BACKGROUND: Opioid overdose is a global health crisis, affecting over 27 million individuals worldwide, with more than 100,000 drug overdose deaths in the United States in 2022-2023. This protocol outlines the development of the PneumoWave chest biosensor, a wearable device being designed to detect respiratory depression in real time through chest motion measurement, intending to enhance early intervention and thereby reduce fatalities.
OBJECTIVE: The study aims to (1) differentiate opioid-induced respiratory depression (OIRD) from nonfatal opioid use patterns to develop and refine an overdose detection algorithm and (2) examine participants\' acceptability of the chest biosensor.
METHODS: The study adopts an observational design over a 6-month period. The biosensor, a small device, will be worn by consenting participants during injecting events to capture chest motion data. Safe injecting facilities (SIF) in Melbourne, Victoria (site 1), and Sydney, New South Wales (site 2), which are legally sanctioned spaces where individuals can use preobtained illicit drugs under medical supervision. Each site is anticipated to recruit up to 100 participants who inject opioids and attend the SIF. Participants will wear the biosensor during supervised injecting events at both sites. The biosensor will attempt to capture data on an anticipated 40 adverse drug events. The biosensor\'s ability to detect OIRD will be compared to the staff-identified events that use standard protocols for managing overdoses. Measurements will include (1) chest wall movement measured by the biosensor, securely streamed to a cloud, and analyzed to refine an overdose detection algorithm and (2) acute events or potential overdose identified by site staff. Acceptability will be measured by a feedback questionnaire as many times as the participant is willing to throughout the study.
RESULTS: As of April 2024, a total of 47 participants have been enrolled and data from 1145 injecting events have already been collected, including 10 overdose events. This consists of 17 females and 30 males with an average age of 45 years. Data analysis is ongoing.
CONCLUSIONS: This protocol establishes a foundation for advancing wearable technology in opioid overdose prevention within SIFs. The study will provide chest wall movement data and associated overdose data that will be used to train an algorithm that allows the biosensor to detect an overdose. The study will contribute crucial insights into OIRD, emphasizing the biosensor\'s potential step forward in real-time intervention strategies.
UNASSIGNED: DERR1-10.2196/57367.

Background: While laypersons can play a crucial role in administering naloxone in opioid overdoses, they must be recruited and trained to effectively manage overdose events as good Samaritans. This study aimed to examine the effectiveness of a technology-based intervention that recruited and trained laypersons to administer naloxone. Methods: Opioid Rapid Response System (ORRS) was an online recruitment and training intervention which capitalized on social cognitive theory and a digital media engagement model to mobilize laypersons to administer intranasal naloxone. ORRS was developed based on a randomized waitlisted controlled trial (N = 220). This secondary analysis is a within-group, extended-baseline assessment of the waitlisted group (n = 106), considering that they served as their own control prior to receiving the training. ORRS was conducted in five counties of Indiana with adults who did not self-identify as a certified first responder. Five indices were generated from 23 variables: knowledge of overdose signs, knowledge of overdose management, self-efficacy in responding, concerns about responding, and intent to respond. Paired t-test compared changes between 3 timepoints. Results: Three indices had significantly greater increases associated with training compared to extended baseline: recognizing opioid overdose signs (difference = 0.08; 95%CI = 0.02, 0.15; t = 2.48; p = 0.01); knowledge of overdose management (difference = 0.27; 95%CI = 0.18, 0.35; t = 5.99; p < 0.01); and self-efficacy in overdose management (difference = 0.68; 95%CI = 0.45, 0.91; t = 5.78; p < 0.01). Concerns related to overdose management significantly decreased as expected (difference = -1.53; 95%CI = -1.86, -1.21; t = -9.27; p < 0.01). Conclusions: ORRS provided strong support for self-efficacy, concerns, and knowledge related to overdose management, and the digital modality accelerates largescale dissemination.

