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Cureus 2020 Jan 23;12(1):e6750. Epub 2020 Jan 23.

Public Health Directorate, Cambridgeshire County Council, Cambridge, GBR.

Background:  Drug-related deaths are a growing public health problem in the United Kingdom, overtaking road fatalities and homicides in terms of annual deaths. In this study, we investigated the causes and circumstances of unintentional drug-related deaths occurring in the county of Cambridgeshire, with the objective of identifying the prevalence of physical, mental, and social health problems within this cohort.

Methods:  We collected data on the demographics and mental and physical health of, and drugs contributing to, 30 consecutive unintentional drug-related deaths recorded by the Cambridgeshire and Peterborough County Council Coroners in 2017. Read More

Int J Drug Policy 2020 Mar 4;77:102672. Epub 2020 Feb 4.

Health Protection Research Unit for Chemical and Radiation Threats and Hazards, Newcastle University, Newcastle NE2 4HH, United Kingdom.

Background: There have been recent increases in use of new psychoactive substances (NPS) associated with acute health harms including hospital presentations due to toxicity and increasing numbers of deaths. In response, the UK Government enacted generic legislation on 26th May 2016 (the Psychoactive Substances Act) making it an offence to produce, possess with intent to supply, supply, import or export, or possess within a custodial setting a psychoactive substance. We studied the impact of this Act on monthly frequency of enquiries made by health professionals to the UK National Poisons Information Service (NPIS) about NPS. Read More

CJEM 2020 Mar;22(2):178-186

Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.

Objectives: Evaluate the relationship between naloxone dose (initial and cumulative) and opioid toxicity reversal and adverse events in undifferentiated and presumed fentanyl/ultra-potent opioid overdoses.

Methods: We searched Embase, MEDLINE, Cochrane Central Register of Controlled Trials, DARE, CINAHL, Science Citation Index, reference lists, toxicology websites, and conference proceedings (1972 to 2018). We included interventional, observational, and case studies/series reporting on naloxone dose and opioid toxicity reversal or adverse events in people >12 years old. Read More

Curr Neuropharmacol 2020 Jan 10. Epub 2020 Jan 10.

Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, AL10 9AB, Herts. 0.

Background: NPS belonging to the benzodiazepine (BZD) class, e.g., 'legal/designer BZDs'/'research chemicals', have recently emerged on the drug (mainly online/virtual) market. Read More

BMC Health Serv Res 2019 Dec 11;19(1):957. Epub 2019 Dec 11.

, Cleveland, USA.

Background: Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Project DAWN (Deaths Avoided with Naloxone) is an opioid overdose education and naloxone distribution program in Ohio that distributes naloxone rescue kits at clinics and in the emergency departments of a single hospital system.

Methods: We performed a retrospective analytic cohort study comparing heroin overdose survivors who presented to the emergency department and were subsequently discharged. Read More

Clin Pract Cases Emerg Med 2019 Nov 14;3(4):440-441. Epub 2019 Oct 14.

Brown University, Department of Emergency Medicine, Division of Medical Toxicology, Providence, Rhode Island.

A 54-year-old man presented to the emergency department with confusion and Parkinsonian features after suspected heroin snorting. He had magnetic resonance imaging of the brain demonstrating isolated symmetric bilateral globus pallidus (GP) restricted diffusion and edema consistent with hypoxic ischemic encephalopathy. In contrast to other anoxic/ischemic insults, where the GP is preferentially spared, autopsy reports on intravenous heroin users have found the GP to be specifically affected, often demonstrating symmetric bilateral lesions. Read More

J Pharm Biomed Anal 2020 Jan 31;178:112944. Epub 2019 Oct 31.

