Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit

Parthvi, Rukma; Khanijo, Sameer; Tsegaye, Adey; Talwar, Arunabh

doi:10.1097/mjt.0000000000000681

Cited by 26 publications

(15 citation statements)

References 28 publications

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“…Opioid overdose (OOD) is a worldwide crisis, primarily due to over-prescription of opioids for the management of chronic pain, and also to the illicit drug market. Opioid overdose accounts for approximately 69,000 deaths worldwide, whereas some 15 million people are addicted [59].…”

Section: Cannabinoids As An Alternative To Opioidsmentioning

confidence: 99%

The Endocannabinoid System: A Potential Target for the Treatment of Various Diseases

Lowe

Toyang²,

Steele

et al. 2021

IJMS

134

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The Endocannabinoid System (ECS) is primarily responsible for maintaining homeostasis, a balance in internal environment (temperature, mood, and immune system) and energy input and output in living, biological systems. In addition to regulating physiological processes, the ECS directly influences anxiety, feeding behaviour/appetite, emotional behaviour, depression, nervous functions, neurogenesis, neuroprotection, reward, cognition, learning, memory, pain sensation, fertility, pregnancy, and pre-and post-natal development. The ECS is also involved in several pathophysiological diseases such as cancer, cardiovascular diseases, and neurodegenerative diseases. In recent years, genetic and pharmacological manipulation of the ECS has gained significant interest in medicine, research, and drug discovery and development. The distribution of the components of the ECS system throughout the body, and the physiological/pathophysiological role of the ECS-signalling pathways in many diseases, all offer promising opportunities for the development of novel cannabinergic, cannabimimetic, and cannabinoid-based therapeutic drugs that genetically or pharmacologically modulate the ECS via inhibition of metabolic pathways and/or agonism or antagonism of the receptors of the ECS. This modulation results in the differential expression/activity of the components of the ECS that may be beneficial in the treatment of a number of diseases. This manuscript in-depth review will investigate the potential of the ECS in the treatment of various diseases, and to put forth the suggestion that many of these secondary metabolites of Cannabis sativa L. (hereafter referred to as “C. sativa L.” or “medical cannabis”), may also have potential as lead compounds in the development of cannabinoid-based pharmaceuticals for a variety of diseases.

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Section: Cannabinoids As An Alternative To Opioidsmentioning

confidence: 99%

The Endocannabinoid System: A Potential Target for the Treatment of Various Diseases

Lowe

Toyang²,

Steele

et al. 2021

IJMS

134

View full text Add to dashboard Cite

show abstract

“…The alkaloids from poppy include morphine, codeine, thebaine, noscapine, and their derivatives, which are used for treating moderate to severe pain. However, they may cause adverse side effects such as dizziness, sedation, nausea, vomiting, respiratory depression, dependency, and tolerance [ 150 , 151 ]. Noscapine has been used as safe cough suppressant and has evoked attention of pharmaceutical industries in cancer treatment ( Table 2 ).…”

Section: Biological Activities Of Alkaloids and Their Potential Applications With Special Reference To Therapeutics And Pharmacologymentioning

confidence: 99%

Diversity in Chemical Structures and Biological Properties of Plant Alkaloids

2021

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Phytochemicals belonging to the group of alkaloids are signature specialized metabolites endowed with countless biological activities. Plants are armored with these naturally produced nitrogenous compounds to combat numerous challenging environmental stress conditions. Traditional and modern healthcare systems have harnessed the potential of these organic compounds for the treatment of many ailments. Various chemical entities (functional groups) attached to the central moiety are responsible for their diverse range of biological properties. The development of the characterization of these plant metabolites and the enzymes involved in their biosynthesis is of an utmost priority to deliver enhanced advantages in terms of biological properties and productivity. Further, the incorporation of whole/partial metabolic pathways in the heterologous system and/or the overexpression of biosynthetic steps in homologous systems have both become alternative and lucrative methods over chemical synthesis in recent times. Moreover, in-depth research on alkaloid biosynthetic pathways has revealed numerous chemical modifications that occur during alkaloidal conversions. These chemical reactions involve glycosylation, acylation, reduction, oxidation, and methylation steps, and they are usually responsible for conferring the biological activities possessed by alkaloids. In this review, we aim to discuss the alkaloidal group of plant specialized metabolites and their brief classification covering major categories. We also emphasize the diversity in the basic structures of plant alkaloids arising through enzymatically catalyzed structural modifications in certain plant species, as well as their emerging diverse biological activities. The role of alkaloids in plant defense and their mechanisms of action are also briefly discussed. Moreover, the commercial utilization of plant alkaloids in the marketplace displaying various applications has been enumerated.

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“…Few hospitals have dedicated inpatient units for treatment of OUD; so most patients presenting at EDs with acute opioid overdose or withdrawal symptoms are stabilized and treated with non-narcotic symptom-relieving medications before being discharged. 15,16 While some EDs have been able to leverage a harm reduction approach by providing take-home naloxone, 17 this strategy has not shown long-term mitigation of overdose risk and subsequent ED presentation. 18 Medications for opioid use disorder (MOUD), including buprenorphine, represent an evidence-based treatment for OUD that supports long-term recovery and reduced risk of overdose death.…”

Section: How Does This Improve Population Health?mentioning

confidence: 99%

Implementing a Novel Statewide Network to Support Emergency Department-initiated Buprenorphine Treatment

Clemency

Hoopsick

Burnett

et al. 2022

WestJEM

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Introduction: Medications for opioid use disorder (MOUD), including buprenorphine, represent an evidence-based treatment that supports long-term recovery and reduces risk of overdose death. Patients in crisis from opioid use disorder (OUD) often seek care from emergency departments (ED). The New York Medication for Addiction Treatment and Electronic Referrals (MATTERS) network is designed to support ED-initiated buprenorphine and urgent referrals to long-term care for patients suffering from OUD. Methods: Using the PRECEDE-PROCEED implementation science framework, we provide an overview of the creation of the MATTERS network in Western New York. We also include an explanation of how the network was designed and launched as a response to the opioid epidemic. Finally, we analyzed the program’s outputs and outcomes, thus far, as it continues to grow across the state. Results: The New York MATTERS network was created and implemented in 2019 with a single hospital referring patients with OUD to three local clinics. In the social assessment and situational analysis phase, we describe the opioid epidemic and available resources in the region at the outset of the program. In the epidemiological assessment phase, we quantify the epidemic on the state and regional levels. In the educational and ecological assessment, we review local ED practices and resources. In the administrative and policy assessment and intervention alignment phase, the program’s unique framework is reviewed. In the piloting phase, we describe the initial deployment of New York MATTERS. Finally, in the process evaluation phase, we depict the early lessons we learned. By the beginning of 2021, the New York MATTERS network included 35 hospitals that refer to 47 clinics throughout New York State. Conclusion: The New York MATTERS network provides a structured approach to reduce barriers to ED-initiated buprenorphine and urgent referral to long-term care. An implementation framework provides a structured means of evaluating this best practice model.

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Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit

Cited by 26 publications

References 28 publications

The Endocannabinoid System: A Potential Target for the Treatment of Various Diseases

The Endocannabinoid System: A Potential Target for the Treatment of Various Diseases

Diversity in Chemical Structures and Biological Properties of Plant Alkaloids

Implementing a Novel Statewide Network to Support Emergency Department-initiated Buprenorphine Treatment

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