The synthetic opioid epidemic and the need for mental health support for first responders who intervene in overdose cases

Jozaghi, Ehsan; Maynard, Russ; Dadakhah-Chimeh, Zahra; Yake, Kevin; Blyth, S. L.

doi:10.17269/s41997-018-0044-7

Cited by 13 publications

(10 citation statements)

References 10 publications

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“…In December of 2017, the Federal government recognized the urgent public health need and provided temporary class exemptions for OPS to be set up by volunteers in the provinces and territories [73]. Yet, where peers may volunteer to fill gaps in services, much of this work in under resourced and unsupported, resulting in a great emotional toll on these individuals [74, 75].…”

Section: Resultsmentioning

confidence: 99%

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

Taha

Maloney‐Hall

Buxton

2019

Subst Abuse Treat Prev Policy

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Background: Canada is facing an urgent challenge to reduce the harms associated with opioids: from January 2016 to December of 2018, more than 11,500 individuals lost their lives due to opioid related harms. This review examines responses to the opioid crisis thus far, the lessons learned from these initiatives and the knowledge gaps that still need to be addressed across the four pillar model adopted by the CDSS. Methods: A search of peer-reviewed literature was conducted in PubMed and PsycNet, and grey literature was retrieved from reputable substance use and health organizations to determine responses to the opioid crisis and related outcomes between 2013 and 2019. Findings related to actions, outcomes and unintended consequences across the categories of prevention, treatment, harm reduction, enforcement and the evidence base were included and synthesized into a narrative review on lessons learned. Results: The opioid crisis is a result of multiple, complex interrelated factors. Many physicians may not feel competent to appropriately treat pain and/or addiction. Pushes for opioid deprescribing have resulted in some individuals using illicit opioids as treatment. A range of effective and accessible pharmacological and psychological treatments are still required. When regulations are barriers, unsanctioned actions, such as overdose prevention sites, may be enacted by individuals to respond to urgent public health needs. A nimble response with evolving enforcement perspectives can aid individuals experiencing harms from opioid use. Conclusions: There is no one size fits all response to this crisis, and consideration should be given to the unique needs of different communities and populations, as well as the broader impact of harms on families, communities, and society. A situation so multifaceted requires both immediate and long-term strategies implemented concurrently in order to address the differing and ongoing needs of Canadians experiencing opioid harms. The expertise of individuals and families affected by the opioid crisis must be included in consultations and decisions related to different strategies, to ensure responses are not stigmatizing, that they will be effective and acceptable and that unintended consequences are quickly recognized and mitigated.

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Section: Resultsmentioning

confidence: 99%

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

Taha

Maloney‐Hall

Buxton

2019

Subst Abuse Treat Prev Policy

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“…Although supervised injection sites and safer smoking rooms may not substantially reduce the number of PWUO and other injection drugs, they have the potential to attenuate the serious medical sequelae of opioid use by facilitating discussions about how to reduce negative consequences of use [64, 65]. Also, it is likely that while becoming an OD responder may involve taking up a new positive social role, it may also involve additional stress that may require additional access to professional support, in order to cope successfully [42, 66]. Although intranasal naloxone, even with suboptimal concentrations, has shown an effect on opioid ODs [17], new devices developed in the US dispense naloxone intranasally in amounts and concentrations that will ensure a proper dosage under all resuscitation circumstances.…”

Section: Discussionmentioning

confidence: 99%

One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

Thylstrup¹,

Hesse²,

Jørgensen³

et al. 2019

Harm Reduct J

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BackgroundOverdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program.MethodsBetween May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose.ResultsIn all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034).ConclusionsPrevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups.Trial registrationThe Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered

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“…Reports suggest that the management of a synthetic opioid overdose requires larger or more frequent repeated doses of naloxone than would normally be recommended. 152 – 157 …”

Section: Management Of Acute Toxicity and Overdosementioning

confidence: 99%

Synthetic opioids: a review and clinical update

Shafi

Berry

Sumnall

et al. 2022

Therapeutic Advances in Psychopharmacology

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The term ‘opioids’ refers to both the natural compounds (‘opiates’) which are extracted from the opium poppy plant ( Papaver somniferum) and their semi-synthetic and synthetic derivatives. They all possess relatively similar biochemical profiles and interact with the opioid receptors within the human body to produce a wide range of physiological effects. They have historically been used for medicinal purposes, their analgesic and sedative effects, and in the management of chronic and severe pain. They have also been used for non-medicinal and recreational purposes to produce feelings of relaxation, euphoria and well-being. Over the last decade, the emergence of an illegal market in new synthetic opioids has become a major global public health issue, associated with a substantial increase in unintentional overdoses and drug-related deaths. Synthetic opioids include fentanyl, its analogues and emerging non-fentanyl opioids. Their popularity relates to changes in criminal markets, pricing, potency, availability compared to classic opioids, ease of transport and use, rapid effect and lack of detection by conventional testing technologies. This article expands on our previous review on new psychoactive substances. We now provide a more in-depth review on synthetic opioids and explore the current challenges faced by people who use drugs, healthcare professionals, and global public health systems.

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The synthetic opioid epidemic and the need for mental health support for first responders who intervene in overdose cases

Cited by 13 publications

References 10 publications

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

Lessons learned from the opioid crisis across the pillars of the Canadian drugs and substances strategy

One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

Synthetic opioids: a review and clinical update

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