buprenorphine and Emergencies

To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply.. Population based retrospective cohort study.. Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada.. 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018.. All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply.. 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk).. Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

Topics: Adolescent; Adult; British Columbia; Buprenorphine; Cause of Death; Cohort Studies; Emergencies; Female; Fentanyl; Humans; Illicit Drugs; Male; Methadone; Middle Aged; Mortality; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Public Health; Retrospective Studies; Risk Assessment; Young Adult

Continuous epidural anesthesia was used in a 34 year-old pregnant woman with acute pancreatitis related to hypertriglyceridemia. She underwent an emergency cesarean section due to severe pancreatitis under spinal anesthesia. After delivery, extended incision was made to examine the pancreas and to perform drainage. Epidural infusion using 1% mepivacaine and buprenorphine was started to reduce pain and improve microcirculation. After starting epidural infusion with other therapies, clinical feature and data improved. This case suggests that reduction of severe pain and improvement of microcirculation are important in therapies of severe pancreatitis.

Topics: Acute Disease; Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Buprenorphine; Cesarean Section; Emergencies; Female; Humans; Mepivacaine; Pancreatitis; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Buprenorphine; Emergencies; Heroin Dependence; HIV Infections; Hospitalization; Humans; Methadone; Morphine; Outpatients; Patient Care Team; Substance-Related Disorders

A fact-finding survey was conducted to ascertain the treatment of 298 patients with acute myocardial infarction (AMI) who were referred to our coronary care unit (CCU) from other medical facilities between May 1978 and December 1987. The controls consisted of 169 patients with AMI who were admitted directly to our CCU during the same period. The mean time from onset of AMI to admission to our CCU was 21.7 +/- 67.9 hours (mean +/- SD) for patients from other medical facilities, and it took longer than that of the controls (11.7 +/- 34.9 hours). However, the mortality was 19.8%, being lower than that of the controls (26.0%). By the Killip's classification, there was no significant differences between both patient groups who belonged to Killip groups I, II and IV, but the mortality of cases in Killip group III was 3.7%, which was lower than that of the controls (7.15%). Among the 298 cases, 169 (56.7%) had received some kind of emergency treatment, and their mortality was 29.9%. However, the mortality of the remaining 129 cases (43.3%) who had received no emergency treatment was only 17.1%. The reason for this contradictory result is attributed to the fact that the former group included relatively severe cases. The number of patients receiving emergency treatment has gradually increased recently; however, the overall results achieved were not satisfactory even with appropriate therapy. Since April 1984, conferences with local practitioners have been held concerning emergency treatment for ischemic heart disease. This resulted in better understanding of CCU among the practitioners, less time delay until admission, and increased frequency and higher quality of emergency treatment. However, the mortality in the CCU did not decline, probably because of the relatively high rate of severe cases. To reduce mortality of AMI, a communication network should be established between practitioners and the CCU.

Topics: Anti-Arrhythmia Agents; Buprenorphine; Coronary Care Units; Emergencies; Female; Humans; Male; Middle Aged; Myocardial Infarction; Narcotics