heroin and Emergencies

This paper reviews available literature regarding the effectiveness, safety and utility of intranasal (i.n.) naloxone for the treatment of heroin overdose.. Scientific literature in the form of published articles during the period January 1984 to August 2007 were identified by searching several databases including Medline, Cinahl and Embase for the following terms: naloxone, narcan, intranasal, nose. The data extracted included study design, patient selection, numbers, outcomes and adverse events.. Reports of the pharmacological investigation and administration of i.n. naloxone for heroin overdose are included in this review. Treatment of heroin overdose by administration of i.n. naloxone has been introduced as first-line treatment in some jurisdictions in North America, and is currently under investigation in Australia.. Currently there is not enough evidence to support i.n. naloxone as first-line intervention by paramedics for treatment of heroin overdose in the pre-hospital setting. Further research is required to confirm its clinical effectiveness, safety and utility. If proved effective, the i.n. route may be useful for drug administration in community settings (including peer-based administration), as it reduces risk of needlestick injury in a population at higher risk of blood-borne viruses. Problematically, naloxone is not manufactured currently in an ideal form for i.n. administration.

Topics: Administration, Intranasal; Drug Overdose; Emergencies; Heroin; Humans; Naloxone; Narcotic Antagonists

A short cut review was carried out to establish whether morphine is better than diamorphine at allieviating chest pain after an acute myocardial infarction. Altogether 66 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Topics: Analgesics, Opioid; Emergencies; Evidence-Based Medicine; Heroin; Humans; Male; Middle Aged; Morphine; Myocardial Infarction

A 17-year-old previously healthy girl with profound circulatory shock following a heroin overdose is reported. Except for opiates no other substances and specifically no cocaine were found in the blood and urine samples. Even though the mechanism of shock is not completely understood, severe depression of left ventricular contractility seems to be the predominant reason. Acute right heart failure with decreased pulmonary capillary wedge pressure and arterial vasodilatation resulting in maldistribution of cardiac output cannot be ruled out as possible contributing factors. The shock was successfully reversed with volume loading and a high dose of dobutamine. The recovery was uneventful and the patient was discharged with normal cardiac function.

Topics: Adolescent; Combined Modality Therapy; Drug Overdose; Emergencies; Female; Heroin; Heroin Dependence; Humans; Shock

To compare the effectiveness of nasal diamorphine spray with intramuscular morphine for analgesia in children and teenagers with acute pain due to a clinical fracture, and to describe the safety profile of the spray.. Multicentre randomised controlled trial.. Emergency departments in eight UK hospitals.. Patients aged between 3 and 16 years presenting with a clinical fracture of an upper or lower limb.. Patients' reported pain using the Wong Baker face pain scale, ratings of reaction to treatment of the patients and acceptability of treatment by staff and parents, and adverse events.. 404 eligible patients completed the trial (204 patients given nasal diamorphine spray and 200 given intramuscular morphine). Onset of pain relief was faster in the spray group than in the intramuscular group, with lower pain scores in the spray group at 5, 10, and 20 minutes after treatment but no difference between the groups after 30 minutes. 80% of patients given the spray showed no obvious discomfort compared with 9% given intramuscular morphine (difference 71%, 95% confidence interval 65% to 78%). Treatment administration was judged acceptable by staff and parents, respectively, for 98% (199 of 203) and 97% (186 of 192) of patients in the spray group compared with 32% (64 of 199) and 72% (142 of 197) in the intramuscular group. No serious adverse events occurred in the spray group, and the frequencies of all adverse events were similar in both groups (spray 24.1% v intramuscular morphine 18.5%; difference 5.6%, -2.3% to 13.6%).. Nasal diamorphine spray should be the preferred method of pain relief in children and teenagers presenting to emergency departments in acute pain with clinical fractures. The diamorphine spray should be used in place of intramuscular morphine.

Topics: Administration, Intranasal; Adolescent; Analgesics, Opioid; Child; Child, Preschool; Emergencies; Female; Fractures, Bone; Heroin; Humans; Injections, Intramuscular; Male; Morphine; Pain; Pain Measurement; Patient Satisfaction; Time Factors

Topics: Emergencies; Heroin; Humans; Illicit Drugs; Pregabalin

Topics: Cocaine; Drug Contamination; Emergencies; Heroin; Humans; Illicit Drugs; N-Methyl-3,4-methylenedioxyamphetamine; United States

