Narcan Or Nar-Can't: Tips and Tricks to Safely Reversing Opioid Toxicity

Total Page:16

File Type:pdf, Size:1020Kb

Narcan Or Nar-Can't: Tips and Tricks to Safely Reversing Opioid Toxicity EM:RAP COMMENTARY Narcan or Nar-can’t: Tips and Tricks to Safely Reversing Opioid Toxicity Kai Li, MD*; Patil Armenian, MD; Jessica Mason, MD; Andrew Grock, MD *Corresponding Author. E-mail: [email protected], Twitter: @kailimed. 0196-0644/$-see front matter Copyright © 2018 by the American College of Emergency Physicians. https://doi.org/10.1016/j.annemergmed.2018.05.010 SEE RELATED ARTICLE, P. 1. nervous system (CNS) depression. The typical ED starting dose seems to be 0.4 mg administered intravenously. Use of [Ann Emerg Med. 2018;72:9-11.] this dose, like all things in medicine, is well supported by multiple, large, randomized trials. Just kidding! It comes Editor’s Note: Annals has partnered with EM:RAP, enabling our readers without subscriptions to EM:RAP to enjoy their from the 1960s anesthesia literature as the dose needed to commentary on Annals publications. This article did not reverse excessive postoperative sedation in opioid-naive undergo peer review and may not reflect the view and patients.3 Decades later, changes in our patient population opinions of the editorial board of Annals of Emergency and the opioids they use have complicated naloxone dosing. Medicine. There are no financial relationships or other Common unknowns such as the opioid amount, type, consideration between Annals and EM:RAP, or its authors. and tolerance influence naloxone dose and time between doses. Unfortunately, a thin line separates improved ANNALS CASE respiratory rate and symptoms from acute iatrogenic Your next patient is a 34-year-old man with a history of withdrawal. Naloxone-induced opioid withdrawal is, to put intravenous drug use who was brought in by emergency medical it mildly, horrifically uncomfortable for patients. More services. In the field, he had a respiratory rate of 5 breaths/min, important, it can also lead to bad outcomes by increasing decreased mental status, and pinpoint pupils, all of which circulating catecholamines, leading to hyperventilation, significantly improved with out-of-hospital naloxone. He now tachycardia, hypertension, acute respiratory distress hasnormalmentalstatusandnormal vital signs, and admits syndrome, heart failure, and cardiac dysrhythmias!4-6 There to intravenous fentanyl (or so he was told) use. After downing is even evidence that ultrarapid opioid detoxification 3 hospital tuna salad sandwiches, he requests discharge. with naloxone is associated with death.7 Sound familiar? Well, it should. Drug overdose is now the leading cause of injury death in the United States, with frequency tripling from 1999 to 2014.1 Illicit opioids Dosing Option 1: Sleeping Beauty Cocktail for Gentle contribute to the significant increase in opioid-associated Awakenings deaths. The result: you have probably administered naloxone Unfortunately, in patients with long-term opioid use, even the 0.4-mg typical starting dose can precipitate recently once, twice, or even dozens of times to reverse acute 8,9 opioid overdoses. But what is the “standard” dose again? And withdrawal symptoms. This pathophysiology even how long do patients need to be observed? For something we do extends to cancer patients with long-term opioid use for frequently, the lack of evidence-based dosing and observation severe chronic pain. Clearly, no one wants to induce acute timesistroubling.Luckyforus,therecentpublicationby opioid withdrawal in a cancer patient. A gentler approach is Scheuermeyer et al2 examines the safety of an empiric needed whether the naloxone is given for diagnostic or emergency department (ED) protocol for the management therapeutic reasons. Dilute 0.4 mg of naloxone in 10 mL of patients with presumed fentanyl intoxication. After primarily of normal saline solution to produce a solution of 0.04 mg/mL. Then administer it in 1-mL boluses, with the goal intravenous fentanyl use, the majority of patients were > safely discharged after a 2-hour observation period. to improve the respiratory depression (respiratory rate 8 breaths/min). In patients receiving methadone, this gentler, “sleeping beauty” method of reversal can reverse respiratory NAR-CAN! BUT HOW MUCH? and CNS depression, with a median dose requirement Naloxone hydrochloride (Narcan) reverses opioid of just 0.08 mg.10 The upsides: no angry, possibly intoxication symptoms such as respiratory and central aggressive patient with acute withdrawal (aka vomiting and Volume 72, no. 1 : July 2018 Annals of Emergency Medicine 9 EM:RAP Commentary Li et al diarrhea-ing). And no risk of really bad patient outcomes reversal, but not so much that he or she requires more associated with acute withdrawal! The downside is that immediate reversal. Additionally, these patients still need these doses require more bedside vigilance to monitor for close monitoring to ensure that clinical symptoms clinical efficacy. improve.and someone needs to help keep the face mask in place. Dosing Option 2: Waking the Giants On the other