had more comorbidities contributing and not contributing to their hospitalization that required management.
HD-tDCS as a neurorehabilitation technique for a case of post-anoxic leukoencephalopathy
Published in Neuropsychological Rehabilitation, 2022
Sarah Garcia, Benjamin M. Hampstead
Post-anoxic leukoencephalopathy (PAL) can occur in more severe cases of anoxia and is a rare condition in which patients show initial recovery, sometimes returning to their baseline status, only to later show clinical decline consistent with hypoxic/anoxic injury days or weeks later (Shprecher & Mehta, 2010; Thacker et al., 1995). PAL causes damage to the brain via global demyelination, though typically sparing the cerebellum and brainstem (Shprecher & Mehta, 2010). While PAL etiology is unknown (Shprecher & Mehta, 2010; Zamora et al., 2015), it has been reported in those who experienced benzodiazepine and opiate overdose (Peter et al., 2004; Salazar & Dubow, 2012), carbon monoxide poisoning, complications from surgical anesthesia, and cardiac arrest (Shprecher & Mehta, 2010).
Patient perspectives of barriers to naloxone obtainment and use in a primary care, underserved setting: A qualitative study
Published in Substance Abuse, 2021
Jennifer Ko, Emily Chan, Shadi Doroudgar
In spite of the effectiveness of community naloxone distribution, opiate overdose remains a considerable cause of mortality. Importantly, the opioid epidemic is evolving and initiatives to combat it are disproportionately distributed across the nation.10 Although non-Hispanic White Americans make up the largest percentage of opioid-related overdose deaths at about 80%, non-Hispanic Black Americans experienced the largest increase in deaths from 2016 to 2017, growing by 25.2% compared to 10.9% among their White counterparts.10 Furthermore, although uninsured, unemployed, or low-income individuals are at higher risk for opioid misuse,11 many do not seek treatment due to unwillingness, lack of health care coverage, fear of negative impacts on job or community opinion, or lack of transportation.12