This study examines the quality of street heroin seized in Vienna in 1999 and whether there was a relationship between the purity of street heroin and the number of heroin-related emergencies as well as the number of heroin-related deaths. Street heroin confiscated by the Viennese police, run-sheets of drug-related emergencies, and postmortem reports of drug-related deaths in Vienna in 1999 were analyzed. A total of 415 retail samples with a total weight of 128.02 g contained a median percentage of 6.5% diacetylmorphine (range: 0.0-47.0%). All the samples contained a diluent, mainly lactose, as well as adulterants, such as caffeine and/or paracetamol. During the study period, 75 heroin-related deaths and 387 heroin-related emergencies were registered in Vienna. Time-series analysis revealed no statistically significant relationship between the rate of heroin-related incidents and the diacetylmorphine concentration of street heroin samples confiscated in Vienna in 1999. The widely held belief that the number of heroin-related deaths could be explained simply through fluctuations in the purity of street heroin could not be substantiated, even though the results of this study do not rule out an association between the purity of heroin and heroin-related deaths/emergencies.

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Austria; Caffeine; Central Nervous System Stimulants; Drug Contamination; Emergencies; Female; Forensic Toxicology; Heroin; Heroin Dependence; Humans; Illicit Drugs; Lactose; Male; Narcotics; Sweetening Agents

Topics: Drug Overdose; Emergencies; Emergency Treatment; Heroin; Humans; Naloxone; Narcotic Antagonists; Narcotics

Topics: Drug Overdose; Emergencies; Emergency Treatment; Heroin; Humans; Methadone; Naloxone; Narcotic Antagonists; Narcotics

Topics: Drug Overdose; Emergencies; Emergency Treatment; Heroin; Humans; Naloxone; Narcotic Antagonists; Narcotics

Topics: Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Cesarean Section; Emergencies; Epinephrine; Female; Heroin; Humans; Injections, Spinal; Lidocaine; Pregnancy

Topics: Abdominal Pain; Adult; Deglutition; Drug Packaging; Emergencies; Foreign Bodies; Gastrointestinal Tract; Heroin; Humans; Illicit Drugs; Male; Poisoning; Radiography, Thoracic; Sleep Stages; Tomography, X-Ray Computed

The purpose of this study was to explore to what extent alcohol is a factor in non-fatal overdoses on the basis of records of ambulance emergencies, and to what extent this varies across gender and age. Furthermore, we wanted to investigate whether alcohol intake, in relation to an overdose, is associated with the risk of recurrent overdoses, and if so, whether such an association varies across gender and age. To investigate the role of alcohol intake in non-fatal overdoses, analyses were conducted both at the event level and at the individual level. Bivariate associations were explored in table analyses and by comparisons of means. To determine whether alcohol intake was associated with experiencing recurrent overdoses, survival analyses were conducted applying Kaplan-Meier estimation and Cox regression models. Furthermore, a linear regression model was estimated to assess the impact of gender age and number of overdoses on the proportion of overdoses in which alcohol was involved. Between groups of clients who had overdosed once, several times or many times, we found that there was a U-shaped relationship. The proportion of overdoses with alcohol involved was highest among those who had overdosed once and those who had overdosed more than ten times. The probability for a recurrent overdose was higher among those who were reported with no alcohol intake in the first overdose. Being female and having alcohol involved in the first overdose registered during our observation period reduced the risk for a recurrent overdose. However, age seemed to be a gradient with respect to alcohol's association with recurrent overdoses. While alcohol was associated with a significantly lower risk for recurrence in the two youngest age groups, this is not the case in the oldest age group. A possible explanation might be that it is a change in the pattern of drug use as an effect of aging where infrequent heroin use in combination with frequent alcohol intake increases with increasing age. For this type of drug users the individual's risk of recurrent overdoses may be lower due to fewer events of heroin intake.

Topics: Adult; Age Factors; Alcoholism; Coma; Comorbidity; Drug Overdose; Emergencies; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; Middle Aged; Norway; Recurrence; Regression Analysis; Respiratory Insufficiency; Risk; Sex Factors

A case is reported of the Lazarus phenomenon (the return of spontaneous circulation after cardiopulmonary resuscitation had been abandoned) in a patient following recreational drug use. The implications for management of cardiac arrest in the emergency department are discussed.

Topics: Adult; Cardiopulmonary Resuscitation; Cocaine; Emergencies; Heart Arrest; Hemodynamics; Heroin; Humans; Male; Remission, Spontaneous; Substance Abuse, Intravenous

Topics: Administration, Intranasal; Adolescent; Age Factors; Analgesics, Opioid; Child; Child, Preschool; Emergencies; Evidence-Based Medicine; Fractures, Bone; Heroin; Humans; Male; Morphine; Radius Fractures; Ulna Fractures

To establish baseline data on prehospital emergencies caused by opiates during a 4-month period, a retrospective analysis of run records of the Emergency Medical System in Vienna, the capital of Austria, was conducted. During the study period, there were 308 opioid emergencies involving 240 persons, an average of 2.5 overdoses per day. Severely compromised patients were treated in 67.8% of the 308 emergencies, and 79.3% of emergencies were transported to hospital; 52.5% of the involved persons were younger than 22 years of age. Sex distribution and periodicity and frequency of emergencies differed among age groups. A subgroup of individuals involved repeatedly in emergencies was identified, partly showing temporal clustering of fatal and nonfatal overdoses. Persons involved in opiate emergencies belong to heterogenous subgroups. At a local level, research should be initiated to clarify the pattern and impact of these emergencies on overall drug abuse prevention.

