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Beyond Fentanyl Test Strips: The Need To Decriminalize All Drug Checking Equipment In Tennessee, Jeremy C. Kourvelas Mph

SMART Policy Briefs

KEY POINTS

• In 2022, Tennessee decriminalized fentanyl test strips (FTS) through Public Chapter 764. Thousands have since been distributed by the state and nonprofit coalitions as a key harm reduction strategy. As of the end of 2023, 44 other states and D.C. had also decriminalized FTS.

• Research indicates that people who use drugs are five times as likely to change their behaviors (including reducing drug use overall) in response to a test result that is positive for fentanyl. People who use methamphetamine are especially likely to change their behaviors.

• However, the law only applies to “narcotic testing equipment used to …

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Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Computational Design And Molecular Modeling Of Morphine Derivatives For Preferential Binding In Inflamed Tissue, Makena Augenstein, Nayiri Alexander, Matthew Gartner

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

The opioid epidemic has impacted over 10 million Americans in 2019. Opioids, like morphine, bind non-selectively in both peripheral tissue, leading to effective pain relief, and central tissue, resulting in dangerous side effects and addiction. The inflamed conditions of injured tissues have a lower pH (pH = 6–6.5) environment than healthy tissue (pH = 7.4). We aim to design a morphine derivative that binds selectively within inflamed tissue using molecular extension and dissection techniques. Morphine binds to the μ-opioid receptor (MOR) when the biochemically active amine group is protonated. Fluorination of a β-carbon from the tertiary amine group led to …

Medication Initiation, Patient-Directed Discharges, And Hospital Readmissions Before And After Implementing Guidelines For Opioid Withdrawal Management, Jillian Zavodnick, Md, Nicolette M. Heinsinger, Angelo C. Lepore, Robert C. Sterling

Department of Medicine Faculty Papers

OBJECTIVES: Rising rates of hospitalization for patients with opioid use disorder (OUD) result in high rates of patient-directed discharge (PDD, also called "discharge against medical advice") and 30-day readmissions. Interdisciplinary addiction consult services are an emerging criterion standard to improve care for these patients, but these services are resource- and expertise-intensive. A set of withdrawal guidelines was developed to guide generalists in caring for patients with opioid withdrawal at a hospital without an addiction consult service.

METHODS: Retrospective chart review was performed to determine PDD, 30-day readmission, and psychiatry consult rates for hospitalized patients with OUD during periods before (July …

Predicting At-Risk Opioid Use Three Months After Ed Visit For Trauma: Results From The Aurora Study, Brittany E. Punches, Uwe Stolz, Caroline E. Freiermuth, Rachel M. Ancona, Samuel A. Mclean, Stacey L. House, Francesca L. Beaudoin, Xinming An, Jennifer S. Stevens, Donglin Zeng, Thomas C. Neylan, Gari D. Clifford, Tanja Jovanovic, Sarah D. Linnstaedt, Laura T. Germine, Kenneth A. Bollen, Scott L. Rauch, John P. Haran, Alan B. Storrow, Christopher Lewandowski, Paul I. Musey Jr., Phyllis L. Hendry, Sophia Sheikh, Christopher W. Jones, Michael C. Kurz, Nina T. Gentile, Meghan E. Mcgrath, Lauren A. Hudak, Jose L. Pascual, Mark J. Seamon, Erica Harris, Anna M. Chang, Claire Pearson, David A. Peak, Roland C. Merchant, Robert M. Domeier, Niels K. Rathlev, Brian J. O'Neil, Leon D. Sanchez, Steven E. Bruce, Robert H. Pietrzak, Jutta Joormann, Deanna M. Barch, Diego A. Pizzagalli, Jordan W. Smoller, Beatriz Luna, Steven E. Harte, James M. Elliott, Ronald C. Kessler, Kerry J. Ressler, Karestan C. Koenen, Michael S. Lyons

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.

METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed …

Sex Differences In Locomotor Activity And Behavioral Sensitization In Rats Administered Fentanyl, Jessica J. Lee, Nareen Sadik, Cameron Davidson Phd, Majd Yahya, Josie Zdun, Shane Perrine Phd

Medical Student Research Symposium

Opioid overdoses have continued to increase, and women have experienced a greater rate of increase than males. Preclinical studies demonstrate marked sex differences in addiction-related behaviors, with females being more vulnerable due to a potential role of estradiol. We sought to understand how the estrous cycle, as a proxy measure of estradiol, influences sex differences in the sensitizing effects of fentanyl. In this ongoing study, we used male and female rats to investigate potential sex effects of fentanyl (20µg/kg subcutaneously) administration for 14 days and a forced abstinence period of 13 days on behavioral sensitization via locomotor activity (LMA) following …

Are Thyrotropin-Releasing Hormone (Trh) And Analog Taltirelin Viable Reversal Agents Of Opioid-Induced Respiratory Depression?, Marieke Hyke Algera, Joseph F Cotten, Monique Van Velzen, Marieke Niesters, Martijn Boon, Daniel S Shoham, Kaye E Dandrea, Rutger Van Der Schrier, Albert Dahan

Journal Articles

Opioid-induced respiratory depression (OIRD) is a potentially life-threatening complication of opioid consumption. Apart from naloxone, an opioid antagonist that has various disadvantages, a possible reversal strategy is treatment of OIRD with the hypothalamic hormone and neuromodulator thyrotropin-releasing hormone (TRH). In this review, we performed a search in electronic databases and retrieved 52 papers on the effect of TRH and TRH-analogs on respiration and their efficacy in the reversal of OIRD in awake and anesthetized mammals, including humans. Animal studies show that TRH and its analog taltirelin stimulate breathing via an effect at the preBötzinger complex, an important respiratory rhythm generator …

A Cross-Sectional Survey Of Potential Factors, Motivations, And Barriers Influencing Research Participation And Retention Among People Who Use Drugs In The Rural Usa, Angela T. Hetrick, April M. Young, Miriam R. Elman, Sarann Bielavitz, Rhonda L. Alexander, Morgan Brown, Elizabeth Needham Waddell, P. Todd Korthuis, Kathryn E. Lancaster

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD.

METHODS: We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and …

Physician-Perceived Barriers To Treating Opioid Use Disorder In The Emergency Department, Gideon Logan, Amber Mirajkar, Jessica Houck, Fernando Rivera-Alvarez, Emily Drone, Parth Patel, Alexandra Craen, Larissa Dub, Nubaha Elahi, David Lebowitz, Ayanna Walker, Latha Ganti

Emergency Medicine Faculty Publications

Objective

We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities.

Methods

This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed …

Opioid-Related Visits To Rural Emergency Departments, Erika C. Ziller Phd, Jean A. Talbot Phd, Deborah Thayer Mba, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Increased rates of acute opioid poisoning and related emergency department (ED) visits in the United States have occurred at the same time as rural EDs face a number of resource constraints. Researchers at the Maine Rural Health Research Center conducted this study to gain insight about rural ED visits for acute opioid poisoning and how they compare with urban ED visits. The authors used data from the 2006 and 2013 Nationwide Emergency Department Sample to examine rural and urban opioid-related visits (ORVs) to EDs, including rate change over time, and the outcomes of these ED visits (treatment and release, inpatient …

Preliminary Analysis Of Vermont's Ems Naloxone Leave-Behind Program, Samantha J. Bissonette

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Background: Naloxone is well known to effectively reverse the effects of unintentional opiate overdose and reduce mortality from opiate overdose (12, 18). Despite activation of emergency medical services (EMS) after an overdose, many patients choose against transport to a hospital for further treatment and initiation of support services. These patients were previously left on scene without any additional support or services, despite encountering emergency medical personnel. To supplement the state's naloxone distribution efforts, Vermont initiated an EMS protocol allowing all levels of providers to provide naloxone leave-behind kits to patients and/or their family or friends when a patient is identified …

A Markov Chain Approach For Forecasting Progression Of Opioid Addiction, Abhijit Gosavi, Susan L. Murray, N. Karagiannis

Engineering Management and Systems Engineering Faculty Research & Creative Works

The U.S. is currently facing an opioid crisis. Naltrexone is a common treatment for drug addiction; it reduces the desire to take opiates. However, addicts often stop treatment or continue to use opioids while in treatment. This results in increased fatalities and associated costs. A Markov-chain model is presented to analyze the progression of opioid addiction to assist the medical community in developing appropriate treatments. The model includes patients who continue opiate use while on naltrexone (blocked patients) and those who use opiates after missing naltrexone doses (unblocked patients). The other types of patients are abstinent (the best-case scenario) and …

