Search Our Scientific Publications & Authors

Eur J Case Rep Intern Med 2017 27;4(2):000511. Epub 2017 Mar 27.

Internal Medicine Department, University Hospital 12 de Octubre, Madrid, Spain.

Background: Delayed leukoencephalopathy (DL) is a rare entity associated with cerebral hypoxia and heroin consumption. We describe the clinical course of three cases of DL due to non-heroin drug use.

Material And Methods: We describe the cases of three DL patients admitted to our hospital in 2012. Read More

Emerg Med J 2018 Dec 22. 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 2018 Nov 28. 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 Psychopharmacol 2018 Nov 19:269881118812103. 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) 2018 Nov 17:1-6. 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 Nov 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 Feb 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

Addiction 2019 Mar 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 2018 Nov 16. 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 Dec 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

Handb Exp Pharmacol 2018 Aug 14. Epub 2018 Aug 14.

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 Jan 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

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

Clin Toxicol (Phila) 2018 Jun 6:1-7. Epub 2018 Jun 6.

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

Background: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated.

Methods: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics. Read More

Drug Test Anal 2018 Sep 29;10(9):1483-1487. Epub 2018 Jun 29.

Alere Forensics, Malvern Hills Science Park, Geraldine Road, Malvern, WR14 3SZ, UK.

New psychoactive substances (NPS) are increasingly being seen in forensic casework globally and encompass a number of types of drugs including "designer opioids", especially fentanyl analogues, which are of particular concern due to their high potency and significant risk of toxicity. They are often sold as heroin or mixed with other illicit drugs and therefore users may be unaware they are taking such hazardous compounds. Two fentanyl analogues that have recently been detected are cyclopropylfentanyl and crotonylfentanyl. Read More

Forensic Sci Int 2018 Jun 26;287:40-46. Epub 2018 Mar 26.

National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia; School of Population and Global Health, University of Melbourne, VIC 3010, Australia.

Introduction: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. Read More

Sci Rep 2018 Apr 3;8(1):5508. Epub 2018 Apr 3.

Minneapolis Medical Research Foundation, Minneapolis, MN, USA.

Vaccines offer an option to treat heroin and prescription opioid abuse and prevent fatal overdoses. Opioid vaccines elicit antibodies that block opioid distribution to the brain and reduce opioid-induced behavioral effects and toxicity. The major limitation to the translation of addiction vaccines is that efficacy is observed only in subjects achieving optimal drug-specific serum antibody levels. Read More

Bull World Health Organ 2018 Mar 5;96(3):165-172. Epub 2018 Feb 5.

Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Objective: To describe an outbreak of lead poisoning among opium users in the Islamic Republic of Iran and estimate the number of affected people in the country.

Methods: We used data from the country's largest poison treatment centre to illustrate the epidemiology of an outbreak of lead poisoning in oral opium users. We describe the government's referral and treatment guidelines in response to the outbreak. Read More

BMC Neurosci 2018 03 5;19(1). Epub 2018 Mar 5.

Wuhan Institute of Biomedical Science, Jianghan University, Wuhan, 430056, China.

Background: Understanding the process of relapse to abused drugs and ultimately developing treatments that can reduce the incidence of relapse remains the primary goal for the study of substance dependence. Therefore, exploring the metabolite characteristics during the relapse stage is valuable.

Methods: A heroin self-administered rat model was employed, and analysis of the H-nuclear magnetic resonance-based metabolomics was performed to investigate the characteristic metabolite profile upon reintroduction to the drug after abstinence. Read More

J Psychopharmacol 2018 Jul 27;32(7):793-801. Epub 2018 Feb 27.

2 Psychopharmacology, Drug Misuse & Novel Psychoactive Substances Research Unit, Department of Pharmacy, Pharmacology & Post-graduate Medicine, University of Hertfordshire, Hatfield, UK.

An index of fatal toxicity for new psychoactive substances has been developed based solely on information provided on death certificates. An updated index of fatal toxicity (T), as first described in 2010, was calculated based on the ratio of deaths to prevalence and seizures for the original five substances (amphetamine, cannabis, cocaine/crack, heroin and 3,4-methylenedioxymethylamphetamine). These correlated well with the 2010 index. Read More

BMC Complement Altern Med 2018 Feb 23;18(1):76. Epub 2018 Feb 23.

Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, 19 Xinjiekouwai Street, Haidian district, Beijing, China.