OBJECTIVE: This study evaluated the prevalence and incidence of opioid use disorder (OUD), rates of opioid overdose (OD), and rates of non-fatal (NF) OD in American Indian/Alaskan Native (AI/AN) populations.
METHODS: We used de-identified patient data from Oracle Cerner Real-World Data™. Rates were estimated over time, and stratified by sex, age, marital status, insurance, and region. Mann-Kendall trend tests and Theil-Sen slopes assessed changes over time for each group while autoregressive modeling assessed differences between groups.
RESULTS: The study identified trends in OUD and OD among 700,225 AI/AN patients aged 12 and above. Between 2012 and 2022, there was a significant upward trend in both OUD and OD rates (p < 0.05) , with OUD diagnosed in 1.75% and OD in 0.38% of the population. The Western region of the US exhibited the highest rates of OUD and OD. The 35-49 age group showed the highest rates of OUD, while the 12-34 age group had the highest rates of OD. Marital status analysis revealed higher rates of OUD and OD among separated, widowed, or single patients. Additionally, individuals with Medicare or Medicaid insurance demonstrated the highest rates of OUD and OD.
CONCLUSIONS: Results show that rates of OUD, OD, and NF OD continue to rise among AI/AN individuals, with some regional and demographic variation. Our study provides foundational estimates of key AI/AN populations bearing greater burdens of opioid-related morbidity that federal, state, and tribal organizations can use to direct and develop targeted resources that can improve the health and well-being of AI/AN communities.

BACKGROUND: Multiple Canadian jurisdictions have reported a pattern of chronic pain among people who died from substance-related acute toxicity. This study examined the prevalence and characteristics of those with chronic pain using data from a national study of people who died of accidental acute toxicity.
METHODS: A cross-sectional analysis of accidental substance-related acute toxicity deaths that occurred in Canada between 1 January 2016 and 31 December 2017 was conducted. The prevalence of pain and pain-related conditions were summarized as counts and percentages of the overall sample. Subgroups of people with and without a documented history of chronic pain were compared across sociodemographic characteristics, health history, contextual factors and substances involved.
RESULTS: From the overall sample (n = 7902), 1056 (13%) people had a history of chronic pain while 6366 (81%) had no documented history. Those with chronic pain tended to be older (40 years and older), unemployed, retired and/or receiving disability supports around the time of death. History of mental health conditions, trauma and surgery or injury was significantly more prevalent among people with chronic pain. Of the substances that most frequently contributed to death, opioids typically prescribed for pain (hydromorphone and oxycodone) were detected in toxicology more often among those with chronic pain than those without.
CONCLUSIONS: Findings underscore the cross-cutting role of multiple comorbidities and unmanaged pain, which could compound the risk of acute toxicity death. Continued prioritization of harm reduction and regular patient engagement to assess ongoing needs are among the various opportunities for intervention.
BACKGROUND: Dans plusieurs provinces et territoires du Canada, on remarque que, souvent, les personnes qui décèdent d’une intoxication aiguë liée à une substance souffraient aussi de douleur chronique. Cette étude traite de la prévalence de la douleur chronique et des caractéristiques des personnes qui en sont atteintes en utilisant les données d’une étude nationale sur les décès par intoxication aiguë accidentelle.
UNASSIGNED: Nous avons réalisé une analyse transversale des décès par intoxication aiguë accidentelle liée à une substance qui ont eu lieu au Canada entre le 1er janvier 2016 et le 31 décembre 2017. Nous avons synthétisé, sous forme d’effectifs et de pourcentages, la prévalence de la douleur ainsi que des problèmes de santé liés à la douleur à partir de l’échantillon global. Nous avons effectué des comparaisons entre les personnes avec antécédents documentés de douleur chronique et les personnes sans antécédents documentés de douleur chronique, sur la base de différentes caractéristiques sociodémographiques, des antécédents médicaux, de facteurs contextuels et des substances consommées.
UNASSIGNED: Au sein de l’échantillon global (N = 7 902), 1 056 (13 %) personnes avaient des antécédents documentés de douleur chronique et 6 366 (81 %) n’en avaient pas. En général, les personnes souffrant de douleur chronique étaient plus âgées (40 ans et plus), n’avaient pas d’emploi et étaient à la retraite ou recevaient des prestations d’invalidité au moment de leur décès. Des antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient beaucoup plus fréquents chez les personnes atteintes de douleur chronique. Parmi les substances le plus couramment en cause dans les décès, les opioïdes habituellement prescrits pour soulager la douleur (hydromorphone et oxycodone) ont été détectés plus souvent dans les analyses toxicologiques des personnes avec douleur chronique que dans les analyses des personnes sans douleur chronique.
CONCLUSIONS: Les résultats font ressortir le rôle transversal que jouent la présence concomitante de problèmes de santé et la douleur non traitée, cette dernière risquant d’accroître le risque de décès par intoxication aiguë. Continuer à prioriser la réduction des méfaits et mettre à contribution régulière des patients pour l’évaluation des besoins courants font partie des pistes d’intervention.
Between 2016 and 2017, at least one in ten of the people in Canada who died from an accidental acute toxicity had a documented history of chronic pain. People with chronic pain tended to be older and with no formal source of income. Mental health challenges, trauma and a previous surgery or injury were significantly more common among people with chronic pain than those without. Almost all individuals with chronic pain accessed health care services in the year before their death.
En 2016 et 2017, au moins une personne sur dix décédée d’une intoxication aiguë au Canada présentait des antécédents documentés de douleur chronique. En général, les personnes souffrant de douleur chronique étaient plus âgées et n’avaient pas de source officielle de revenus. Les antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient nettement plus fréquents chez les personnes avec douleur chronique que chez celles sans douleur chronique. Presque toutes les personnes atteintes de douleur chronique avaient consulté des services de santé dans l’année précédant leur décès.