Nanotechnology and Water Sustainability (NanoWS) Research Unit, University of South Africa, College of Science and Engineering and Technology (CSET), UNISA Science Campus, 1710 Roodepoort, Johannesburg, South Africa. Electronic address:

Increased use of psychoactive drugs and their continuous release into the aquatic environment threatens the aquatic life, human and animal's life. As such this study was aimed at investigating the occurrence and the associated exposure human health risks of psychoactive drugs residues. The psychoactive drugs investigated include amphetamine, methylphenidate, heroin, cocaine and metabolites included are mainly morphine, 6-acetylmorphine and benzoylecgonine. Read More

Bioorg Med Chem Lett 2019 Dec 28;29(24):126754. Epub 2019 Oct 28.

Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 S. Limestone, Lexington, KY 40536, United States. Electronic address:

Cholinesterase inhibitors have long been used in the treatment of Alzheimer's Disease (AD) via the protection of acetylcholine levels. However, recent research has shown that the specific inhibition of butyrylcholinesterase (BChE) could better ameliorate symptoms within patients. In addition, it has recently been shown that selective inhibition of BChE can also significantly attenuate the toxicity and physiological effects of heroin. Read More

Addict Behav 2020 02 15;101:106142. Epub 2019 Oct 15.

Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, USA.

Introduction: Polysubstance use and misuse can increase risks for nonfatal and fatal drug overdose. To categorize drugs used in combination in nonfatal overdoses, we analyzed data from emergency department (ED) overdose-related visits in 18 states funded by CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program.

Methods: From 2017 to 2018, 120,706 ED visits included at least one hospital discharge code indicating acute drug poisoning for opioids, stimulants, hallucinogens, cannabis, anti-depressants, sedatives, alcohol, benzodiazepines, or other psychotropic drugs. Read More

J Clin Med 2019 Aug 23;8(9). Epub 2019 Aug 23.

Department of Immunology, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania.

Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Read More

Forensic Sci Int 2019 Sep 22;302:109848. Epub 2019 Jun 22.

National Institute of Toxicology and Forensic Sciences,Ministry of Justice , Calle José Echegaray, 4, 28232 - Las Rozas de Madrid, Madrid, Spain. Electronic address:

Opium is a substance extracted from Papaver somniferum L that is chronically abused specially in the traditional production regions. Reports on opium poisoning has largely disappeared from the occidental literature on drug problems but recent scientific articles show cases of death related to opium in industrialized countries. This fact led us to consider the interest of knowing the state of the art of acute opium intoxication in modern times. Read More

Emerg Med Australas 2020 Feb 21;32(1):88-92. Epub 2019 Jul 21.

Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

Objective: Naloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning.

Methods: This was a retrospective review of poisoned patients presenting to a clinical toxicology unit in Brisbane from January 2015 to December 2017. Read More

Acad Forensic Pathol 2018 Sep 31;8(3):729-737. Epub 2018 Aug 31.

Over a three-month period in early 2017, the Hennepin County Medical Examiner's Office investigated nine apparent opioid toxicity deaths that occurred in three separate urban, suburban, and rural counties in our jurisdiction. All decedents were known substance abusers and had reportedly recently used heroin; most were found with drug paraphernalia. Complete autopsies variably showed classic stigmata of opioid overdose with no significant injury or natural disease to explain death. Read More

Br J Clin Pharmacol 2019 09 17;85(9):2098-2107. Epub 2019 Jul 17.

Translational Australian Clinical Toxicology Program, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.

Aims: We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs.

Methods: This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug-associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF. Read More

Clin Toxicol (Phila) 2020 Feb 16;58(2):117-123. Epub 2019 May 16.

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Prepacked naloxone kits (PNKs) are frequently used to reverse opioid intoxication. It is unknown if the presence of illicitly manufactured fentanyl and its analogs (IMFs) in heroin supply is affecting the PNK doses given by laypersons. We investigated the trend of PNK dose administered to reverse opioid toxicity in suspected/undifferentiated opioid intoxication. Read More

Forensic Sci Int 2019 Jul 26;300:75-81. Epub 2019 Apr 26.

