<i>Notes from the Field:</i> Nitazene-Related Deaths — Tennessee, 2019–2021

Roberts, Allison; Korona-Bailey, Jessica; Mukhopadhyay, Sutapa

doi:10.15585/mmwr.mm7137a5

Cited by 7 publications

(7 citation statements)

References 2 publications

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“…This is an opportunity for public health awareness and to educate those providing bystander naloxone and patients using illicit opioids about the higher potential for OD and death, and that repeat doses of naloxone may be needed to reverse NPO overdose. Similarly, this is an opportunity for education among patients with substance use disorder as a public health outreach to educate the potential additional adverse effects with the rise of NPOs in the NPS drug supply …”

Section: Discussionmentioning

confidence: 99%

“…Another patient with N-piperidinyl etonitazene requiring an initial dose of naloxone of 8 mg. Prior case reports have suggested that patients with NPO overdose are at higher risk for fatality, and future research should examine statistically significant differences in cumulative naloxone dose and other severe clinical outcomes. Regardless, emergency clinicians should be aware of NPOs and be prepared to treat accordingly.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Similarly, this is an opportunity for education among patients with substance use disorder as a public health outreach to educate the potential additional adverse effects with the rise of NPOs in the NPS drug supply. 10,11 Many patients may believe they are using heroin; however, the number of deaths caused by heroin is declining, while the overall number of opioid-related deaths is increasing. 12 The ongoing ToxIC Fentalog study group has reported via public health alerts a rise in fentanyl and fentanylanalogue OD in patients who were in the ED across the country, 2 but now the addition of nitazenes presents an additional layer of complexity that may not be well known by patients and clinicians alike.…”

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

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Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients

Amaducci,

Aldy,

Campleman

et al. 2023

JAMA Netw Open

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ImportanceSynthetic opioids, such as the fentanyl analogue and nitazene drug class, are among the fastest growing types of opioids being detected in patients in the emergency department (ED) with illicit opioid overdose (OD). However, clinical outcomes from OD of novel potent opioids (NPOs), specifically nitazenes, are unknown aside from small case series.ObjectiveTo determine naloxone administration and clinical sequelae of patients who were in the ED with NPO overdose compared with fentanyl OD.Design, Setting, and ParticipantsThis is a cohort study subgroup analysis of adults admitted to the ED and tested positive for NPOs among in the ongoing nationwide ToxIC Fentalog cohort study from 2020 to 2022. Patients who were in the ED with a presumed acute opioid OD and residual blood samples were included, and those testing positive for NPOs were analyzed. Patients were included in this analysis if their confirmatory testing was positive for an NPO analyte, such as brorphine, isotonitazene, metonitazene, and/or N-piperidinyl etonitazene. A comparison group included patients that were positive for fentanyl and devoid of any other analytes on toxicologic analysis.ExposuresPatients were exposed to NPOs, including brorphine, isotonitazene, metonitazene and/or N-piperidinyl etonitazene.Main Outcomes and MeasuresThe primary outcome was the total number of naloxone doses and total cumulative naloxone dose administered as part of routine clinical care following the OD. Naloxone requirements and clinical sequelae of NPO-positive patients were compared with those testing positive for fentanyl only.ResultsDuring the study period, 2298 patients were screened, of whom 717 met inclusion criteria, 537 had complete laboratory testing data, with 11 (2.0%) positive for only fentanyl and 9 (1.7%) positive for NPOs (brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene). The age range of patients was aged 20 to 57 years (4 males [44.4%] and 5 females [55.6%]). The NPO group received a statistically significantly higher mean (SD) number of naloxone boluses in-hospital (1.33 [1.50]) compared with the fentanyl group (0.36 [0.92]) (P = .02), which corresponded to a moderately large effect size (Cohen d = 0.78). Metonitazene overdose was associated with cardiac arrest and more naloxone doses overall. Metonitazene cases had a mean (SD) number of 3.0 (0) naloxone doses, and 2 of 2 patients (100%) with metonitazene overdoses were administered cardiopulmonary resuscitation.Conclusions and RelevanceIn this cohort study of patients admitted to the ED with confirmed opioid overdose testing positive for NPOs, in-hospital naloxone dosing was high compared with patients who tested positive for fentanyl alone. Further study is warranted to confirm these preliminary associations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Substance Use and Addictionmentioning

confidence: 99%

See 2 more Smart Citations

Naloxone Use in Novel Potent Opioid and Fentanyl Overdoses in Emergency Department Patients

Amaducci,

Aldy,

Campleman

et al. 2023

JAMA Netw Open

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“…In the case of opioids and “new‐psychoactive substances” (NPS) [68–70], new analogs must be obtained by law enforcement, and characterized, before they can be added to the database. Expansion of the spectral libraries has been most active in this field as new materials appear “on the street” with alarming frequency: synthetic cannabinoids (“spice”) [71], cathinones (“bath salts”) [72], fentanyl and its analogs, and most recently nitazenes [14, 73, 74], and xylazine [75, 76] – a tranquilizer only approved for veterinary (non‐human) use in injectable solutions. See also the discussion below regarding spectroscopic techniques ability to determine a “core” chemical structure, which can help to determine that a compound is an analog of a known species.…”

Section: Vibrational Spectroscopymentioning

confidence: 99%

Field‐portable detection of fentanyl and its analogs: A review

Crocombe,

Giuntini,

Schiering

et al. 2023

Journal of Forensic Sciences

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The need to detect fentanyl and its analogs in the field is an important capability to help prevent unintentional exposure or overdose on these substances, which may result in death. Many portable methods historically used in the field by first responders and other field users to detect and identify other chemical substances, such as hazardous materials, have been applied to the detection and identification of these synthetic opioids. This paper describes field portable spectroscopic methods used for the detection and identification of fentanyl and its analogs. The methods described are automated colorimetric tests including lateral flow assays; vibrational spectroscopy (mid‐infrared and Raman); gas chromatography–mass spectrometry; ion mobility spectrometry, and high‐pressure mass spectrometry. In each case the background and key details of these technologies are outlined, followed by a discussion of the application of the technology in the field. Attention is paid to the analysis of complex mixtures and limits of detection, including the required spectral databases and algorithms used to interrogate these types of samples. There is also an emphasis on providing actionable information to the (likely) non‐scientist operators of these instruments in the field.

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