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Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic.
Int J Drug Policy. 2017 08; 46:172-179.IJ

Abstract

Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.

Authors+Show Affiliations

British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada. Electronic address: nfairbairn@cfenet.ubc.ca.San Francisco Department of Public Health, United States; University of California, San Francisco, United States.Clinical Addiction Research and Education Unit, Boston University School of Medicine, Boston Medical Center, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28687187

Citation

Fairbairn, Nadia, et al. "Naloxone for Heroin, Prescription Opioid, and Illicitly Made Fentanyl Overdoses: Challenges and Innovations Responding to a Dynamic Epidemic." The International Journal On Drug Policy, vol. 46, 2017, pp. 172-179.
Fairbairn N, Coffin PO, Walley AY. Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic. Int J Drug Policy. 2017;46:172-179.
Fairbairn, N., Coffin, P. O., & Walley, A. Y. (2017). Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic. The International Journal On Drug Policy, 46, 172-179. https://doi.org/10.1016/j.drugpo.2017.06.005
Fairbairn N, Coffin PO, Walley AY. Naloxone for Heroin, Prescription Opioid, and Illicitly Made Fentanyl Overdoses: Challenges and Innovations Responding to a Dynamic Epidemic. Int J Drug Policy. 2017;46:172-179. PubMed PMID: 28687187.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic. AU - Fairbairn,Nadia, AU - Coffin,Phillip O, AU - Walley,Alexander Y, Y1 - 2017/07/04/ PY - 2017/03/21/received PY - 2017/05/28/revised PY - 2017/06/12/accepted PY - 2017/7/9/pubmed PY - 2018/4/27/medline PY - 2017/7/9/entrez KW - Fentanyl KW - Naloxone KW - Overdose KW - Synthetic opioids SP - 172 EP - 179 JF - The International journal on drug policy JO - Int J Drug Policy VL - 46 N2 - Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/28687187/Naloxone_for_heroin_prescription_opioid_and_illicitly_made_fentanyl_overdoses:_Challenges_and_innovations_responding_to_a_dynamic_epidemic_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0955-3959(17)30168-8 DB - PRIME DP - Unbound Medicine ER -