U.S. Army, Combat Capabilities Development Command Chemical Biological Center, Aberdeen Proving Ground, MD, USA.

In 2017, 47,600 overdose deaths were reported to be associated with the abuse of opioids, including prescription painkillers (e.g. oxycodone), opiates (e. Read More

Forensic Sci Int 2019 Jul 17;300:13-18. Epub 2019 Apr 17.

LGC Sport and Specialised Analytical Services, Fordham, Cambridgeshire, United Kingdom.

Background: Fentanyl and analogues such as butyrylfentanyl, carfentanil, 4-fluorobutyrylfentanyl, and furanylfentanyl may be either added to, or sold as, heroin. Fentanyl and carfentanil have approximately 100 and 10,000 times the potency of morphine, respectively, and there is thus a high risk of death with the use of these drugs.

Methods: We looked for fentanyl/fentanyl analogues using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in selected biological samples obtained post-mortem February 2017-end January 2018. Read More

BMC Emerg Med 2019 04 29;19(1):29. Epub 2019 Apr 29.

Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway.

Background: Female drug users report poorer physical and mental health than male drug users. We describe female and male patients treated for acute recreational drug toxicity, and look for gender differences in clinical state, treatment, and toxic agents taken.

Methods: Retrospective case series from a primary care emergency outpatient clinic and a hospital emergency department in Oslo, Norway. Read More

J Mol Model 2019 Apr 24;25(5):121. Epub 2019 Apr 24.

Department of Physical Sciences, Indian Institute of Science Education & Research (IISER) Mohali, Sector 81 SAS Nagar, Manauli PO, 140306, Punjab, India.

Heroin, or diamorphine (CHNO), is an opium product used for various pharmaceutical and euphoric purposes. In this work, the molecular dynamics simulation study of the heroin inside the two lipid bilayers, dipalmitoylphosphatidylcholine (DMPC) and dipalmitoylphosphatidylcholine (DPPC) are presented. The whole study was conducted at three different temperatures. Read More

Mol Pharm 2019 06 14;16(6):2364-2375. Epub 2019 May 14.

Hennepin Healthcare Research Institute , Minneapolis , Minnesota 55404 , United States.

This study focused on formulating conjugate vaccines targeting oxycodone and heroin for technology transfer, good manufacturing practice (GMP), and clinical evaluation. Lead vaccines used the highly immunogenic carrier protein keyhole limpet hemocyanin (KLH), which poses formulation problems because of its size. To address this barrier to translation, an oxycodone-based hapten conjugated to GMP-grade subunit KLH (OXY-sKLH) and adsorbed on alum adjuvant was studied with regard to carbodiimide coupling reaction time, buffer composition, purification methods for conjugates, conjugate size, state of aggregation, and protein/alum ratio. Read More

Neurotoxicology 2019 07 8;73:183-187. Epub 2019 Apr 8.

Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK; Clinical Toxicology, Faculty of Life Sciences and Medicine, King's College London, London, UK.

Seizures are a recognized and potentially serious complication of recreational drug use. This study examined a large international data set of presentations to Emergency Departments with acute recreational drug toxicity, the European Drug Emergencies Plus (Euro-DEN Plus) Network, to compare presentations with and without seizures and estimate incidence and associated drugs. Amongst 23,947 presentations between January 2014 and December 2017, there were 1013 (4. Read More

Subst Use Misuse 2019 20;54(6):980-985. Epub 2019 Jan 20.

a British Columbia Centre on Substance Use , British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , British Columbia , Canada.

Background: In North America, rates of overdoses are increasing largely due to the adulteration of illicit drugs by illicit synthetic opioids.

Objectives: We sought to examine the prevalence and correlates of self-reported exposure to adulterated drugs among people who experienced a non-fatal opioid overdose.

Methods: Data were derived from three prospective cohort studies of people who use drugs in Vancouver, Canada between June and November 2016. Read More

Emerg Med J 2019 Apr 22;36(4):219-224. Epub 2018 Dec 22.