For the past decade, illicitly manufactured fentanyl has been a primary contributor in drug overdose deaths regardless of age. The pediatric population is particularly vulnerable to fentanyl exposure, yet there are limited case reports involving this population. Postmortem cases from 2019 to 2023 were retrospectively analyzed to determine the prevalence of fentanyl in decedents between 0 and 12 years of age. Over this time frame, the fentanyl positivity rate increased from 2.6 to 6.2% (n = 632). The most commonly reported age group was 0-4 years, with a peak around 1 year of age for toddlers. Fentanyl concentrations in blood (n = 573) ranged from 0.19 to 360 ng/mL (mean 18 ng/mL, median 6.9 ng/mL). Polydrug use was present in 428 cases; midazolam (n = 96) and methamphetamine (n = 66) were the most common drugs found concurrently in blood with fentanyl, followed by markers of illicitly manufactured fentanyl, such as xylazine (n = 23), para-fluorofentanyl (n = 18), and acetyl fentanyl (n = 17). This report contrasts the differences in postmortem pediatric fentanyl toxicology results for three groups of case histories: likely medical intervention (n = 113), pregnancy/birth related (n = 136), and inadvertent/intentional exposure (n = 196). Overall, this study provides a retrospective review of postmortem pediatric fentanyl concentrations in a variety of biological matrices and highlights the need for comprehensive toxicology testing in postmortem pediatric casework.

UNASSIGNED: Nonpharmaceutical fentanyl (NPF) is driving the national epidemic of opioid overdose deaths. Clinicians can play a role in fostering awareness of this growing risk and delivering interventions to reduce mortality. However, there is limited research assessing clinician knowledge, attitudes, and practices relating to NPF and harm reduction strategies.
UNASSIGNED: A 34-question survey was designed to assess knowledge, attitudes, and practices related to NPF and harm reduction strategies of adult and pediatric hospital-based and emergency clinicians at a single academic medical center. Results were summarized using descriptive statistics. Chi square and Fishers exact tests were used to compare groups.
UNASSIGNED: There were 136 survey responses. The majority (88%) of respondents correctly answered a question on NPF potency. Most respondents were aware that NPF exposure was very (84%) or somewhat likely (10%) for someone using illicit opioids and very (44%) or somewhat likely (46%) for nonopioid drugs. Respondents viewed overdose prevention as highly important for patients using illicit opioids (93%) and nonopioid drugs (86%) but few (21%) were very/extremely familiar with overdose prevention strategies and just over half (57%) were comfortable/very comfortable counseling about overdose prevention. There was wide variability in utilization of harm reduction/treatment strategies (7.3% frequently providing fentanyl test kits to 70% frequently prescribing naloxone). Higher levels of comfort and familiarity with overdose prevention were associated with more frequent counseling on harm reduction strategies. Pediatric-only clinicians had less familiarity (5% very/extremely familiar) and comfort (35% comfortable/very comfortable) with overdose prevention, and limited use of harm reduction strategies (0%-31% using each strategy frequently).
UNASSIGNED: While clinicians had knowledge and awareness of NPF and rated overdose prevention as highly important, utilization of harm reduction and treatment strategies was variable. This study highlights opportunities for education and system-based support to improve clinician-driven harm reduction practices for patients at risk of overdose.