hand, the synthetic opioids (eg, fentanyl, carfentanil) require increased amounts of naloxone for Intranasal Naloxone opioid reversal, and their prevalence is increasing. During Intranasal naloxone, although more extensively studied in the out-of-hospital setting, can be useful in ED patients periods of known fentanyl outbreaks, dosing as high as fi 12 mg of naloxone has been reported!11 Although it is with dif cult intravenous access who need immediate universally acknowledged that patients may need escalating reversal. Typical administration is 1 mL of a solution of 1 doses of naloxone to reverse the effects of opioid mg/mL per naris, for a total dose of 2 mg. Out-of-hospital studies show an 83% response rate15 and response rates intoxication, there is no established best protocol. Some 16 articles have suggested increasing the dose of naloxone similar to that of intravenous naloxone. However, the similar rates of response observed in these studies could be every 2 to 3 minutes (from 0.5 to 2 mg, to 4 to 10 mg, and 6 fi 12 related to the delay in obtaining intravenous access. nally 15 mg). Although unimproved CNS or respiratory fi depression after 2 naloxone doses may indicate other cause Potential downsides include dif cult titration and or cointoxicants, no response to a 15-mg dose of naloxone unpredictable absorption, but data in rats describe a 100% fi bioavailability and half-life similar to that of intravenous more de nitively indicates another diagnosis. Anecdotally, 17 some clinicians have doubled the dose of naloxone every 2 naloxone. to 3 minutes (ie, 0.04 to 0.08 to 0.16 mg) until clinical response is achieved. More research needs to be conducted SO THE NAR-CAN WORKED.NOW WHAT? in this area, but, in summary, naloxone should be given in Unfortunately, and perhaps predictably, there is no systematically increasing dosages up to 12 to 15 mg when simple answer because many variables, including the synthetic opioid overdose is suspected. duration of effect, the specific potency and type of opioid Additionally, new routes of administration have made consumed, the administration route, coingestants, and the naloxone administration much easier, especially when patient’s underlying opioid tolerance (to name just a few), venous access is unavailable or difficult to obtain. complicate the opioid’s duration. In one study of healthy patients sedated by opioids, a Nebulized Naloxone 0.4-mg dose of intravenous naloxone reversed the effects Nebulized naloxone (2 mg in 3 mL normal saline within 2 minutes. However, symptoms started to return solution administered through a standard face mask) has after 15 to 30 minutes and completely returned within 45 been touted as an effective method to administer the minutes.18 According to this information, it may be appropriate dose of naloxone for a gentler awakening. The reasonable to discharge a patient without recurrence of purported benefit is its exemplary titratability, or should symptoms after 1 hour of observation if you know that the we say self-titratability. Nebulized naloxone is gradually opioid was short acting and pure. Studies have supported inhaled, in contrast to a single, rapid intravenous bolus. the safety of discharging patients after 1 hour of observation Once CNS depression improves enough, the patient can in the ED after use of heroin.19 However, real life is never (and likely will) remove the face mask. All without the so straightforward. risk for precipitating withdrawal! It sounds brilliant and One argument for prolonged observation is that elegant in principle, but studies so far have shown adulteration of street drugs may prolong the opioid contradicting outcomes, ranging from no improvement intoxication. Street heroin may include fentanyl, over placebo13 to a reduced need for supplementation of diphenhydramine, codeine, morphine, phenobarbital, oxygen and improvement in Glasgow Coma Scale score.14 and diazepam.20 In addition, novel synthetic As such, if a clinically suspected opioid overdose is not opioids (such as U-47700) have unpredictable or responding to nebulized naloxone, intravenous naloxone unknown pharmacokinetics.21 Studies have shown should be given. Based on clinical experience, the recurrence of symptoms from opioid toxicity, requiring practical downsides are that this treatment applies only to repeated reversal from naloxone up to 187 minutes a very limited patient population, a patient with enough after initial naloxone administration.12 There are also opioid-induced CNS or respiratory depression to warrant regional variations in adulterants, making it difficult to 10 Annals of Emergency Medicine Volume 72, no. 1 : July 2018 Li et al EM:RAP Commentary generalize one specific study result to all recreational REFERENCES drug users. 1. Rudd RA, Seth P, David F, et al. Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452. Route of Administration 2. Scheuermeyer FX, DeWitt C, Christenson J, et al. Safety of a brief emergency department observation protocol for patients with The route of administration can change the duration of presumed fentanyl overdose. Ann Emerg Med.