Dalhousie University, Halifax, Canada.

Introduction: Death due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Read More

J Forensic Sci 2019 May 28;64(3):888-896. Epub 2018 Nov 28.

The Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA, 19090.

The following report summarizes a study performed on seized drug exhibits collected in two U.S. states to evaluate the presence and identification of cutting agents. Read More

J Neurol 2019 Feb 26;266(2):316-329. Epub 2018 Nov 26.

Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Objective: Toxic leukoencephalopathy is a rare but critical neurological disorder in heroin abusers. Our aim is to compare the clinical manifestations, brain MRIs and prognoses of heroin-induced leukoencephalopathy by different intake routes.

Methods: We present two patients with toxic leukoencephalopathy caused by intravenous (IV) injection of heroin and 48 additional cases from systematic reviews of the literature published between 1994 and 2018. Read More

J Pharmacol Exp Ther 2019 02 21;368(2):229-236. Epub 2018 Nov 21.

Departments of Pharmacology (L.R.G., D.R.M., J.H.W., C.P.F.) and Psychiatry (C.P.F.) and Addiction Research, Treatment & Training Center of Excellence (L.R.G., D.R.M., J.H.W., C.P.F.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom (S.M.H., A.D.)

One consequence of the ongoing opioid epidemic is a large number of overdose deaths. Naloxone reverses opioid-induced respiratory depression; however, its short duration of action limits the protection it can provide. Methocinnamox (MCAM) is a novel opioid receptor antagonist with a long duration of action. Read More

J Psychopharmacol 2019 03 19;33(3):347-354. Epub 2018 Nov 19.

1 Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

Background: The unprecedented proliferation of new psychoactive substances (NPS) threatens public health and challenges drug policy. Information on NPS pharmacology and toxicity is, in most cases, unavailable or very limited and, given the large number of new compounds released on the market each year, their timely evaluation by current standards is certainly challenging.

Aims: We present here a metabolomics-targeted approach to predict the pharmacological profile of NPS. Read More

Clin Toxicol (Phila) 2019 05 17;57(5):325-330. Epub 2018 Nov 17.

a Department of Forensic Medicine , Monash University , Melbourne , Australia.

Aim: Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases. Read More

Sci Rep 2018 11 13;8(1):16762. Epub 2018 Nov 13.

Molecular Modeling and Biopharmaceutical Center, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA.

Heroin is a growing national crisis in America. There is an increasing frequency of heroin overdoses. All of the currently used therapeutic approaches to treatment of heroin abuse and other opioid drugs of abuse focus on antagonizing a brain receptor (particularly µ-opiate receptors). Read More

J Pharmacol Exp Ther 2019 02 8;368(2):282-291. Epub 2018 Nov 8.

Hennepin Healthcare Research Institute (formerly Minneapolis Medical Research Foundation), Minneapolis, Minnesota (M.D.R., F.B., S.J.P., T.M.H., J.R.V., P.R.P., M.P.); Department of Medicinal Chemistry, University of Minnesota College of Pharmacy Minneapolis, Minnesota (M.L.N.); MLN BioPharma Consulting LLC (M.L.N.) Minneapolis, Minnesota; and Departments of Pharmacology (M.P.) and Medicine (P.R.P., M.P.), and Center for Immunology (M.P.), University of Minnesota Medical School, Minneapolis, Minnesota.

Fentanyl is an extremely potent synthetic opioid that has been increasingly used to adulterate heroin, cocaine, and counterfeit prescription pills, leading to an increase in opioid-induced fatal overdoses in the United States, Canada, and Europe. A vaccine targeting fentanyl could offer protection against the toxic effects of fentanyl in both recreational drug users and others in professions at risk of accidental exposure. This study focuses on the development of a vaccine consisting of a fentanyl-based hapten (F) conjugated to keyhole limpet hemocyanin (KLH) carrier protein or to GMP-grade subunit KLH (sKLH). Read More

PLoS One 2018 7;13(11):e0207027. Epub 2018 Nov 7.