Background: Methamphetamine (METH) is a psychostimulant with high abuse liability that affects the monoamine neurotransmitter systems, particularly the dopamine system. Currently there are no effective medications for the treatment of METH abuse to restore METH-induced dopaminergic dysfunction. The Jitai tablet (JTT), a commercial traditional Chinese medicinal preparation, has been shown to modulate the dopaminergic function both in heroin addicts and in morphine-dependent rats. Read More

Int J Prev Med 2018 5;9. Epub 2018 Jan 5.

Department of Clinical Toxicology, Excellent Center of Clinical Toxicology, Loghman Hakim Hospital Poison Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Substance abuse and its consequences are major health hazards in the world. Opium addiction is a common form of substance abuse in Iran. Adulteration of illegal substances in the process of production and distribution of the drug in black market with many types of materials have been reported. Read More

Medicine (Baltimore) 2018 02;97(5):e9784

Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Basel, Switzerland.

The aim of the study was to compare self-reported and analytically confirmed substance use in cases of acute recreational drug toxicity.We performed a retrospective analysis of emergency department presentations of acute recreational drug toxicity over 2 years (October 2013 to September 2015) within the European Drug Emergencies Network Plus project.Among the 10,956 cases of acute recreational drug toxicity during the study period, 831 could be included. Read More

Radiographics 2018 Jan-Feb;38(1):109-123

From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.).

The United States is in the midst of an opioid use epidemic, which has severe medical, social, and economic consequences. Addictions to and abuse of prescription and illicit opioids are increasing, and emergency department radiologists are increasingly being faced with the task of examining patients who present with opioid-related complications. These complications may be the result of direct drug toxicity or nonsterile injection of the drugs. Read More

Br J Pharmacol 2018 02 6;175(3):532-543. Epub 2018 Jan 6.

Clinical Pharmacology and Toxicology, Department of Biomedicine, Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.

Background And Purpose: Opioids may inhibit the 5-HT transporter (SERT) and the noradrenaline transporter (NET). NET inhibition may contribute to analgesia, and SERT inhibition or interactions with 5-HT receptors may cause serotonergic toxicity. However, the effects of different opioids on the human SERT, NET and 5-HT receptors have not been sufficiently studied. Read More

J Am Board Fam Med 2017 Nov-Dec;30(6):832-834

From the Penn State Health, State College, PA (NDV, CH, RER, MBS); Mount Nittany Physician Group, State College (AFC).

The antidiarrheal loperamide has had a recent, drastic increase in off-label use as an alternative treatment for symptoms of opioid withdrawal. The concept of this is easily discovered on the Internet and social media, where there are multiple blogs and forums promoting loperamide use at doses of 70 to 200 mg per day. Unfortunately, the serious side effects are not well recognized. Read More

Am J Public Health 2018 01 21;108(1):131-136. Epub 2017 Nov 21.

All of the authors are with the Department of Epidemiology, Mailman School of Public Health, and the Center for Injury Epidemiology and Prevention, Columbia University, New York, NY. Guohua Li is also with the Department of Anesthesiology, College of Physicians and Surgeons, Columbia University.

Objectives: To assess cohort effects in prescription opioid and heroin overdose mortality in the United States.

Methods: Using the National Center for Health Statistics' multiple-cause-of-death file for 1999 to 2014, we performed an age-period-cohort analysis of drug overdose mortality in the United States.

Results: Compared with those born in 1977 and 1978, individuals born between 1947 and 1964 experienced excess risks of prescription opioid overdose death (e. Read More

Int J Drug Policy 2018 01 20;51:42-51. Epub 2017 Nov 20.

School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.

Background: A recent Cochrane review of randomised trials identified a lack of evidence for interventions provided to drug-using offenders. We use routine data to address whether contact with treatment services reduces heroin users' likelihood of a future acquisitive offence or drug-related poisoning (DRP) death.

Methods: Heroin-users were identified from probation assessments and linked to drug-treatment, mortality and offending records. Read More

Forensic Sci Int 2017 Dec 18;281:18-28. Epub 2017 Oct 18.

