Articles: narcotic-antagonists.
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Evidence from randomized controlled trials establishes that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention. However, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among US patient populations receiving treatment in usual care settings. This study compared overdose mortality among those in medication versus non-medication treatments in specialty care settings. ⋯ Among Maryland patients in specialty opioid treatment, periods in treatment are protective against overdose compared with periods out of care. Methadone and buprenorphine are associated with significantly lower overdose death compared with non-medication treatments during care but not after treatment is discontinued.
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BMJ Support Palliat Care · Sep 2020
Case ReportsNaloxegol rescue with methylnaltrexone highly effective.
Opioid-induced constipation (OIC) is common and can significantly affect quality of life. Naloxegol and methylnaltrexone are peripherally acting µ-opioid receptor antagonists (PAMORAs) which are effective for the management of OIC. We report on a case in the palliative care setting where a patient with established OIC had an inadequate response to naloxegol but an effective and immediate response to methylnaltrexone at the dose recommended for her weight. This is the first reported case of two PAMORAs used concomitantly.
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Currently, ≤5% of bystanders witnessing an opioid overdose (OD) in the US administer antidote to the victim. A possible model to mitigate this crisis would be a system that enables 9-1-1 dispatchers to both rapidly deliver naloxone by drone to bystanders at a suspected opioid OD and direct them to administer it while awaiting EMS arrival. ⋯ Our results suggest that bystanders can carry out 9-1-1 dispatcher instructions to fetch drone-delivered naloxone and potentially decrease the time interval to intranasal administration which supports further development and testing of a such a system.
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Emergency department encounters are an opportunity to distribute naloxone kits to patients at risk of opioid overdose. Several programs cite mixed uptake and implementation barriers including staff education and burden. Emergency nurses can facilitate many approaches to naloxone distribution (eg, prescription, overdose education, dispensing take-home naloxone). To evaluate acceptance, we investigated nurse perceptions about take-home naloxone, describing potential barriers to program implementation. ⋯ Perceptions and moral distress may be a barrier to ED-based take-home naloxone programs. Development of interventions targeting naloxone misperceptions and addiction stigma should be a goal of expanded implementation efforts.