Computational Biology Department, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America.

Opioids are widely used for treating different types of pains, but overuse and abuse of prescription opioids have led to opioid epidemic in the United States. Besides analgesic effects, chronic use of opioid can also cause tolerance, dependence, and even addiction. Effective treatment of opioid addiction remains a big challenge today. Read More

Addiction 2019 03 3;114(3):504-512. Epub 2018 Dec 3.

Department of Forensic Medicine, Monash University, Melbourne, Australia.

Aims: To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases.

Methods: Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study. Read More

Chem Res Toxicol 2019 01 16;32(1):113-121. Epub 2018 Nov 16.

ABiox Company, 720 East First Street , Newberg , Oregon 97132 , United States.

The leaves of the Mitragynine speciosia tree (also known as Kratom) have long been chewed, smoked, or brewed into a tea by people in Southeastern Asian countries, such as Malaysia and Thailand. Just this past year, the plant Kratom gained popularity in the United States as a "legal opioid" and scheduling it as a drug of abuse is currently pending. The primary alkaloid found in Kratom is a μ-opioid receptor agonist, mitragynine, whose structure contains a promising scaffold for immunopharmacological use. Read More

J Med Toxicol 2018 12 30;14(4):306-322. Epub 2018 Oct 30.

Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.

Opioid use disorder continues to be a significant source of morbidity and mortality in the USA and the world. Pharmacologic treatment with methadone and buprenorphine has been shown to be effective at retaining people in treatment programs, decreasing illicit opioid use, decreasing rates of hepatitis B, and reducing all cause and overdose mortality. Unfortunately, barriers exist in accessing these lifesaving medications: users wishing to start buprenorphine therapy require a waivered provider to prescribe the medication, while some states have no methadone clinics. Read More

J Anal Toxicol 2019 Jan;43(1):1-9

University of Florida, Gainesville, FL, USA.

In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs. Read More

Daru 2018 Sep 29;26(1):77-83. Epub 2018 Jun 29.

Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, P.O. Box 8678-3-65178, Hamadan, Iran.

Background: The toxic metals and/or bacterial contaminants in illicit drugs are the main health problems in drug users worldwide. Hence, the potential risks of these contaminants were evaluated in some of the illicit drugs during 2015 and 2016.

Methods: The metals analysis were performed using graphite furnace atomic absorption spectrophotometry. Read More

Drug Test Anal 2019 Feb 18;11(2):292-304. Epub 2018 Oct 18.

NHS Tayside, Ninewells Hospital, Dundee, UK.

The abuse of heroin (diamorphine) and heroin-related deaths are increasing around the world. The interpretation of the toxicological results from suspected heroin-related deaths is notoriously difficult, especially in cases where there may be limited samples. To help forensic practitioners with heroin interpretation, we determined the concentration of morphine (M), morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) in blood (femoral and cardiac), brain (thalamus), liver (deep right lobe), bone marrow (sternum), skeletal muscle (psoas), and vitreous humor in 44 heroin-related deaths. Read More

Handb Exp Pharmacol 2018;252:495-541

Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.

This chapter describes how new psychoactive substances (NPS) have been involved in fatal intoxications from 2010 and onwards. It summarizes the circumstances, antemortem symptoms, and adverse effects that have led to death after ingestion of one or more NPS and tabulates concentrations, and postmortem findings from these intoxications.Consumption of NPS exerts health problems and unknown risks for the users. Read More

Forensic Sci Int 2018 Sep 19;290:219-226. Epub 2018 Jul 19.

Department of Forensic Medicine, Monash University, Melbourne, Australia.

