Articles: narcotic-antagonists.
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Fentanyl use has been linked with an increasing number of opioid-related deaths. The emergency department (ED) is a critical contact point for patients with opioid use disorder (OUD) to access basic healthcare. Little information is known about buprenorphine precipitated opioid withdrawal (BPOW). This study sought to examine the rates of BPOW in patients who used fentanyl and received buprenorphine in the ED. ⋯ We demonstrate that the prevalence of BPOW is low in a cohort of patients who use fentanyl. When precipitated withdrawal does occur, however, it can be severe and require intensive treatment, ICU admission, and prolonged hospital stay.
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Observational Study
Effect of a best practice advisory activated "kit in hand" naloxone distribution program in the emergency department.
We implemented a "kit in hand" naloxone distribution program at emergency department (ED) discharge activated by electronic health record Best Practice Advisory (BPA). The purpose of this study was to evaluate naloxone kit distribution before and after implementation. ⋯ Implementation of a BPA-activated kit in hand naloxone distribution program increases the rate of successful naloxone distribution to patients presenting to the ED following unintentional opioid overdose, a subpopulation at very high risk for recurrence of overdose. Opportunities for program improvement were identified as there were instances where kits were intended to be distributed but barriers in the process existed.
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Previous studies on the comparative effectiveness between buprenorphine and methadone provided limited evidence on differences in treatment effects across key subgroups and were drawn from populations who use primarily heroin or prescription opioids, although fentanyl use is increasing across North America. ⋯ Receipt of methadone was associated with a lower risk of treatment discontinuation compared with buprenorphine/naloxone. The risk of mortality while receiving treatment was similar for buprenorphine/naloxone and methadone, although the CI estimate for the hazard ratio was wide.
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J Pain Symptom Manage · Dec 2024
Perceptions Towards Naloxone among Patients with Cancer Receiving Opioids.
Naloxone nasal spray is recommended for patients with risk factors for opioid overdose. However, cancer patients' perceptions and beliefs regarding naloxone prescriptions and their self-perceived risks for overdose are understudied. ⋯ Most patients understood the benefits of naloxone and felt safe having one at home. More research is needed to identify knowledge gaps and develop educational strategies for those who find it nonbeneficial.
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Straub L, Bateman BT, Hernández-Díaz S, et al. Comparative safety of in utero exposure to buprenorphine combined with naloxone vs buprenorphine alone. JAMA. 2024;332:805-816. 39133511.