Browsing by Subject "overdose"

Now showing 1 - 8 of 8
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    Discordance between Self-reported and Biologically Tested Exposure to Fentanyl among People at Risk of Opioid Overdose
    (American Society of Addiction Medicine, 2022-11) Park, Ju Nyeong; Urquhart, Glenna; Morris, Miles; Dahal, Rejwi; Rouhani, Saba; Sherman, Susan G.; Pathology and Laboratory Medicine, School of Medicine
    Drug overdose remains a leading cause of death in the US, and the majority of opioid overdose fatalities involve fentanyl. This study aims to measure the degree of concordance between self-reported and biologically tested exposure to fentanyl. We conducted a cross-sectional analysis using survey and urinalysis data collected between 2019 and 2020 from Anne Arundel County, Maryland. Among urinalysis participants (n=113), 30% reported daily fentanyl use, and among this group, only 54% had a fentanyl-positive result. Cohen’s Kappa between self-reported and biologically detected fentanyl use was 0.26, indicating minimal agreement between the two markers. Limitations to interpreting self-reported and urinalysis data are discussed in this report.
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    Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models
    (Addictive Behaviors, 2018-03-20) Phalen, Peter; Ray, Bradley; Watson, Dennis P.; Huynh, Phillip; Green, Marion S.
    Introduction: The opioid epidemic has been largely attributed to changes in prescribing practices over the past 20 years. Although current overdose trends appear driven by the opioid fentanyl, heroin has remained the focus of overdose fatality assessments. We obtained full toxicology screens on lethal overdose cases in a major US city, allowing more accurate assessment of the time-course of fentanyl-related deaths. Methods: We used coroner data from Marion County, Indiana comprising 1583 overdose deaths recorded between January 1, 2010 and April 30, 2017. Bayesian multilevel models were fitted to predict likelihood of lethal fentanyl-related overdose using information about the victim's age, race, sex, zip code, and date of death. Results: Three hundred and seventy-seven (23.8%) overdose deaths contained fentanyl across the seven-year period. Rates rose exponentially over time, beginning well below 15% from 2010 through 2013 before rising to approximately 50% by 2017. At the beginning of the study period, rates of fentanyl overdose were lowest among Black persons but increased more rapidly, eventually surpassing Whites. Currently, White females may be at particularly low risk of fentanyl overdose and Black females at high risk. Rates were highest for younger and middle-aged groups. Over time, fentanyl was more likely detected without the presence of other opioids. Conclusions: Fentanyl has increasingly been detected in fatal overdose deaths in Marion County. Policy and program responses must focus on education for those at highest risk of fentanyl exposure and death. These responses should also be tailored to meet the unique needs of high-risk demographics.
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    Opioid Overdoses in Indiana: A Closer Look at Opioid Type
    (Richard M. Fairbanks School of Public Health, 2018-06) Kooreman, Harold
    The misuse of prescription and illicit opioids remains at epidemic proportions, costing the United States billions of dollars annually. Overdose deaths in both the U.S. and Indiana have seen a dramatic increase over the past 10 years. Until recently, prescription opioids were responsible for the greatest number of overdose deaths, but now have been surpassed by fatalities involving heroin and illicitly manufactured narcotics, primarily fentanyl.
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    Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL)
    (2024-10) Greene, Marion; Sanner, Lindsey; Gutta, Jyotsna; Williamson, Curtis; McNamee, Cassidy
    In the fall of 2023, the Marion County Public Health Department (MCPHD) was awarded the federal Overdose Data to Action: Limiting Overdose through Collaborative Actions in Localities (OD2A: LOCAL) grant. This 5-year initiative by the Centers for Disease Control and Prevention (CDC) supports local jurisdictions in addressing the overdose crisis through surveillance and evidence-based prevention and harm reduction strategies, with the overarching goal to reduce drug overdoses and health inequities. To achieve this goal, MCPHD funds and collaborates with 16 community organizations (subawardees).
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    Police Officer Attitudes towards Intranasal Naloxone Training
    (Elsevier, 2015-01) Ray, Bradley; O'Donnell, Daniel; Kahre, Kailyn; School of Public and Environmental Affairs
    Background One approach to reduce fatal opioid overdose is by distributing naloxone to law enforcement officers. While several cities have implemented these naloxone programs, little research has investigated officer attitudes about their training. The present research attempts to fill this gap by analyzing survey data from police officers following intranasal naloxone training. Methods All of the police officers within the same district in Indianapolis, Indiana, underwent training to recognize opioid overdose and to administer intranasal naloxone (N = 117). Following training, officers completed a survey that measured prior experience with opioid overdose, perceived importance of training, and items from the Opioid Overdose Attitudes Scale (OOAS) to measure attitudes following training. Results The officers had overwhelmingly positive feelings about the training, that it was not difficult, and that other officers should be trained to use naloxone. The OOAS items suggest that officers know the appropriate actions to take in the event of an overdose and feel that administering intranasal naloxone will not be difficult. Finally, we found that officers who had more experience with opioid overdose had more positive attitudes about the training. Conclusion Distributing naloxone to police officers is likely a trend that will continue so it is important to understand how police officers respond to training to assure that future trainings are as effective as possible. Further research is needed to investigate the impact that these programs have on the community.