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

Introduction: Accurate attribution of heroin-related deaths, as well as the differentiation from other opioid analgesic-related deaths, is essential from a public health perspective. Heroin-related deaths involve a number of complexities where heroin-specific or non-specific metabolites and indicators (6-acetylmorphine [6-AM], morphine, and codeine) may or may not be detected. The aims of this study were therefore to develop a model for improved consistency in the attribution of heroin-related deaths and to determine areas of variation in the current decision-making processes. Read More

eNeuro 2017 Sep-Oct;4(5). Epub 2017 Oct 30.

Behavioral Neuroscience Branch, National Institute on Drug Abuse - Intramural Research Program, National Institutes of Health, Baltimore, MD 21224.

While opioid abuse is an established medical and public health issue, the increased availability of highly potent synthetic opioids, such as fentanyl, has given rise to acute health complications, including a comatose state and death during drug overdose. Since respiratory depression that leads to acute hypoxia is the most dangerous complication of opioid drug use, we examined the effects of intravenous heroin and heroin contaminated with 10% fentanyl on oxygen levels in the nucleus accumbens (NAc) monitored using high-speed amperometry in freely moving rats. Additionally, we examined the effects of heroin, fentanyl, and their mixture on locomotion and temperatures in the NAc, temporal muscle, and skin. Read More

Basic Clin Pharmacol Toxicol 2018 Apr 15;122(4):436-441. Epub 2017 Dec 15.

Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.

Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Read More

J Anal Toxicol 2018 Jan;42(1):e6-e11

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 65 Ashley Ave, Charleston, SC 29425, USA.

Fentanyl analogs pose a unique challenge for forensic pathologists and toxicologists. The extreme potency of these analogs results in minute blood, urine and vitreous concentrations that are technically difficult to identify. This in addition to their absence from standard drug screening may potentiate a setting of apparent drug overdose without an immediately identifiable source. Read More

Tuberk Toraks 2017 Jun;65(2):154-156

Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Smoking heroin (chasing the dragon), is a method of inhaling heroin via heating the drug on a tin-foil above a flame. It also has been associated both with the indirect effects of heroin overdose and with direct pulmonary toxicity. We describe a case of acute eosinophilic pneumonia secondary to heroin inhalation in our medical intensive care unit. Read More

Folia Med (Plovdiv) 2017 09;59(3):303-309

Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria

Background: There is no specific toxicological screening of clinical laboratory parameters in clinical toxicology when it comes to acute exogenous poisoning.

Aim: To determine routine clinical laboratory parameters and indicators for assessment of vital functions in patients with acute intoxications.

Materials And Methods: One hundred and fifty-three patients were included in the present study. Read More

Iran J Child Neurol 2017 ;11(3):15-18

Pediatric Medical Toxicology Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: Environmental hazards, including poisons, can cause irreparable effects and even fatal for children. Poisoning in children is common and serious, but often is preventable and treatable. This study aimed to evaluate the prevalence of drugs and chemical toxicity leading to apnea. Read More

Drug Alcohol Depend 2017 10 13;179:42-46. Epub 2017 Jul 13.

Friends Research Institute, Inc., Baltimore, MD, USA.

Background: There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients.

Methods: This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined. Read More

Prehosp Emerg Care 2017 Nov-Dec;21(6):682-687. Epub 2017 Jul 7.

Study Objective: Naloxone, an opioid-antagonist deliverable by an intra-nasal route, has become widely available and utilized by law enforcement officers as well as basic life support (BLS) providers in the prehospital setting. This study aimed to determine the frequency of repeat naloxone dosing in suspected narcotic overdose (OD) patients and identify patient characteristics.

Methods: A retrospective chart review of patients over 17 years of age with suspected opioid overdose, treated with an initial intranasal (IN) dose of naloxone and subsequently managed by paramedics, was performed from April 2014 to June 2016. Read More

BMJ Case Rep 2017 Jun 28;2017. Epub 2017 Jun 28.

Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.

A man aged 33 years with previous heroin substance abuse was found unconscious lying in a bush. The patient had been without heroin for some time but had just started to use intravenous heroin again, 0.5-2 g daily. Read More

Hum Psychopharmacol 2017 05;32(3)

UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.

Objective: "Krokodil" is the street name for an impure homemade drug mixture used as a cheap substitute for heroin, containing desomorphine as the main opioid. Abscesses, gangrene, thrombophlebitis, limb ulceration and amputations, jaw osteonecrosis, skin discoloration, ulcers, skin infections, and bleeding are some of the typical reported signs in humans. This study aimed to understand the toxicity of krokodil using Wistar male rats as experimental model. Read More