Recommended publications
  • The Challenge of Managing Wounds in the Injecting Drug- Dependent Patient
    Clinical PRACTICEClinical DEVELOPMENT REVIEW The challenge of managing wounds in the injecting drug- dependent patient Managing wounds in the patient who injects drugs is complex for healthcare professionals. As with the non- drug taking population, the problems of mobility, odour from the wound, social limitation and pain still occur, but fears of discrimination may lead to reluctance to seek medical intervention, potentially leading to slower recovery and chronicity. This article focuses on the problems encountered by injecting drug users, a group that can suffer significant wound care issues, including infection, wound abscess and fistula formation, along with other management problems, such as a reciprocal mistrust of healthcare professionals. Andy Roden Irrespective of the route of doses of opioid are given to patients KEY WORDS administration, once heroin is taken with chronic pain.’ Heroin users report a feeling of well-being, Drug addiction relaxation and safety, which Finnie and It is quite possible that a patient Nicolson (2002; p. s18) describe as ‘like may have a tolerance/addiction to Analgesics being wrapped up in a warm blanket’. opioids, which requires analgesia, as Wound care management It is these properties, along with the well as pain from a chronic wound, Healthcare professionals euphoria associated with taking heroin, which also needs managing. This can which makes it such a potentially be a difficult task for the healthcare powerfully addictive drug. professional and is one where specialist help from a drug and alcohol specialist eroin (diacetylmorphine or team will be required. By administering diamorphine) is a powerful There is no therapeutic opioids, practitioners may also be seen Hanalgesic synthesised from discovery that has been so as condoning or reinforcing the drug- the group of mixed alkaloids present great a blessing and so great taking behaviour.
    [Show full text]
  • Predictors of Skin and Soft Tissue Infections Among Sample of Rural Residents Who Inject Drugs
    Baltes et al. Harm Reduct J (2020) 17:96 https://doi.org/10.1186/s12954-020-00447-3 RESEARCH Open Access Predictors of skin and soft tissue infections among sample of rural residents who inject drugs Amelia Baltes1* , Wajiha Akhtar2, Jen Birstler3, Heidi Olson‑Streed4, Kellene Eagen1, David Seal5, Ryan Westergaard2 and Randall Brown1 Abstract Introduction: Skin and soft tissue infections (SSTIs) are among the leading causes of morbidity and mortality for people who inject drugs (PWID). Studies demonstrate that certain injection practices correlate with SSTI incidence among PWID. The opioid epidemic in the USA has particularly afected rural communities, where access to preven‑ tion and treatment presents unique challenges. This study aims to estimate unsafe injection practices among rural‑ dwelling PWID; assess treatments utilized for injection related SSTIs; and gather data to help reduce the overall risk of injection‑related SSTIs. Methods: Thirteen questions specifc to SSTIs and injection practices were added to a larger study assessing unmet health care needs among PWID and were administered at six syringe exchange programs in rural Wisconsin between May and July 2019. SSTI history prevalence was estimated based on infections reported within one‑year prior of response and was compared to self‑reported demographics and injection practices. Results: Eighty responses were collected and analyzed. Respondents were white (77.5%), males (60%), between the ages 30 and 39 (42.5%), and have a high school diploma or GED (38.75%). The majority of respondents (77.5%) reported no history of SSTI within the year prior to survey response. Females were over three times more likely to report SSTI history (OR 3.07, p 0.038) compared to males.