Topics: Adult; Age Distribution; Austria; Drug Overdose; Emergencies; Emergency Medical Services; Female; Heroin; Humans; Male; Narcotics; Sex Distribution

Topics: Adult; Brain; Diabetic Ketoacidosis; Diagnosis, Differential; Drug Overdose; Emergencies; Fatal Outcome; Heroin; Heroin Dependence; Humans; Male; Patient Transfer; Psychiatric Department, Hospital

Gluteal compartment syndrome is a rare disorder that most often occurs in conjunction with prolonged immobility after a sedative overdose but also may result from direct trauma. Patients present with localized tenderness, induration, and pain with passive flexion of the gluteal muscles. Signs of sciatic nerve compression occur frequently, and rhabdomyolysis may be associated with the syndrome. If the diagnosis of gluteal compartment syndrome is suspected, intracompartmental pressures should be measured. If pressures are high or if sufficient clinical suspicion remains, the patient should undergo prompt fasciotomy.

Topics: Adult; Alcoholism; Buttocks; Compartment Syndromes; Emergencies; Heroin; Humans; Male; Pressure; Rhabdomyolysis; Substance-Related Disorders

During the course of the Drug Emergency Study in Bremen it became obvious that there are many problems left unsolved related to the medical care of intoxicated heroine addicts. From January to June 1992 there were 1230 drug emergencies, 409 hospital admissions and 644 emergency transportation. With or without antidote treatment, most patients leave the medical care system as soon as possible because of withdrawal symptoms. The physicians involved answered a short questionnaire about these problems: 80% of the physicians are dissatisfied with the present medical care situation for intoxicated drug addicts and feel that these patients are a burden for the hospitals (81%) and for themselves (73%); 93% of the physicians think that a central drug emergency unit, offering medical and psycho-social care would solve the present problems and would be a possibility for lowering drug emergencies and, as a further result, drug mortality.

Topics: Attitude of Health Personnel; Cost of Illness; Emergencies; Emergency Service, Hospital; Female; Germany; Health Services Needs and Demand; Health Services Research; Heroin; Heroin Dependence; Humans; Male; Patient Admission; Physicians; Poisoning; Prospective Studies; Quality of Health Care; Retrospective Studies; Substance Abuse Treatment Centers; Surveys and Questionnaires; Transportation of Patients; Treatment Refusal; Urban Population

During the first ten months of 1992 the Oslo Ambulance Department registered 716 incidences of assumed drug-related intoxications. 80% happened in down town Oslo. 19 cases of asystoly were recorded, 13 of the patients recovered after treatment, without sequelae. Five of these patients left the location after emergency help and they refused hospitalization. 432 of the patients were unconscious when the ambulance personal arrived, 472 were treated with naloxone both by the intramuscular and the intravenous route. Most of the persons refused further observation. A team of specially trained out reach workers offers help after acute medical treatment by means of "streetwork". The intervention is directed at addicts who have experienced an overdose.

Topics: Adolescent; Adult; Drug Overdose; Emergencies; Female; Heroin; Heroin Dependence; Humans; Male; Naloxone; Norway; Poisoning; Social Support

Clinical and epidemiological features of intravenous drug addicts (IVDA), who attended the emergency department between 1984 and 1988, were studied. The number of cases treated over these 4 years had increased three-fold (256 vs 724). The median age had increased by 3 years (p less than 0.01). The sex ratio had not changed. A third of the cases knew that they were HIV-seropositive in 1988. The main reason for consultation in 1984 was overdosage and in 1988 it was fever. The rate of admission was similar in both years (around 21%). There was a significant increase in admissions caused by respiratory diseases in 1988 (p less than 0.0001) and a significant decrease of admissions caused by overdosage (p less than 0.001).

