Serious adverse events in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

Digiusto, Erol; Shakeshaft, Anthony; Ritter, Alison; O’Brien, Susannah; Mattick, Richard P.

doi:10.1111/j.1360-0443.2004.00654.x

Cited by 90 publications

(86 citation statements)

References 49 publications

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“…These withdrawal symptoms may have resulted from voluntary or forced periods of abstinence, including incarceration or drug treatment attempts, although we did not find an independent effect of enrollment in detoxification in the past six months on the risk of recent overdose, as demonstrated in other studies. 23 In this sample, younger heroin injectors were at greatest risk of experiencing a recent overdose. Although this finding has been replicated in at least one other study, 7 most studies have indicated greater risk of overdose among older users.…”

Section: Discussionmentioning

confidence: 99%

“…Length of drug use, 4,15 polydrug use, 4,[16][17][18] risky drug use, 13,15,19 disrupted life circumstances, 20,21 and conflicts within social networks 19 are associated with overdose. Risk of overdose increases with periods of reduced tolerance, including release from prison 22 and naltrexone detoxification, 23 while overdose risk is decreased with agonist maintenance therapy 24 ; opioid metabolites in the hair of overdose decedents are far below the levels of active heroin users, 25,26 suggesting periods of abstinence preceding death. Drug dependence may have a more complicated relationship with overdose, with heroin dependence possibly protecting users through increased tolerance and cocaine dependence resulting in direct toxicity.…”

mentioning

confidence: 99%

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Identifying Injection Drug Users at Risk of Nonfatal Overdose

Coffin¹,

Tracy²,

Bucciarelli³

et al. 2007

Academic Emergency Medicine

101

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Objectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose.Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months.Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age.Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Coffin¹,

Tracy²,

Bucciarelli³

et al. 2007

Academic Emergency Medicine

101

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“…Although opioid antagonists up‐regulated μ‐receptors and induced supersensitivity to morphine in a mouse model,91 healthy humans show no evidence of μ‐receptor up‐regulation in the respiratory control system, the most likely site of opioid overdose lethality 92. Overall, the risk of overdose is significantly lower in patients who are actively involved in medication‐assisted treatment whether it is with methadone, buprenorphine, or naltrexone 93. Attempts to override the antagonist blockade, however, can result in fatal overdose,11 which should be discussed with patients at each treatment visit.…”

Section: Current Approach To Treatment Of Opioid Use Disorder: Choosimentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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“…Secondly, there are doubts about the safety of oral naltrexone in treating unselected opioid-dependent patients. Its acute toxicity may indeed be low [5], but the risk of fatal opioid overdose is doubled when patients stop taking naltrexone and return to opioid use, as most of them do [11,12]. A drug that is no better than placebo in unselected opioid-dependent patients and that doubles the risk of overdose when these patients stop using it does not have strong claims to being safe and effective.…”

Section: How Safe and Effective Are Naltrexone Implants?mentioning

confidence: 99%