sodium-oxybate and Opioid-Related-Disorders

The drug abusing patient can provide a management dilemma for health care providers including nurses, obstetrician, anesthesiologist, and pediatrician. Certain illicit drugs may mimic other diseases of pregnancy and result in inappropriate treatment for the mother and child. Pain management may be challenging in such patients because of increasing drug tolerance and increased sensitivity to pain. This article highlights the clinical presentation in a pregnant patient who may have recently used some of the more commonly abused drugs. The ability to identify such a patient is crucial so that the appropriate screening and treatment can occur.

Topics: Amphetamines; Cocaine; Ethanol; Female; Humans; Inhalant Abuse; Labor, Obstetric; Opioid-Related Disorders; Pain Management; Pregnancy; Pregnancy Complications; Sodium Oxybate; Substance-Related Disorders

Topics: Acetaldehyde; Alcohol Withdrawal Delirium; Anesthesia, General; Blood Proteins; Carbon Dioxide; Catecholamines; Ethanol; Hemoperfusion; Humans; Opioid-Related Disorders; Oxygen; Pregnanediones; Sodium Oxybate; Substance Withdrawal Syndrome; Substance-Related Disorders

COVID-19 has exacerbated income inequality, structural racism, and social isolation-issues that drive addiction and have previously manifested in the epidemic of opioid-associated overdose. The co-existence of these epidemics has necessitated care practice changes, including the use of telehealth-based encounters for the diagnosis and management of opioid use disorder (OUD).. We describe the development of the "Addiction Telehealth Program" (ATP), a telephone-based program to reduce treatment access barriers for people with substance use disorders staying at San Francisco's COVID-19 Isolation and Quarantine (I&Q) sites. Telehealth encounters were documented in the electronic medical record and an internal tracking system for the San Francisco Department of Public Health (SFDPH) COVID-19 Containment Response. Descriptive statistics were collected on a case series of patients initiated on buprenorphine at I&Q sites and indicators of feasibility were measured.. Between April 10 and May 25, 2020, ATP consulted on the management of opioid, alcohol, GHB, marijuana, and stimulant use for 59 I&Q site guests. Twelve patients were identified with untreated OUD and newly prescribed buprenorphine. Of these, all were marginally housed, 67% were Black, and 58% had never previously been prescribed medications for OUD. Four self-directed early discharge from I&Q-1 prior to and 3 after initiating buprenorphine. Of the remaining 8 patients, 7 reported continuing to take buprenorphine at the time of I&Q discharge and 1 discontinued. No patients started on buprenorphine sustained significant adverse effects, required emergency care, or experienced overdose.. ATP demonstrates the feasibility of telephone-based management of OUD among a highly marginalized patient population in San Francisco and supports the implementation of similar programs in areas of the U.S. where access to addiction treatment is limited. Legal changes permitting the prescribing of buprenorphine via telehealth without the requirement of an in-person visit should persist beyond the COVID-19 public health emergency.

Topics: Adult; Alcoholism; Analgesics, Opioid; Buprenorphine; COVID-19; Delivery of Health Care; Feasibility Studies; Female; Health Services Accessibility; Humans; Ill-Housed Persons; Male; Marijuana Abuse; Methadone; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Public Health; Quarantine; San Francisco; SARS-CoV-2; Sodium Oxybate; Substance-Related Disorders; Telemedicine; Telephone

To describe the clinical features of gamma-hydroxybutyrate (GHB) and gamma-butyrolactone (GBL) toxicity.. Retrospective case-study of 65 GHB and GBL intoxications seen in an urban emergency department.. 63% of intoxications occurred in male patients. The median age was 24 years (range 16-41 years). 65% co-ingested alcohol or illicit drugs, mostly MDMA and cocaine. 83% presented with coma. The mean+/-S.D. time to regain consciousness among comatose patients was 111+/-61 min and was significantly longer in patients who co-abused illicit drugs such as cocaine or MDMA (155+/-60 min). Bradycardia occurred in 38%, hypotension in 6% and hypothermia in 48%. Agitation was observed in 17% of all patients and was significantly more frequent in patients with alcohol co-use (29%). Vomiting occurred in 31% of all patients and tended to be more frequent in patients who co-used alcohol (39%). Management of GHB and GBL overdose was supportive. Four patients needed admission to an intensive care unit for mechanical ventilation (6%).. Overdosing of GHB and GBL frequently results in non-reactive coma reflecting the severity of poisoning. Multiple drug use is common and significantly influences the clinical presentation.

Topics: 4-Butyrolactone; Adolescent; Adult; Alcoholism; Anesthetics, Intravenous; Bradycardia; Case-Control Studies; Coma; Drug Overdose; Female; Humans; Hypothermia; Male; Opioid-Related Disorders; Retrospective Studies; Sodium Oxybate; Solvents