    [Show full text]
  • Msm, Crystal Meth and Intravenous Drug Use in a Sexual Setting
    TINA AND SLAMMING MSM, CRYSTAL METH AND INTRAVENOUS DRUG USE IN A SEXUAL SETTING Leon Knoops, Ingrid Bakker, Renate van Bodegom, Paul Zantkuijl 1 COLOPHON GLOSSARY Authors Ass play: anal insertion of fingers, fist, dildos or other Leon Knoops, Ingrid Bakker, Renate van Bodegom - objects Mainline en Paul Zantkuijl - Soa Aids Nederland Barebacking: anal sex without a condom BDSM: Bondage and Discipline, Dominance and Interviews with MSM Submission, Sadism and Masochism Leon Knoops - Mainline • role play involving physical restraints, and focusing on intense stimulation and/or playing with power relations Interviews with professionals • kinky sex Ingrid Bakker - Mainline en Willem van Aaken - Booty-bumping: a mode of administering a water-soluble Soa Aids Nederland drug by injecting it into the rectum with a needleless syringe Editing Bo!om: passive sexual role Ejay de Wit - Loaded Content Chems: drugs, chemical substances Chemsex: having sex while under the influence of drugs/ Reference editing chemical substances Mary Hommes - Soa Aids Nederland Coming out: self-disclosure of sexual orientation to the outside world English translation: Coming down: immediate a"ermath of drug use, during The English Writer which the physical and psychological consequences of use are experienced Proofreading Crystal meth: methamphetamine (see: Tina) Joost Breeksema Downer: narcotic drug (inhibitory effect on central nervous system) Design and layout Entactogen: a class of psychoactive drugs that produce planpuur. experiences of emotional communion, oneness,
    [Show full text]
  • Skin Popping Scars – a Telltale Sign of Past and Present Subcutaneous Drug Abuse
    DOI 10.1515/crpm-2012-0056 Case Rep. Perinat. Med. 2012; 1(1-2): 37–39 Amos Grunebaum* and Daniel Skupski Skin popping scars – a telltale sign of past and present subcutaneous drug abuse Abstract Case Background: Identifying women with past and present drug abuse is an essential aspect of prenatal care. A 33-year-old primiparous pregnant woman was admit- Case: Despite having typical telltale physical signs of ted to the hospital at 38 weeks with a history of premature prior subcutaneous drug injections, a 33-year-old preg- rupture of membranes (PROM) about 5 h before admis- nant woman who had regular prenatal care visits with sion. She received prenatal care from a private obstetrician multiple obstetric care providers was only identified as a from the 6th week of pregnancy. At 34 weeks, she moved drug abuser after a cesarean section, when her skin scars to a different city where she continued prenatal care with were identified by one provider as the result of “skin another private obstetrician. popping” related to injections of illicit drugs before this She did not mention her history of drug use during her pregnancy. prenatal care, and physical examinations done by both Conclusion: This case demonstrates that obstetricians obstetricians were unremarkable. On admission, her cervix must become aware of the telltale signs of drug abuse, was 1 cm dilated, not effaced, with the vertex at −3 station. such as subcutaneous injections (skin popping) with The estimated fetal weight was 3600 g, and the fetal heart illicit drugs leading to scaring of the arms and other parts rate was reassuring.