BACKGROUND: Firearm homicide and opioid overdoses were already leading causes of death in the U.S. before both problems surged during the COVID-19 pandemic. Firearm violence, overdoses, and COVID-19 have all disproportionately harmed communities that are socially and economically marginalized, but the co-occurrence of these problems in the same communities has received little attention. To describe the co-occurrence of firearm homicides and opioid overdose deaths with COVID-19 mortality we used 2017-2021 medical examiner\'s data from Chicago, IL. Deaths were assigned to zip codes based on decedents\' residence. We stratified zip codes into quartiles by COVID-19 mortality rate, then compared firearm homicide and fatal opioid overdose rates by COVID-19 quartile.
RESULTS: Throughout the study period, firearm homicide and opioid overdose rates were highest in the highest COVID-19 mortality quartile and lowest in the lowest COVID-19 mortality quartile. Increases in firearm homicide and opioid overdose were observed across all COVID-19 mortality quartiles.
CONCLUSIONS: High co-occurrence of these deaths at the community level call for addressing the systemic forces which made them most vulnerable before the pandemic. Such strategies should consider the environments where people reside, not only where fatal injuries occur.

OBJECTIVE: This study aimed to summarize validity estimates of International Classification of Diseases (ICD) codes in identifying opioid overdose (OOD) among patient data from emergency rooms, emergency medical services, inpatient, outpatient, administrative, medical claims, and mortality, and estimate the sensitivity and specificity of the algorithms in the absence of a perfect reference standard.
METHODS: We systematically reviewed studies published before December 8, 2023, and identified with Medline and Embase. Studies reporting sufficient details to recreate a 2 × 2 table comparing the ICD algorithms to a reference standard in diagnosing OOD-related events were included. We used Bayesian latent class models (BLCM) to estimate the posterior sensitivity and specificity distributions of five ICD-10 algorithms and of the imperfect coroner\'s report review (CRR) in detecting prescription opioid-related deaths (POD) using one included study.
RESULTS: Of a total of 1990 studies reviewed, three were included. The reported sensitivity estimates of ICD algorithms for OOD were low (range from 25.0% to 56.8%) for ICD-9 in diagnosing non-fatal OOD-related events and moderate (72% to 89%) for ICD-10 in diagnosing POD. The last included study used ICD-9 for non-fatal and fatal and ICD-10 for fatal OOD-related events and showed high sensitivity (i.e. above 97%). The specificity estimates of ICD algorithms were good to excellent in the three included studies. The misclassification-adjusted ICD-10 algorithm sensitivity estimates for POD from BLCM were consistently higher than reported sensitivity estimates that assumed CRR was perfect.
CONCLUSIONS: Evidence on the performance of ICD algorithms in detecting OOD events is scarce, and the absence of bias correction for imperfect tests leads to an underestimation of the sensitivity of ICD code estimates.
RéSUMé: OBJECTIFS: Cette étude avait pour objectifs de recenser les estimations de la validité des codes de Classification Internationale des Maladies (CIM) à diagnostiquer les cas de surdose aux opioïdes (SDO) chez des patients en utilisant les données de salles d’urgence, services médicaux d’urgence, hospitalisations, soins ambulatoires, services administratifs, demandes de remboursement de frais médicaux, ainsi que de mortalité, et d’estimer la sensibilité et la spécificité d’algorithmes utilisant la CIM en l’absence d’un test de référence parfait. MéTHODES: Nous avons examiné systématiquement les études publiées avant le 8 décembre 2023, et identifiées dans Medline et Embase. Les études rapportant suffisamment de détails permettant de recréer un tableau 2 × 2 comparant les algorithmes de la CIM à un test de référence pour le diagnostic d’événements liés aux SDO ont été incluses. Les données d’une étude éligible ont été utilisées pour estimer, avec des modèles Bayésiens de classes latentes (MBCL), les distributions a posteriori de la sensibilité et de la spécificité de cinq algorithmes de la CIM-10 et du test imparfait de révision du rapport du coroner (RRC) dans la détection des décès liés aux opioïdes de prescription (DOP). RéSULTATS: Trois parmi les 1 990 études examinées ont été retenues. Les estimations rapportées de la sensibilité des codes CIM étaient faibles (variant de 25,0 % à 56,8 %) pour CIM-9 dans le diagnostic des événements liés aux SDO non-fatales dans une étude, et modérées (72 % à 89 %) pour CIM-10 dans le diagnostic des DOP dans une autre étude. La dernière étude incluse combinait des codes CIM-9 pour les cas non-fatals et fatals et CIM-10 pour les cas fatals et démontrait des estimations de sensibilité élevées (c.à.d. supérieures à 97 %). Les estimations de la spécificité étaient bonnes à excellentes dans les trois études. Les estimations de la sensibilité des algorithmes de la CIM-10 corrigées pour les erreurs de classification pour les décès liés aux opioïdes, obtenues à partir de nos MBCL, étaient systématiquement plus élevées que celles rapportées et qui supposaient que RRC était un test parfait. CONCLUSION: Les évidences sur la performance des algorithmes de la CIM dans la détection des cas de SDO sont rares, et l’absence de correction de biais pour des tests diagnostiques imparfaits conduit à une sous-estimation de la sensibilité des codes de la CIM.