Basic Life Support And Opioid Overdose Management: Knowledge And Attitudes Among Students Matriculating Into Medical School - A Cross-Sectional Analysis To Inform Curricular Change, Nicholas Macdonald, Dimitrios Papanagnou, Md

Phase 1

Purpose: While Basic Life Support (BLS) skills are typically included in undergraduate medical education (UME) curricula, graduating students continue to demonstrate substandard skills retention. In the setting of the opioid epidemic, effective opioid overdose management (OOM) training should likewise take place during UME. To date, there is a paucity of literature that describes incoming medical students’ knowledge and attitudes on these topics prior to beginning their studies. The purpose of this study is to describe medical students’ knowledge and attitudes towards BLS and OOM prior to their medical training to inform curricular change in UME.

Methods: We conducted an observational, …

Gut Microbiome Analysis In Morphine Exposure And Naltrexone-Induced Withdrawal, Nick Rapp, Sean O'Sullivan, James Schwaber

Phase 1

Introduction and Objectives: Relatively little is understood about the underlying physiological changes that occur in the withdrawal state of opiate users. Research on the effects of alcohol withdrawal on the Gut-brain axis (GBA) has revealed shifts in relative numbers of specific bacterial species that correlate with increased central nervous system (CNS) inflammation via neurological crosstalk. The purpose of this research was to determine if similar shifts in the relative abundance of bacterial populations occur in the opiate withdrawal state.

Methods: Fourteen rats were randomized into four groups. Control and experimental rats were administered 75 mg morphine pellets or placebo (sugar) …

Trends And Associated Factors Of Use Of Opioid, Heroin, And Cannabis Among Patients For Emergency Department Visits In Nevada: 2009–2017, Pearl C. Kim, Ji Won Yoo, Chris R. Cochran, Seong Min Park, Sungyoun Chun, Yong-Jae Lee, Jay J. Shen

School of Medicine Faculty Publications

To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada. The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions. The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly …

Association Of Naloxone Coprescription Laws With Naloxone Prescription Dispensing In The United States, Minji Sohn, Jeffery C. Talbert, Zhengyan Huang, Michelle R. Lofwall, Patricia R. Freeman

Institute for Pharmaceutical Outcomes and Policy Faculty Publications

Importance: To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients.

Objective: To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies.

Design, Setting, and Participants: This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month …

A 10-Year Review Of Opioid-Related Deaths At West Tennessee Regional Forensic Center: 2007-2017, Haley M. St John, Juliette Scantlebury Md

Longitudinal Scholar's Project

Prescription opioid deaths have tripled since 1999, and currently opioid overdose kills 115 Americans per day on average (1). Prior to 2014, prescription opioids have been the primary driver of opioid-related mortality. In recent years, the United States has seen a steady decline in the rate of opioid prescription. At the same time, there has been a significant increase in the number of deaths attributed to non-prescription opioids such as heroin, illicitly manufactured fentanyl, and fentanyl analogues. In 2017, among 70,237 drug overdose deaths nationally, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, and county urbanization levels …

The Epidemic Of Neonatal Abstinence Syndrome, Historical References Of Its Origins, Assessment, And Management, Enrique Gomez-Pomar, Loretta P. Finnegan

Pediatrics Faculty Publications

Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence. The first case of NAS …

An Update On The Opioid Epidemic: Perception Vs. Reality, Nicholas E. Hagemeier

ETSU Faculty Works

No abstract provided.

Medication Assisted Treatment And The Three Legged Stool: Medical Providers, Chemical Dependency Professionals, And Clients, Steven Matt Magrath

Antioch University Dissertations & Theses

Opioid dependence has reached epidemic levels in the United States and around the world. With the increased prescribing of opioid pharmaceuticals and the influx of inexpensive heroin, the health care cost to society has topped $72.5 billion annually (Murphy et al., 2016). Opioid overdose deaths have now surpassed motor vehicle deaths and have tripled since 1990. In some age groups opioid overdose is the leading cause of death. This study seeks to analyze the only field that directly treats this primary brain disease: medication assisted treatment for opioid dependence. The three primary participants in this partnership include: (a) doctors and …