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Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico.
Harm Reduct J
January 2025
Asociación Bajacaliforniana de Salud Pública A.C, Tijuana, Baja California, Mexico.
Background: Xylazine is a α2-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.
View Article and Find Full Text PDFBarriers and Enablers in Prehospital Pediatric Analgesia.
Prehosp Emerg Care
December 2024
Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island.
Article Synopsis
- Children represent a small percentage of EMS transports but often experience under-treatment of pain; this study examines factors influencing EMS clinicians' ability to provide effective prehospital pain management for pediatric patients.
- Key enablers identified include longer transport times, the need to stabilize patients, and clinician familiarity with intranasal fentanyl, while barriers include concerns over patient stability, caregiver discomfort with pain medications, and limited pediatric experience among EMS staff.
- Focus groups with EMS clinicians highlighted perspectives on pain management decision-making, available resources, and patient and family reactions, reaching thematic saturation in the analysis of both facilitators and obstacles in administering analgesia to children.
Time Course of Reversal of Fentanyl-Induced Respiratory Depression in Healthy Subjects by Intramuscular Nalmefene and Intramuscular and Intranasal Naloxone.
J Clin Pharmacol
September 2024
Imbrium Therapeutics L.P., a subsidiary of Purdue Pharma L.P., Stamford, CT, USA.
The increase in opioid overdose deaths, particularly involving potent, long-acting synthetic opioids, has led to calls for stronger, longer-acting opioid-overdose-reversal agents. Using an opioid-induced respiratory depression model, we investigated the onset and time course of action of naloxone and a long-acting opioid antagonist, nalmefene, in reversing the effects of an ongoing intravenous fentanyl infusion over a period of up to 100 min. Healthy, moderately experienced opioid users received intramuscular (IM) nalmefene 1 mg, IM naloxone 2 mg, or intranasal (IN) naloxone 4 mg after fentanyl-induced respiratory depression was established based on reduction in respiratory minute volume (MV).
View Article and Find Full Text PDFEvaluation of Intranasal Fentanyl and Midazolam Among Inpatient Pediatric Patients.
Hosp Pediatr
October 2024
Internal Medicine and Pediatrics.
Article Synopsis
- A study looked at how safe and helpful it is to use nose sprays of certain medicines, fentanyl and midazolam, for kids in hospitals.
- The study found that most kids received midazolam, and these medicines were often used when kids had to go through procedures like getting an IV or a lumbar puncture.
- No serious side effects were reported, but the researchers say more studies should be done before using these medicines more widely in hospitals.
Associations with early vomiting when using intranasal fentanyl and nitrous oxide for procedural sedation in children: A secondary analysis of a randomised controlled trial.
Emerg Med Australas
September 2024
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Objective: Intranasal (IN) fentanyl and nitrous oxide (NO) can be combined to provide procedural sedation and analgesia to children. This combination is advantageous because of rapid onset of action and non-parenteral administration, but is associated with increased vomiting. We sought to describe the associations of demographic and procedural factors with early vomiting when using this combination in children.
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