UNASSIGNED: Published guidelines that help clinicians identify patients who would benefit from the co-prescription of intranasal naloxone (IN) exclude \"palliative care patients.\" In the absence of clear care standards, palliative care (PC) clinicians may experience uncertainty in how to approach IN co-prescriptions.
UNASSIGNED: Explore the attitudes of PC clinicians in the United States of America who work at regional health care institutions regarding IN prescriptions for patients they prescribe opioids for.
UNASSIGNED: An 18-question electronic survey was distributed to PC clinicians that practice at institutions in Wisconsin or Minnesota with at least 10 other PC clinicians between February and May 2023. The survey explored clinical scenarios in which respondents would and would not prescribe IN.
UNASSIGNED: Fifty-six PC clinicians responded to the survey-response rate 41%. Most respondents (90.9%) did not feel IN prescriptions should be reserved for patients with a full code status; 67.9% of respondents felt that IN prescriptions are reasonable for certain patients with a terminal illness and comfort goals of care. Neither prognosis, duration of opioid therapy, nor dose of opioid therapy were significant factors in determining whether most respondents prescribed IN for their patients. Most respondents (81.8%) felt clinician counseling and patient consent were essential before prescribing IN.
UNASSIGNED: Most PC clinicians in our survey felt that IN prescriptions can be appropriate for patients they prescribe opioids for. Bystander safety was an emerging rationale for why respondents chose to prescribe IN for their patients. Despite public health efforts to make IN more freely available, most respondents felt clinician counseling was essential before prescribing IN for their patients.

BACKGROUND: Fentanyl is a synthetic opioid, exposure to which has led to hundreds of thousands of overdose deaths. Novel vaccines are being developed that might protect against fentanyl overdose. Proactive attention to strategic communications and stakeholder engagement may smooth uptake of a novel vaccine given known challenges around vaccine hesitancy and concern for stigma related to substance use.
METHODS: Qualitative interviews (N = 74) with a purposive sample of adolescents/young adults with opioid use disorder (OUD), family members of persons with OUD, experts in substance use treatment and harm reduction, and community members were conducted and thematically analyzed to discern attitudes toward a fentanyl vaccine, and directions for communications and engagement.
RESULTS: Major themes reflected personal concerns for biomedical risk and system-level concerns for alignment and integration of an overdose preventing vaccine with prevailing beliefs about addiction and associated frameworks and philosophies for treatment and response.
CONCLUSIONS: Acceptability and implementation of a novel fentanyl vaccine targeting overdose will need precision communications that address biomedical, moral/spiritual, and structural perspectives about the nature of addiction. Education about the purpose and limits of a fentanyl vaccine, partnerships with diverse stakeholders from throughout the opioid response ecosystem and interweaving of a vaccine strategy into comprehensive prevention and treatment are recommended.