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Browsing by Subject "Opioid overdose"
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Item Acute Cytotoxic Cerebellar Edema Subsequent to Fentanyl Patch Intoxication in an Infant(Hindawi, 2021-09-07) Haut, Lindsey N.; Radhakrishnan, Rupa; Lutfi, Riad; Kao, Louise W.; Ackerman, Laurie L.; Emergency Medicine, School of MedicineThe opioid epidemic continues to have devastating consequences for children and families across the United States with rising prevalence of opioid use and abuse. Given the ease of access to these medications, accidental ingestion and overdose by children are becoming increasingly more common. The recognition of opioid-induced neurotoxicity and the associated life-threatening complication of acute cerebellar cytotoxic edema are crucial, as are the high morbidity and mortality without timely intervention. We discuss an infant with acute cytotoxic cerebellar edema following mucosal exposure to a transdermal fentanyl patch.Item Point process modeling of drug overdoses with heterogeneous and missing data(Institute of Mathematical Statistics, 2021) Liu, Xueying; Carter, Jeremy; Ray, Brad; Mohler, George; Computer and Information Science, School of ScienceOpioid overdose rates have increased in the United States over the past decade and reflect a major public health crisis. Modeling and prediction of drug and opioid hotspots, where a high percentage of events fall in a small percentage of space–time, could help better focus limited social and health services. In this work we present a spatial-temporal point process model for drug overdose clustering. The data input into the model comes from two heterogeneous sources: (1) high volume emergency medical calls for service (EMS) records containing location and time but no information on the type of nonfatal overdose, and (2) fatal overdose toxicology reports from the coroner containing location and high-dimensional information from the toxicology screen on the drugs present at the time of death. We first use nonnegative matrix factorization to cluster toxicology reports into drug overdose categories, and we then develop an EM algorithm for integrating the two heterogeneous data sets, where the mark corresponding to overdose category is inferred for the EMS data and the high volume EMS data is used to more accurately predict drug overdose death hotspots. We apply the algorithm to drug overdose data from Indianapolis, showing that the point process defined on the integrated data out-performs point processes that use only coroner data (AUC improvement 0.81 to 0.85). We also investigate the extent to which overdoses are contagious, as a function of the type of overdose, while controlling for exogenous fluctuations in the background rate that might also contribute to clustering. We find that drug and opioid overdose deaths exhibit significant excitation with branching ratio ranging from 0.72 to 0.98.Item Prevention and Intervention with Young People as a Critical Public Health Strategy to Curtail the Opioid Epidemic: A Call to Action(Heighten Science Publications Inc., 2023) Danielson, Carla Kmett; McCauley, Jenna; Hinkley, Jesse; Hahn, Austin; Moreland, Angela; López, Cristina; Goodyear, Morgan; Adams, Zack; McCart, Mike; Psychiatry, School of MedicineOpioid use continues to represent a significant public health problem in the United States, as well as globally. The opioid epidemic has motivated advances in the effective treatment of opioid use disorder (OUD), with a particular focus on medications for OUD (MOUD), including methadone, buprenorphine, and naltrexone. Although these medications are remarkably effective, MOUD expansion initiatives alone have not been sufficient to combat the opioid epidemic. Further, critical questions remain regarding the effectiveness of these medications for individuals who initiate opioid use under age 16. Key strategies to combat the opioid epidemic, including MOUD and naloxone distribution, target intervention for individuals who have already developed an OUD. Like every other health problem, shifting attention earlier in the etiological process can lend itself to a more cost-effective approach by preventing the onset of behaviors that contribute to subsequent increases in morbidity and mortality. Therefore, we argue that targeted interventions for adolescents with substance use problems, including for non-opioid drugs (i.e., cannabis, alcohol), is critical to prevent the onset of OUD and turn the tide of the opioid overdose epidemic. In line with this call to action to move toward earlier intervention as a public health strategy, we propose several concrete recommendations. These include use of universal screening and prevention strategies for teens, an enhanced focus on addressing mental health (i.e., depression, trauma-related anxiety) and ecological (i.e., low caregiver monitoring, affiliating with substance using peers) precursors of substance use initiation in adolescents, a significant restructuring of resource allocation to more effectively and equitably address youth substance use and mental health problems, and continuous efforts dedicated to the de-stigmatization of the disease of substance use disorders.Item The impact of obesity in patients hospitalized with opioid/opiate overdose(Sage, 2022) Archibald, Paul; Subramoney, Kavitha; Beydoun, Hind A.; Harris, Ché Matthew; Medicine, School of MedicineBackground: Although a direct link between opioid use in obese patients and risk of overdose has not been established, obesity is highly associated with higher risk for opioid/opiate overdose. Evidence for clinical impact of obesity on patients with opioid/opiate overdose is scarce. The aim of this study was to determine effects of obesity on health-care outcomes and mortality trends in hospitalized patients who presented with opioid/opiate overdose in the United States between 2010 and 2014. Design: Multivariate logistic and linear regression analysis compared clinical outcomes and hospital resource utilization between obese and nonobese patients. Trend analysis of in-hospital mortality was also analyzed. Setting: United States. Participants: 302,863 adults ≥ 18 years and hospitalized with a principle diagnosis of opioid/opiate overdoses between 2010 and 2014. Measurements: Primary measurement was in-hospital mortality. Secondary measurements included respiratory failure, cardiogenic shock, mechanical ventilations/intubations, hospital charges, and length of stay. Findings: Prevalence for in-hospital mortality was lower in patients with obesity (2.2% vs 2.9%). Obese patients had higher adjusted odds for respiratory failure (aOR = 1.7, [(CI) 1.6-1.8]) and mechanical ventilation/intubation (aOR = 1.17, [(CI) 1.10-1.2]). They also had longer length of stays (aMD = 0.4 days, [(CI) 0.25-0.58 days] and higher total hospital charges (aMD = $5,561, [(CI) $3,638-$7,483]. Trends of in-hospital mortality for patients with obesity did not significantly increase (2.1% in 2010 to 2.4% in 2014, p trend = 0.37), but significantly increased for obese patients (2.4% in 2010 to 3.4% in 2014; p trend <0.01). Conclusions: Prevalence and trends of mortality were lower in patients with obesity hospitalized for opiate/opioid overdose compared to those without obesity between 2010 and 2014 in the United States.