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    Relationship Between Characteristics of Medications and Drug-Induced Liver Disease Phenotype and Outcome
    (Elsevier B.V., 2014-09) Vuppalanchi, Raj; Gotur, Raghavender; Reddy, K. Rajender; Fontana, Robert J.; Ghabril, Marwan; Kosinski, Andrzej S.; Gu, Jiezhun; Serrano, Jose; Chalasani, Naga; Department of Medicine, IU School of Medicine
    Background & Aims: It is not known if specific characteristics of medication are associated with type of drug-induced liver injury (DILI) or outcome. We examined the relationships among select characteristics of medications and DILI phenotype and outcome. Methods: We analyzed 383 cases of DILI caused by a single orally administered prescription agent from the DILI Network Prospective Study with causalities of definite, highly likely, or probable. Relationship of daily dosage (≥ 50 mg vs. ≤ 49 mg), preponderance of hepatic metabolism (≥50% vs <50%), or Biopharmaceutics Drug Disposition Classification System (BDDCS) class (1–4, based on solubility and metabolism of the drug) were compared with clinical characteristics and outcomes. Results: Compared to cases of DILI in the <50 mg/day group, those associated with daily dosages ≥50 mg had shorter latency (median 38 days vs 56 days; P=.03) and a different biochemical pattern of liver injury (P=.04); no differences in pattern of injury, recovery, severity, or outcome were observed. Patients with DILI caused by medications with or without preponderant hepatic metabolism did not differ in clinical characteristics or outcomes. Compared to other classes of BDDCS, DILI caused by BDDCS class 1 medications had significantly longer latency (P<.001) and greater proportion of hepatocellular injury (P=.001). However, peak liver biochemical values and patients’ time to recovery, disease severity, and outcomes did not differ among the 4 BDDCS classes. Conclusions: Characteristics of medications (dosage, hepatic metabolism, and solubility) are associated with features of DILI such as latency and pattern of liver injury, but not with recovery, severity, or outcome.
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    Toxicity of Bupropion Overdose Compared With Selective Serotonin Reuptake Inhibitors
    (AAP, 2019-08) Overberg, Adam; Morton, Shannon; Wagner, Emily; Froberg, Blake; Emergency Medicine, School of Medicine
    OBJECTIVES: Adolescent depression and attempted and completed suicide are increasing in the United States. Because suicide is often impulsive, the means of self-harm are frequently items of convenience like medication. Authors of a recent study compared tricyclic antidepressant overdose to bupropion overdose. Fluoxetine and escitalopram are the only agents with Food and Drug Administration approval for pediatric depression, but off-label bupropion prescriptions are common. We sought to compare the effects of selective serotonin reuptake inhibitors (SSRIs) and bupropion in overdose. METHODS: This was an analysis of the National Poison Data System from June 2013 through December 2017 for adolescent (ages 10–19) exposures to SSRIs or bupropion coded as “suspected suicide.” Demographics, clinical effects, therapies, and medical outcome were analyzed. RESULTS: There were 30 026 cases during the study period. Sertraline and fluoxetine accounted for nearly 60%, whereas bupropion was reported in 11.7%. Bupropion exposure was significantly associated with death (0.23% vs 0%; P < .001) or serious outcome (58.1% vs 19%; P < .001) as well as the 10 most common clinical effects, including seizures (27.0% vs 8.5%; P < .001) and hallucinations (28.6% vs 4.3%; P < .001). Bupropion exposure was significantly associated with the need for cardiopulmonary resuscitation (0.51% vs 0.01%; P < .001), intubation (4.9% vs 0.3%; P < .001), vasopressors (1.1% vs 0.2%; P < .001), and benzodiazepines (34.2% vs 5.5%; P < .001). There was a significant increase in all exposures and in proportion of serious outcomes over time. CONCLUSIONS: Adolescents who attempt self-harm are at higher risk for serious morbidity and poor outcomes with bupropion than with SSRIs. These risks, and the patient’s propensity for self-harm, should be evaluated when therapy with bupropion is considered.
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    Working with Overdose Lifeline to Influence State Policy: Syringe Decriminalization, Senate Bill 11, and A Day of Advocacy
    (2019-04-26) Pike, Caitlin; Richardson, Heather; Sterling, Catherine
    Our Capstone group worked with Overdose Lifeline, an Indianapolis non-profit group that advocates for increased harm reduction solutions to prevent overdose deaths and disease transmission. On January 3, 2019, Sen. Mike Bohacek and Sen. James Merritt introduced Senate Bill 11, which acted to amend current Syringe Exchange Program (SEP) legislation. Specifically, SB 11 proposed to “establish and maintain a syringe exchange program registry” that would track SEP participants statewide. The bill required a “qualified entity” to create a database that contains SEP participant names, dates of birth, last four of SSNs, and other identifying information to be determined, but did not name that entity and left many other questions unanswered.