Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs

Bluthenthal, Ricky N.; Simpson, Kelsey; Ceasar, Rachel Carmen; Zhao, Johnathan; Wenger, Lynn; Kral, Alex H.

doi:10.1016/j.drugalcdep.2020.107932

Cited by 36 publications

(12 citation statements)

References 64 publications

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“…However, when naloxone is administered to individuals who are opioid-dependent, it can precipitate acute withdrawal syndrome which encompasses uncomfortable and often distressing symptoms including agitation, sweating, pain, vomiting, and flu-like symptoms, and rarely may cause more severe symptoms including pulmonary edema [10][11][12][13], seizure [14,15], and arrhythmias and cardiac arrest [16,17]. People who use drugs report experiencing extreme pain related to opioid withdrawal and health risks including receptive syringe sharing and overdose are associated with experiences of withdrawal [18,19].…”

Section: Introductionmentioning

confidence: 99%

Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

et al. 2021

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Introduction Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration. Methods The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms. Results A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08–2.48)) or four or more (AOR 2.19 (95% CI: 1.32–3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone. Conclusions This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.

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Section: Introductionmentioning

confidence: 99%

Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

et al. 2021

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“…These general themes (e.g., tolerance/withdrawal, access to substance, route of administration, identification) were then compared to empirically supported factors related to risk of substance misuse as outlined in previous literature [i.e., injection drug use ( Kenney et al, 2018 ), higher physical and mental morbidity burdens ( Smolina et al, 2020 )]. More specifically, final annotation codes created to specifically identify imminent substance misuse risk with consideration of unique fentanyl misuse risk factors included: mentions (1) he/she is a regular drug user ( Degenhardt et al, 2010 ), (2) a high substance tolerance ( Darke and Hall, 2003 ) or withdrawal ( Bluthenthal et al, 2020 ), (3) a previous overdose or knowing others who have overdosed ( Britton et al, 2010 ), (4) polysubstance use ( Betts et al, 2015 ; Coffin et al, 2003 ), (5) current access to or actively seeking the substance ( Paulozzi, 2012 ), (6) functional ( Barash et al, 2017 ) and quality of life impairments ( Zibbell et al, 2019 ), (7) intravenous method of use ( Britton et al, 2010 ), and (8) drugs being cut with another substance ( LaRue et al, 2019 ). Factors further extended to seeking advice on dosage or use methods, as well as supportive commenting for risky drug use ( Webster, 2017 ).…”

Section: Methodsmentioning

confidence: 99%

Detecting risk level in individuals misusing fentanyl utilizing posts from an online community on Reddit

Garg

Taylor

Sherief

et al. 2021

Internet Interventions

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“…Hence, satisfactory and tailored chronic pain management is a priority both morally and ethically, helping maintain patients’ quality of life and protecting against subsequent psychological and physical complications [ 6 , 7 , 8 ]. During the SARS-CoV-2 pandemic, due to the reallocation of public health resources and the emergence of a series of complex needs and urgent requirements [ 9 , 10 , 11 ], the need for comprehensive chronic pain management has become even more challenging.…”

Section: Introductionmentioning

confidence: 99%

Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques

Bianco

Papa

Schatman

et al. 2021

JCM

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Background: Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. Methods: Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. Results: Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.

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Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs

Cited by 36 publications

References 64 publications

Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

Detecting risk level in individuals misusing fentanyl utilizing posts from an online community on Reddit

Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques

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