    [Show full text]
  • Opium HEROIN BARBITURATES Hallucinogens
    OPIUM OPIUM • Opium poppy, Papaver somniferum var. album, is the species of plant from which opium and poppy seeds are extracted. • The Latin botanical name means, loosely, the "sleep‐bringing poppy, white form", referring to the sedative properties of some of these opiates • The plant itself is also valuable for ornamental purposes, and has been known as the "common garden poppy", • Poppy seeds of Papaver somniferum are an important food item and the source of poppyseed oil, a healthy edible oil that has many uses. Poppy seeds are called Khuskhus in Hindi, Gasagasalu in Telugu, Gasagasa in Kannada, Posto dana in Bengali. • The opium poppy is the principal source of all natural opiates. • Opium (raw opium) is the latex harvested by making incisions on the green capsules (seed pods). Poppy straw is the dried mature plant except the seeds, harvested by mowing. • Morphine is the predominant alkaloid found in the varieties of opium poppy plant cultivated in most producing countries • Poppies as medicine: Australia, Turkey and India are the major producers of poppy for medicinal purposes and poppy‐based drugs, such as morphine or codeine • In medicine, the term opiate describes any of the narcotic opioid alkaloids found as natural products in the opium poppy plant, as well as many semisynthetic chemical derivatives of such alkaloids • There are a number of broad classes of opioids: • Natural opiates: alkaloids contained in the resin of the opium poppy, primarily morphine, codeine, and thebaine, papaverine and noscapine • Semi‐synthetic opioids: created from the natural opiates, such as hydromorphone, hydrocodone, oxycodone, oxymorphone, desomorphine, diacetylmorphine (heroin), nicomorphine, dipropanoylmorphine, benzylmorphine and ethylmorphine; • Fully synthetic opioids: such as fentanyl, pethidine, methadone, tramadol and dextropropoxyphene; • Endogenous opioid peptides, produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins.
    [Show full text]
  • Terminology and Information on Drugs Third Edition
    Terminology and Information on Drugs Third edition Terminology and Information on Drugs Third edition UNITED NATIONS NEW YORK, 2016 UNITED NATIONS PUBLICATION Sales No. E.16.XI.8 ISBN: 978-92-1-148287-4 eISBN: 978-92-1-057914-8 Original language: English © United Nations, March 2016. All rights reserved, worldwide The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Photographs: UNODC and Health Sciences Authority, Singapore. ACKNOWLEDGEMENTS UNODC’s Laboratory and Scientific Section (LSS), headed by Dr. Justice Tettey, wishes to express its appreciation and thanks to the following experts who participated in an expert group meeting and/or contributed to the development and review of this revision of Terminology and Information on Drugs: Dr. Heesun Chung Graduate School of Analytical Science and Technology (GRAST), South Korea Prof. Les Iversen Advisory Council on the Misuse of Drugs (ACMD), United Kingdom Dr. Wendy Lim Jong Lee Health Sciences Authority, Singapore Dr. Franco Tagliaro University of Verona, Italy Mr. Eleuterio Umpiérrez Faculty of Chemistry, Universidad de la República, Uruguay Mr. Scott Oulton DEA Office of Forensic Sciences, United States The preparation of this manual was coordinated by Dr. Conor Crean, Dr. Iphigenia Naidis and Ms. Susan Ifeagwu, staff of LSS.
    [Show full text]
  • What Do We Know About Opioids and the Kidney?
    International Journal of Molecular Sciences Review What Do We Know about Opioids and the Kidney? Mary Mallappallil *, Jacob Sabu, Eli A. Friedman and Moro Salifu Department of Internal Medicine, State University of New York at Downstate, Brooklyn, New York, NY 11203, USA; [email protected] (J.S.); [email protected] (E.A.F.); [email protected] (M.S.) * Correspondence: [email protected]; Tel.: +1-917-301-9860 Academic Editor: Monica Valentovic Received: 21 November 2016; Accepted: 17 January 2017; Published: 22 January 2017 Abstract: Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and chronic kidney injury. Both the direct and indirect effects of the drug, and the context which leads to the development of renal failure, are explored. While commonly used safely for pain control and anesthesia in those with kidney disease, the concerns with respect to side effects and toxicity of opioids are addressed. This is especially relevant with the worldwide increase in the use of opioids for medical and recreational use. Keywords: opioids; renal failure; pharmacokinetics 1. Introduction The universal increase in opioid use requires practitioners to be comfortable with the use of these medications, especially in those with organ dysfunction such as kidney disease to avoid complications. This article targets to highlight the safe use of opioids in those with kidney disease. Pain occurs when a signal from a noxious stimulus is transmitted via peripheral nerve fibers to the spino-thalamic tract, and finally relayed to the somatosensory cortex.
