Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review

Winstanley, Erin L.; Mahoney, James J.; Castillo, Felipe; Comer, Sandra D.

doi:10.1016/j.drugalcdep.2021.108838

Cited by 21 publications

(19 citation statements)

References 127 publications

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“…45 Consistent with prior studies, 11 NFOD events made up approximately 94% of all overdose events in this study and the incidence of NFOD was more than 15 times that of fatal events. NFOD events have known cognitive and physical consequences attributed to loss of oxygen, including seizures, heart complications, neurological problems, and long-term brain injury, [46][47][48] making it critical to reduce their prevalence. NFOD events also offer an opportunity to provide interventions when they do happen.…”

Section: Discussionmentioning

confidence: 99%

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

et al. 2022

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ImportanceStudies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk.ObjectiveTo examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration.Design, Setting, and ParticipantsIn this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022.ExposuresSubstance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics.Main Outcomes and MeasuresHazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events.ResultsThe study identified 6816 people (5980 male [87.7%]; 2820 aged &lt;30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses.Conclusions and RelevanceThis cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.

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Section: Discussionmentioning

confidence: 99%

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

et al. 2022

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“…Receptor mu binding is responsible for the psychotropic effects of opioids, and eventual respiratory depression and death by overdose. Even though the vast majority of deaths as a result of illicit drug consumption are attributed to opioid use [44], it is important to notice that prolonged use of opioids and non-fatal overdoses are clinically significant, as they can lead to neurocognitive impairments [45,46]. Oxidative stress has been demonstrated to be one of the main mechanisms of neuronal damage induced by licit and illicit opioids, as shown by studies in both animal and human subjects.…”

Section: Opioid Use Disordermentioning

confidence: 99%

Oxidative Stress in Substance Use Disorders: Endogenous and Exogenous Mechanisms of Repair

Lirio¹,

Santos²,

Silva³

et al. 2023

Importance of Oxidative Stress and Antioxidant System in Health and Disease

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Substance use disorders (SUDs) can be defined as patterns of symptoms caused by the abusive consumption of recreational or prescribed substances that an individual continues to use despite their negative effects. Oxidative stress is one of the main pathophysiological processes occasioned by SUDs in different brain areas. Oxidative damage and subsequent deleterious symptoms can happen because of the consumption of psychoactive drugs, both stimulants and depressants. This chapter focuses on SUDs associated with depressant drugs, such as alcohol, opioids, benzodiazepines, and their effects on the central nervous system (CNS). We present the main characteristics of the SUDs and later explore endogenous mechanisms of repair, such as neuroglia and the endocannabinoid system. We also examine the neuroprotective effects of exogenous substances such as phytocannabinoids (e.g., cannabidiol) and N-acetylcysteine (NAC), which have shown important roles in anti-inflammatory pathways and antioxidative cascades, and how these molecules can be potential tools in the treatment of neurological symptoms of SUDs.

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“…Con respecto a la sobredosis por opioides, esta se ha definido como el síndrome clínico secundario a la exposición a una dosis tóxica de opioides que incluye depresión del estado de consciencia, bradipnea y respiraciones superficiales, hipoxia y miosis (22,23). El manejo inicial y urgente de estos pacientes incluye el abordaje y estabilización en paralelo de la vía aérea, la ventilación y circulación; apoyado en el uso de naloxona, un antagonista opioide de corta acción, de preferencia por vía intravenosa y a dosis de 0,4mg, titulando a dosis repetidas cada 2 a 3 minutos de acuerdo con la aparición de reflejos protectores de la vía aérea y la respuesta del esfuerzo ventilatorio, cuya recuperación y frecuencia mayor a 12 veces por minuto debe tomarse como principal meta terapéutica y no la reversión completa de la alteración de la consciencia pues se corre el riesgo de generar un síndrome de abstinencia y convulsiones (22,24).…”

Section: Lesiones Isquémicas Agudasunclassified

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

Leal¹,

Hoyos-Zuluaga

Álvarez³

2022

Rev Neuropsiquiatr

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El abordaje de pacientes intoxicados que presentan antecedentes de patología psiquiátrica supone un reto en la atención médica. La presencia de una patología dual puede conducir a que algunos síntomas somáticos sean desestimados y no se consideren como manifestación de una posible patología grave subyacente. Se reporta el caso de una paciente que, durante su hospitalización debida a un episodio depresivo, presentó una sobredosis incidental de opioides. Al recuperarse de ella, sin embargo, presentó comportamiento desorganizado e ideas delirantes, inicialmente atribuidas a la depresión. Estudios ulteriores demostraron una causa orgánica grave subyacente: lesión isquémica bilateral del globo pálido. Se analiza el cuadro clínico a la luz de la literatura pertinente, abordando los temas de delirium, espectro clínico debido a las lesiones del globo pálido y finalizando con una breve descripción sobre la sobredosis y neurotoxicidad por opioides. Frente a síntomas no concordantes con la evolución usual de una descompensación psicopatológica o una intoxicación por drogas, debe ahondarse en la exploración de posibles causas orgánicas, objetivo para el cual se sugiere considerar estudios de neuroimágenes en todo paciente que experimente una sobredosis de opioides y que posteriormente presente graves manifestaciones de una alteración cognitiva.

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Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review

Cited by 21 publications

References 127 publications

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

Oxidative Stress in Substance Use Disorders: Endogenous and Exogenous Mechanisms of Repair

¿Psicosis luego de sobredosis por opioides? Lesión isquémica bilateral del globo pálido como causa orgánica insospechada.

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