Naloxone Use in the Opioid Epidemic
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
Drug overdose deaths continue to rise in the United States. Two out of three overdose deaths involve an opioid, which includes prescription opioids, heroin, and synthetic opioids such as fentanyl. Naloxone is thought to be a competitive antagonist of the mu-, kappa-, and delta-receptors, inhibiting both the toxic and clinical effects of opioids, making it an effective antidote for opioid overdoses. Access to naloxone has been increasing in recent years. Between 2017 and 2018, naloxone prescriptions doubled from 270,000 prescriptions written in 2017 to 556,000 prescriptions written in 2018. The opioid crisis was created by multiple factors, and it will take a concerted effort from multiple disciplines, including healthcare professionals, legislators, and the general public, to address it effectively. Wider access to naloxone is an important component to help fight opioid deaths and ensure that this crisis does continue in the future.
Pain management and sedation
Chris Carter in Critical Care Nursing in Resource Limited Environments, 2019
A survey of the International Association for the Study of Pain members in low resource settings revealed 91% of members reported limited education was the main barrier to pain management. The perception amongst healthcare professionals can influence pain management strategies; for example, Chan et al. reported while surgeons recognised effective pain management improved recovery, they also found 70% of surgeons felt patients should expect pain post-operatively. Effective pain management in critical care allows endotracheal tube (ETT) tolerance, mechanical ventilation, suctioning and other distressing procedures to be undertaken, co-operation with care, reduce stress response and cause less disturbing memories. Assessing pain in a critically ill patient can be challenging, due to sedation or an ETT preventing communication, resulting in pain often being underassessed and undertreated. Critically ill patients often require continuous infusions of both short-acting analgesia and sedations if ventilated. Examples include: analgesics: morphine or fentanyl and sedations: midazolam or propofol.
Opioids
David J. George in Poisons, 2017
Opioids are indispensable in medical practice because of their ability to relieve pain irrespective of the source. Opioids also produce sedation and euphoria, which can foster misuse and abuse leading to addiction. The abusive use of opioids in variable doses in erratic dosing schedules combined with the concurrent use of other stimulant or sedative drugs can have life-threatening consequences. The three principle symptoms of an opioid overdose are miosis, unconsciousness, and respiratory depression. Toxicological testing of blood and urine from the woman revealed lethal levels of fentanyl and buprenorphine; no other drugs were detected. Urine screening was positive for cocaine and opioids. Vital signs remained normal for a 6-hour observation period and then he transferred to an inpatient psychiatric ward. Opioids are marketed in many forms and strengths. Long-lasting oral tablets and capsules can pose an increased risk of toxic overdose when used therapeutically without medical follow-up and dosage adjustments.
Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour?
Published in Journal of Obstetrics and Gynaecology, 2015
M. Genc, N. Sahin, J. Maral, E. Celik, A. A. Kar, P. Usar, B. Korkut, S. Guclu
In this study we aimed to explore the effects of epidural analgesia achieved by a combination of low-dose bupivacaine and fentanyl infused through an epidural catheter on mother, foetus and labour process in nulliparous at-term pregnant women during vaginal delivery. This study was designed in a prospective, randomised controlled manner. Epidural analgesia was achieved in 50 nulliparous women. Fifty nulliparous women did not undergo epidural analgesia procedure. The duration of the first stage of labour was significantly shortened, while the second stage was significantly lengthened in pregnant women who underwent epidural analgesia (p < 0.05). In conclusion, starting epidural analgesia application during the active phase of the first stage of labour may shorten the duration of the first stage compared with the group of nulliparous women not undergoing epidural analgesia. The factor that has an impact on this may be the addition of fentanyl to bupivacaine used for epidural analgesia.
Prevalence of recent fentanyl use among treated users of illicit opioids in England: based on piloted urine drug screens
Published in Clinical Toxicology, 2019
Prun Bijral, Karen P. Hayhurst, Sheila M. Bird, Tim Millar
Objective: To use a pilot of national fentanyl screening to establish the current prevalence of recent fentanyl use among treated users of illicit opioids in the English treatment system and inform the design of a full study. Design: Cross-sectional fentanyl metabolite urine screening in randomly-selected study sites, stratified to cover all nine geographical regions of England, supplemented with self-report subsequent to a positive fentanyl test. Patients: 468 adult (18 years of age and above) patients receiving treatment for opioid use disorder, screened December 2017 to May 2018. Results: The fentanyl-positive rate in patients receiving treatment for opioid use disorder in the English treatment system was 3% (15/468, 95% CI 1.8% to 5.2%) with a per-site range (for the 10 sites in 9 regions where fentanyl was detected) of between 2% (1/57) and 15% (4/27). Self-report data indicated that the majority of fentanyl-positives (12/15, 80%) was unaware of having purchased fentanyl. Conclusions: Despite alerts already in place, patients receiving treatment for opioid use disorder, who were fentanyl-positive, were unwittingly purchasing and consuming fentanyl.
Fentanyl Dependence Caused by the Non-Medical Use: A Case Report
Published in Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 2010
Omer Gecici, Zehra Gokmen, Melike Nebioglu
Fentanyl is a pure and selective μ opioid receptor agonist. Its analgesic potency is 80–800 times greater than that of morphine with fewer adverse effects. Available formulations of fentanyl patches in Turkey contain 1.25, 2.5, 5, and 7.5 mg or 10 mg of fentanyl and provide a dose of 12.5–100 lgh for up to 72 h. Abuse of fentanyl patches has been ıncreasingly reported along with different routes of administration such as oral-transmural, intravenous, inhalation, and rectal use. There are many case reports about complications of fentanyl patches because of misuse or abuse. However, this is the first case from Turkey reporting fentanyl dependency in a 59 year old male patient, who had started to use fentanyl without any medical indication. Although abuse of fentanyl is commonly reported, patients should be carefully scrutinized for fentanyl dependence as well.
Related Knowledge Centers
- Benzodiazepine
- Pain
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- Abstral
- Opioid
- Anesthetic