    [Show full text]
  • The Textures of Heroin: User Perspectives on “Black Tar” and Powder Heroin in Two US Cities
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author J Psychoactive Manuscript Author Drugs. Author Manuscript Author manuscript; available in PMC 2017 September 01. Published in final edited form as: J Psychoactive Drugs. 2016 ; 48(4): 270–278. doi:10.1080/02791072.2016.1207826. The Textures of Heroin: User Perspectives on “Black Tar” and Powder Heroin in Two US Cities Sarah G. Mars, Ph.D.a, Philippe Bourgois, Ph.D.b, George Karandinos, B.A.c, Fernando Montero, M.Phil.d [Ph.D. Candidate], and Daniel Ciccarone, M.D., M.P.H.e aQualitative Project Director, Heroin in Transition, Department of Family and Community Medicine, University of California, San Francisco bVisiting Professor of Anthropology and Social Medicine, Director, Center for Social Medicine and Humanities; Semel Institute of Neuropsychiatry, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles cPaul and Daisy Soros New American Fellow, Harvard University dDepartment of Anthropology, Columbia University eProfessor of Family and Community Medicine, Department of Family and Community Medicine, University of California, San Francisco Abstract Since the 1990s, US heroin consumers have been divided from the full range of available products: east of the Mississippi River, Colombian-sourced powder heroin (PH) dominates the market, while to the west, Mexican-sourced “black tar” (BTH) is the main heroin available. By conducting qualitative research in two exemplar cities, Philadelphia (PH) and San Francisco (BTH), we compare users’ experiences of heroin source-types, markets, health consequences and consumption preferences. The strict division of heroin markets may be changing with novel forms of powder heroin appearing in San Francisco.
    [Show full text]
  • Rx OPIOIDS – Friend Or Foe
    Rx OPIOIDS – Friend or Foe DATA and MEDIA SPIN SELF-MEDICATION and ABUSE MEDICAL USES PAIN MYTHS- UNDERTREATMENT of PAIN BENEFITS of PROPER PAIN CONTROL ADDICTION-PSEUDOADDICTION–PHYSICAL DEPENDENCE-TOLERANCE GOOD STUFF – BAD STUFF – SEXUAL ISSUES WITHDRAWAL DEATHS DIFFERENT OPIOIDS SS=Special Stuff…Fx=Effects…Px=Problem…Tx=Treatment…Sx=Symptoms > = More – Greater – Increased…< = Less – Decreased – Not as much…~ = About PHYSICAL DEPENDENCE DOES NOT MEAN ADDICTION Presented by: Billy Heckle, CAC II, Registered Pharmacist The William J. McCord Adolescent Treatment Facility 910 Cook Road Orangeburg, SC 29118 803-534-2328 Ext. 117 [email protected] 10-10-2015 1 When used correctly opioids are irreplaceable for pain relief and the reduction of suffering. They allow those who suffer from acute or chronic pain conditions to live productive lives, keep jobs, socialize and enjoy their partner. According to most responsible and scientific studies 97-99% of people who are prescribed opioids for acute or chronic pain take them ‘correctly’. The same studies saw an “addiction rate” of ~ 1%. (“More recent” studies have placed the addiction rate at 20-30%. These studies used different criteria for their personal definition of addiction (Not DSM) that was heavily reliant on Physical Dependence and “Aberrant Behaviors”). Sadly, this group of people who suffer painful conditions are not the group that gets the media attention and headlines On the other hand, when these drugs are abused, they can cause serious Px in all parts of a person’s life.
    [Show full text]
  • Program Participant Guide
    Program Participant Guide 1 Access, Harm reduction, Overdose Prevention, and Education This manual provides non-judgemental, reliable information about drug use and the services available to people who use drugs. Harm Reduction Participant Guide About the Program .................................................1 Health Risks & Complications............................11 Safer Injection Guidelines...................................21 Overdose Prevention............................................36 Resources ..............................................................46 C O N T E S THE PROGRAM 1 HOURS, LOCATION, CONTACT program 774 Albany Street, Boston, MA 02118 Drop in phone: 617-534-3967 Outreach phone: 617-592-7828 Website: www.bphc.org/AHOPE AHOPE has a permanent site you can visit at 774 Albany Street, but we also offer clean supplies and services from our mobile van, which travels regular routes around the city. For the most updated schedule of the AHOPE drop-in and mobile van sites/times, please check our website at www.bphc.org/AHOPE or call us at 617-534-3976. 2 THE PROGRAM program Access Harm reduction Overdose Prevention Education (AHOPE) AHOPE, the Boston Public Health Commission’s Needle Exchange Program, was created to reduce the spread of infectious diseases like HIV/AIDS, Hepatitis C, and tuberculosis among individuals who inject drugs and their sexual and drug use partners. The program operates under the philosophy of harm reduction, which focuses on safer drug use. Harm reduction takes a neutral stance on drug use, neither supporting use or shaming people who use drugs. The program provides supplies, education, and referrals to ensure that those who use drugs have the information and resources to use in the safest possible way. Staff are trained to offer harm reduction advice and risk reduction options.