Background & Aims: Heroin use is associated with a disproportionately high level of morbidity and mortality with most deaths attributable to drug overdose. Aggregate heroin purity data has been used to examine the relationship between overdose and variability in street-level heroin, however heroin purity data alone may not be the most appropriate nor a sensitive enough measurement tool for this assessment. The aim of this study was to measure the variability in effective dose of street-level heroin seizures, accounting for variation in both purity and mass, and determine the proportion of samples with higher than expected effective dose that would not be detected using a purity-only measure. Read More

J Med Toxicol 2019 01 31;15(1):4-11. Epub 2018 Jul 31.

Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.

Introduction: Polydrug use involving heroin and benzodiazepines is common. The potential risk of additive pharmacological effects may be associated with poorer outcomes in patients who use benzodiazepines together with heroin. The aim of this study was to determine the clinical picture of patients presenting to the emergency department following acute drug toxicity involving heroin and benzodiazepines. Read More

Drug Alcohol Depend 2018 09 4;190:112-119. Epub 2018 Jul 4.

National Institute on Drug Abuse, Division of Epidemiology, Services, and Prevention Research, Rockville, MD, USA.

Background: Little is known about risk factors for repeated opioid overdose and fatal opioid overdose in the first year following nonfatal opioid overdose.

Methods: We identified a national retrospective longitudinal cohort of patients aged 18-64 years in the Medicaid program who received a clinical diagnosis of nonfatal opioid overdose. Repeated overdoses and fatal opioid overdoses were measured with the Medicaid record and the National Death Index. Read More

JAMA Neurol 2018 11;75(11):1423-1434

Neurocritical Care and Stroke Division, Department of Neurology, The Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.

Importance: Opioid addiction affects approximately 2.4 million Americans. Nearly 1 million individuals, including a growing subset of 21 000 minors, abuse heroin. Read More

Drug Alcohol Depend 2018 09 13;190:62-71. Epub 2018 Jun 13.

Tennessee Department of Health, Office of Informatics and Analytics, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN, 37243, United States; Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, United States.

Background: Opioid overdose deaths have continued to rise in Tennessee (TN) with fentanyl emerging as a major contributor. Current data are needed to identify at-risk populations to guide prevention strategies. We conducted a large statewide observational study among TN adult decedents (2013-2016) to evaluate the association of sociodemographic factors and prescribing patterns with opioid overdose deaths. Read More

Front Pharmacol 2018 20;9:654. Epub 2018 Jun 20.

Section of Legal Medicine, Università Politecnica delle Marche, Ancona, Italy.

A class of opioid agonists not structurally related to fentanyl, derived from research publications of pharmaceutical companies or patents within the United States and abroad are contributing to the current opioid epidemic. Novel synthetic opioids (NSOs) created to circumvent drug control laws such as U-47700, U-49900, AH-7921, or MT-45 have no recognized therapeutic use, are clandestinely manufactured and sold on conventional or dark web. We herein provide a review of the pharmacological properties available on most of these substances trying to provide a better knowledge on these compounds, particularly with respect to toxicity and dangerous adverse effects in users. Read More

J Forensic Sci 2019 Jan 25;64(1):149-153. Epub 2018 Jun 25.

Michigan Medicine Department of Pathology/Wayne County Medical Examiner's Office, 1300 E Warren Ave, Detroit, MI, 48207.

Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is a potent opioid analgesic with no medicinal uses. We report deaths between 2016 and 2017 at the Medical Examiner's Office in Detroit, MI where acetyl fentanyl was found in the decedent's blood and compare them to previously published deaths between 2015 and 2016. The recent cases (cohort B) had a mean acetyl fentanyl concentration of 0. Read More

Handb Clin Neurol 2018 ;155:333-352

Neurology Service, Hôpital Erasme, Brussels, Belgium.

The cerebellum is a brain region which is particularly susceptible to intoxication. Clinical presentation is heterogeneous. It is often considered that elderly patients and patients presenting pre-existing structural lesions of the posterior fossa are particularly at risk of developing a toxic-induced cerebellar syndrome (TOICS). Read More