Topics: Age Factors; Chi-Square Distribution; Drug Overdose; Emergencies; Emergency Service, Hospital; Heroin; Heroin Dependence; HIV Seropositivity; Humans; Retrospective Studies; Sex Factors; Spain; Substance Abuse, Intravenous; Substance Withdrawal Syndrome

Topics: Adult; Cocaine; Emergencies; Foreign Bodies; Heroin; Humans; Intestine, Small; Male; Stomach

Topics: Adult; Cocaine; Emergencies; Female; Heroin; Humans; Joint Prosthesis; Masseter Muscle; Prosthesis-Related Infections; Staphylococcal Infections; Substance Abuse, Intravenous; Temporomandibular Joint

The clinical, radiological and analytical aspects, and the complications observed in 16 cases of swallowing or insertion into the rectum of illicit drugs ("body-packing") are described. The drugs detected were heroin (6 cases), cocaine (5 cases) and cannabis (5 cases). In 15 cases abdominal plain X-rays were useful in the detection of the drug packages, their position and progression in the gastrointestinal tract and the presence of complications. The most valuable finding for radiologic diagnosis was the presence of a radiolucent halo surrounding the drug packages, or "double condom" sign, which was observed in 13/15 cases (87%). Urine analysis was positive for opiates or metabolites of cocaine in 7/9 cases (78%). One case presented acute heroin intoxication and three subjects gastric or intestinal obstruction requiring surgical treatment. In another case a packet, which had been retained in the stomach for five days, was extracted by upper gastrointestinal endoscopy using a Dormia basket with no complications.

Topics: Adult; Cannabis; Cocaine; Digestive System; Emergencies; Female; Foreign Bodies; Heroin; Humans; Illicit Drugs; Intestinal Obstruction; Male; Radiography

Topics: Adult; Drug Overdose; Emergencies; Female; Heroin; Humans; Ophthalmoplegia; Substance Abuse, Intravenous

One hundred cases of intracorporeal concealment of narcotic drugs were observed over a 6-month period at the medico-judicial emergency centre of the Hotel-Dieu hospital, Paris. Twelve cases concerned dealers who had ingested packs at the time they were arrested. The other subjects had been carrying the drug in their digestive tract, rectum or vagina for transportation. The illicit drugs thus transported were cocaine in 20 cases (ingestion), heroin in 65 cases (ingestion 7, rectal or vaginal cavity 58) and cannabis in 3 cases. Packs for sale being fragile, the dealers were particularly exposed to overdosage. Their management prior to intoxication was the same as that of acute ordinary drug poisoning, i.e. washing out of the stomach. In carriers, the risk of severe poisoning was associated with ingestion. The lack of antidote makes cocaine poisoning particularly dangerous. Surgical extraction is now reserved to cases with intestinal mechanical complications and to those increasingly rarer cases of fragile transportation packs.

Topics: Adult; Cannabinoids; Cocaine; Digestive System; Drug and Narcotic Control; Drug Packaging; Emergencies; Female; Foreign Bodies; Forensic Medicine; France; Heroin; Humans; Male; Middle Aged; Radiography; Rectum; Vagina

Topics: Coma; Emergencies; Heroin; Humans; Naloxone; Respiration, Artificial; Respiratory Insufficiency

Two patients deliberately ingested single paper packages containing heroin. These were recovered intact by induction of emesis with syrup of ipecacuanha.

Topics: Adult; Emergencies; Foreign Bodies; Heroin; Humans; Ipecac; Male; Radiography; Stomach; Substance-Related Disorders

Topics: Diagnosis-Related Groups; Emergencies; Emergency Service, Hospital; Heroin; Heroin Dependence; Humans; Spain

Topics: Adult; Emergencies; Heroin; Humans; Male; Naloxone; Substance-Related Disorders

Topics: Emergencies; Heroin; Heroin Dependence; Humans; Michigan

Topics: Emergencies; Heroin; Heroin Dependence; Humans; Nalorphine; Naloxone; Pulmonary Edema; Respiratory Insufficiency; Substance-Related Disorders

Topics: Adolescent; Alcoholism; Amphetamine; California; Cannabis; Child; Community Health Services; Emergencies; Heart Massage; Heroin; Heroin Dependence; Humans; Interpersonal Relations; Lysergic Acid Diethylamide; Narcotic Antagonists; Respiration, Artificial; Scopolamine; Social Conformity; Substance-Related Disorders

Topics: Amphetamine; Antidepressive Agents; Barbiturates; Caustics; Dextropropoxyphene; Emergencies; Hallucinogens; Heroin; Humans; Hydrocarbons, Chlorinated; Insecticides; Iron; Organophosphorus Compounds; Petroleum; Phenothiazines; Strychnine; Substance-Related Disorders; Tranquilizing Agents; Vitamins

Topics: Amphetamine; Barbiturates; Crisis Intervention; Emergencies; Hallucinogens; Heroin; Humans; Substance-Related Disorders