ABSTRACT
AIM: Experiencing a nonfatal overdose (NFOD) is a significant risk factor for a subsequent nonfatal or fatal overdose. Overdose mortality rates in rural Appalachian states are some of the highest in the USA, but little is known about correlates of overdose among rural populations of people who inject drugs (PWID). Our study aimed to identify correlates of experiencing a recent (past 6 months) NFOD among rural PWID in Cabell County, West Virginia. METHODS: Using data from a June-July 2018 cross-sectional survey that was designed to estimate the size and characteristics of the PWID population in Cabell County, West Virginia, we used log binomial regression to identify correlates (e.g., structural vulnerabilities and substance use) of NFOD in the past 6 months. RESULTS: The majority of our sample of 420 PWID were male (61.2%), White, non-Hispanic (83.6%), and reported recent heroin injection (81.0%). More than two-fifths (42.6%) experienced a recent NFOD. Independent correlates of NFOD included witnessing an overdose in the past 6 months (adjusted prevalence ratio [aPR] = 2.28; 95% CI 1.48-3.50), attempting to quit using drugs in the past 6 months (aPR = 1.54; 95% CI 1.11-2.14), and the number of drugs injected (aPR = 1.16; 95% CI 1.10-1.23) CONCLUSIONS: A large proportion of rural PWID in Appalachia reported having recently overdosed. The associations between witnessing an overdose, attempting to quit using drugs, and number of drugs injected with recent nonfatal overdose underscore the need for expanded access to overdose prevention resources that are tailored to the needs of this population. Expanding access to evidence-based overdose prevention strategies-such as take-home naloxone programs, treatment with methadone or buprenorphine, and harm reduction services-may decrease overdose morbidity and mortality among rural PWID in Appalachia.
Subject(s)
Drug Overdose , Pharmaceutical Preparations , Substance Abuse, Intravenous , Cross-Sectional Studies , Drug Overdose/epidemiology , Female , Humans , Male , Substance Abuse, Intravenous/drug therapy , Substance Abuse, Intravenous/epidemiology , West Virginia/epidemiologySubject(s)
Analgesics, Opioid/adverse effects , Drug Overdose/epidemiology , Epidemics/prevention & control , Fentanyl/analogs & derivatives , Illicit Drugs/adverse effects , Opioid-Related Disorders/epidemiology , Analgesics, Opioid/chemical synthesis , Analgesics, Opioid/economics , Drug Overdose/drug therapy , Drug Overdose/etiology , Drug Overdose/mortality , Fentanyl/adverse effects , Fentanyl/chemical synthesis , Fentanyl/economics , Heroin/therapeutic use , Humans , Illicit Drugs/legislation & jurisprudence , Naloxone/therapeutic use , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/mortality , United States/epidemiologySubject(s)
Neonatal Abstinence Syndrome/drug therapy , Neonatal Abstinence Syndrome/etiology , Opioid-Related Disorders/complications , Adjuvants, Anesthesia/therapeutic use , Adult , Drug Therapy, Combination , Female , Humans , Infant, Newborn , Length of Stay , Neonatal Abstinence Syndrome/diagnosis , Neonatal Abstinence Syndrome/economics , Opiate Substitution Treatment , PregnancyABSTRACT
INTRODUCTION: There are limited number of approved therapies for C. difficile infections (CDIs) and new treatments are needed to decrease recurrence rates. Over the past 5 years, four novel antibiotics have been evaluated in clinical trials that offer distinct advantages over existing therapies for the treatment of CDI. AREAS COVERED: This article reviews the preclinical and clinical studies of cadazolid, LFF571, ridinilazole, and surotomycin. The advantages that these antibiotics may have in the treatment of CDI is compared with current therapies metronidazole, vancomycin, and fidaxomicin. Expert commentary: The antibiotics examined have the potential to improve rates of CDI treatment without recurrence. We anticipate that one or more of these medications will be approved within five years.
ABSTRACT
Background. Bradykinin has shown to affect pain hypersensitivity via reducing the pain threshold when it binds to bradykinin B1 receptors. Bradykinin B1 receptors are upregulated following tissue injury. Thus, any mechanism causing an increase in bradykinin could escalate pain perception. Angiotensin-converting enzyme inhibitors (ACEIs) increase bradykinin by blocking the ACE enzyme from inactivating bradykinin. Angiotensin receptor blockers (ARBs) do not increase bradykinin as much and may not make patients as susceptible to chronic pain by the described expected mechanism. Objective. This analysis observed retrospective data from a single community pharmacy to determine if there was a difference between patient groups who chronically used ACEIs and ARBs regarding their use of chronic pain medications. Methods. Reports were generated containing all prescription fills of ACEIs and ARBs during the 18-month period and length of therapy was determined from that report per patient. The patients meeting the length of therapy requirements were assessed for pain medication usage to determine presence and length of pain medication therapy. Results. The percentage of patients filling chronic pain medications among chronic ACEI patients was 3.99% higher than chronic ARB patients. This was not statistically different. Other evaluated group differences were not statistically significant.
