The Opioid-Overdose Crisis and Fentanyl: The Role of Online Information Seeking via Internet Search Engines

Abstract

Opioid abuse is a severe public health threat. Recent evidence points to a disturbing increase in the illicit use of fentanyl, a potent synthetic opioid, with abuse often involving illicitly produced opioids mixed with heroin. Public health experts have emphasized that there is an urgent need for new, effective harm-reduction strategies and technologies. We asked whether Internet search engines could contribute toward this goal. Using state-level data from the USA, we provide evidence for a cross-sectional and longitudinal statistical relationship between opioid-related overdose deaths and the number of Google searches using the term "fentanyl." This finding points to the relevance of Internet search engines: Userswho may be non-addicted vulnerable individuals, addicts, addicts' friends and family members, or physiciansdo in fact search for fentanyl online. We argue that during such searches, an info box including a warning (i.e., awareness material to educate users about the risks) and a help message (i.e., references to professional help) can be presented to target users and possibly prevent both unintentional and suicidal overdoses. Even if this info box only helps some users, the high number of daily Google searches renders this a promising public health intervention to supplement other opioid harm-reduction strategies.

The ventilatory depressant actions but not the antinociceptive effects of morphine are blunted in rats receiving intravenous infusion of L-cysteine ethyl ester

“…The clinical effectiveness of opioids as analgesics is often compromised by their ability to induce adverse effects on ventilatory parameters [ 1 – 6 ]. Although the administration of opioid receptor (OR) antagonists can in many cases reverse opioid-induced respiratory depression (OIRD), these antagonists also diminish the analgesic/antinociceptive actions of opioids, which may not be a problem in overdose situations, but which is contraindicated when analgesia is required during and after injuries and surgical procedures [ 2 – 4 ].…”

L-cysteine methyl ester overcomes the deleterious effects of morphine on ventilatory parameters and arterial blood-gas chemistry in unanesthetized rats

“…Our evidence that 500 μmol/kg of L-CYSme overcomes the adverse effects of morphine on breathing, ABG chemistry and gas-exchange in alveoli, should be extended to include whether 100 or 250 μmol/kg doses overcome morphine OIRD. Synthetic opioids are playing a major role in the current opioid crisis ( Arendt, 2021 ; Deo et al, 2021 ) and further investigation needs to include whether L-CYSme can overcome the adverse actions of high potency opioids, such as fentanyl. Another limitation of this study is the lack of data about the efficacy of L- or D-thiolesters in preventing/reversing OIRD in female rats, especially since opioids exert qualitatively and quantitatively different ventilatory responses in females compared to males ( Dahan et al, 1998 ; Hosseini et al, 2011 ).…”

“…The clinical usefulness of opioids analgesics, such as morphine and fentanyl, is compromised by their deleterious effects on breathing and alveolar gas exchange ( van Dorp et al, 2007 ; Dahan et al, 2010 ; Dahan et al, 2018 ; Boom et al, 2012 ; Algera et al, 2019 ; Arendt, 2021 ). Opioid-induced respiratory depression (OIRD) can be overcome by administration of opioid receptor (OR) antagonists, such as naloxone, but these antagonists also block the analgesic and sedative actions of opioids, which may not be an issue in cases involving unexpected overdose, but which would be highly problematic in situations requiring analgesia/sedation, such as during and after surgery ( Dahan et al, 2010 ; Dahan et al, 2018 ; Boom et al, 2012 ).…”

D-Cysteine Ethyl Ester Reverses the Deleterious Effects of Morphine on Breathing and Arterial Blood–Gas Chemistry in Freely-Moving Rats

“…Our findings that a 500-μmol/kg dose of D-CYSee reverses the adverse actions of morphine on breathing, ABG chemistry and alveolar gas exchange need to be evaluated at lower doses. The ability of D-CYSee to reverse the adverse effects of higher potency opioids, such as fentanyl and carfentanil, should be determined, especially considering the key role that these synthetic opioids are playing in the current opioid epidemic ( Arendt, 2021 ; Deo et al, 2021 ). Another important limitation is the lack of evidence as to the efficacy of D-CYSee in reversing OIRD elicited by morphine and fentanyl in female rats knowing that opioids can exert qualitatively/quantitatively different responses in females than males ( Dahan et al, 1998 ; Hosseini et al, 2011 ).…”