    [Show full text]
  • Drugs and Human Performance Fact Sheets Technical Report Documentation Page 1
    NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION Drugs and Human Performance Fact Sheets Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. DOT HS 809 725 4. Title and Subtitle 5. Report Date Drugs and Human Performance Fact Sheets April 2014 (Revised) 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. COUPER, Fiona J. and LOGAN, Barry K 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) Washington State PatrolForensic Laboratory Services Bureau 2203 Airport Way S., Seattle, WA 98134 11. Contract or Grant No. 12. Sponsoring Agency Name and Address’ 13. Type of Report and Period Covered National Highway Traffic Safety Administration Final Report; 400 Seventh St., SW. August 2000-March 2004 Washington, DC 20590 14. Sponsoring Agency Code 15. Supplementary Notes The following toxicologists made significant contributions to both the drafting and review of the Fact Sheets: Michael Corbett Ph.D., Laurel Farrell MS., Marilyn Huestis Ph.D., Wayne Jeffrey MS, and Jan Raemakers, Ph.D. James F.Frank Ph.D. served as the NHTSA Contracting Officer's Technical Representative. 16. Abstract A panel of international experts on drug-impaired driving met in Seattle during August 2000 to review developments in the field of drugs and human performance over the last 10 years; to identify the specific effects that both illicit and prescription drugs have on driving; and to develop guidance for others when dealing with drug-impaired driving problems. Delegates represented the fields of psychopharmacology, behavioral psychology, drug chemistry, forensic toxicology, medicine, and law enforcement experts trained in the recognition of drug effects on drivers in the field.
    [Show full text]
  • Cutaneous Manifestations of Injectable Drug Use: Hidden Secrets
    Psychocutaneous Medicine Cutaneous Manifestations of Injectable Drug Use: Hidden Secrets Wioletta Bara ´nska-Rybak, DSc; Izabela Bła ˙zewicz, MD; Monika K ˛akol, MD; Mirosław Roter, MD; Roman Nowicki, DSc Practice Points Skin and soft tissue infections are the most common cause of hospital admission among injectable drug users. The most common microorganisms identified in these abscesses are Staphylococcus aureus, facultative gram-negative bacteria, and anaerobic bacteria. The strongest risk factor for skin and soft tissue infections is skin popping, or subcutaneous drug injec- tion, which introduces bacteria and irritating substances directly into the skin. Abscesses related to drug use are the most ddiction to injectable narcotics is a substantial common cutaneous manifestations among injec- source of morbidity and mortality in the world. tion drug users, often occurringCUTIS when the veins AAccording to the European Monitoring Centre become less accessible. In these cases, other for Drugs and Drug Addiction, an estimated 56,000 to techniques may be used to administer drugs, 103,000 individuals were dependent on drugs.1 There such as skin popping (subcutaneous injection) are many methods of drug administration, including or muscle popping (intramuscular injection). The intravenous, subcutaneous (skin popping), and intra- main risk factors for abscess formation include muscular (muscle popping) routes. When the veins skin popping, use of unsterilized needles, and become less accessible, drugs are injected directly injectionDo of speedball (a mixtureNot of cocaine and into theCopy skin or muscle, which can lead to multiple heroin). We present a case of recurrent abscesses cutaneous manifestations. Skin and soft tissue infec- accompanied by fever, hypersomnia alternating tions (SSTIs) are the most common cause of hospital with insomnia, diaphoresis, fatigue, recent weight admission among injectable drug users.2 Abscesses loss, and agitation following subcutaneous injec- related to drug use are the most frequent type of SSTI.
    [Show full text]