The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children. To better understand this phenomenon, we examined ...mortality trends for the US and nineteen comparator nations in the Organization for Economic Cooperation and Development for children ages 0-19 from 1961 to 2010 using publicly available data. While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US was 76 percent greater for infants and 57 percent greater for children ages 1-19. During this decade, children ages 15-19 were eighty-two times more likely to die from gun homicide in the US. Over the fifty-year study period, the lagging US performance amounted to over 600,000 excess deaths. Policy interventions should focus on infants and on children ages 15-19, the two age groups with the greatest disparities, by addressing perinatal causes of death, automobile accidents, and assaults by firearm.
Opioid withdrawal management in the fentanyl era Thakrar, Ashish P.; Kleinman, Robert A.
Addiction (Abingdon, England),
September 2022, 2022-09-00, 20220901, Letnik:
117, Številka:
9
Journal Article
A 35-year-old woman with multiple substance use disorders, including opioids, methamphetamine, cocaine, and alcohol, presented to the hospital with suicidal ideation and severe opioid withdrawal. She ...had a history of previous suicide attempts and unintentional opioid overdoses. The patient had recently stopped taking methadone and slow-release oral morphine and reported high use of intravenous fentanyl. She also had a history of various psychiatric disorders. The patient's withdrawal symptoms were initially managed with hydromorphone, and then methadone and slow-release oral morphine were initiated. The case highlights the challenges faced by patients with opioid use disorder in the hospital setting. There are no specific guidelines for managing fentanyl withdrawal in hospitals, and undertreated withdrawal symptoms and stigma often lead patients to leave the hospital prematurely. Short-acting opioids can be used as adjuncts to relieve withdrawal symptoms in these patients, but dosing must be tailored to individual patient factors. Further research is needed to improve the management of fentanyl withdrawal in hospitals.
IMPORTANCE: The rise of fentanyl and other high-potency synthetic opioids across US and Canada has been associated with increasing hospitalizations and unprecedented overdose deaths. Hospitalization ...is a critical touchpoint to engage patients and offer life-saving opioid use disorder (OUD) care when admitted for OUD or other medical conditions. OBSERVATIONS: Clinical best practices include managing acute withdrawal and pain, initiating medication for OUD, integrating harm reduction principles and practices, addressing in-hospital substance use, and supporting hospital-to-community care transitions. Fentanyl complicates hospital OUD care. Fentanyl’s high potency intensifies pain, withdrawal, and cravings and increases the risk for overdose and other harms. Fentanyl’s unique pharmacology has rendered traditional techniques for managing opioid withdrawal and initiating buprenorphine and methadone inadequate for some patients, necessitating novel strategies. Further, co-use of opioids with stimulants drugs is common, and the opioid supply is unpredictable and can be contaminated with benzodiazepines, xylazine, and other substances. To address these challenges, clinicians are increasingly relying on emerging practices, such as low-dose buprenorphine initiation with opioid continuation, rapid methadone titration, and the use of alternative opioid agonists. Hospitals must also reconsider conventional approaches to in-hospital substance use and expand clinicians’ understanding and embrace of harm reduction, which is a philosophy and set of practical strategies that supports people who use drugs to be safer and healthier without judgment, coercion, or discrimination. Hospital-to-community care transitions should ensure uninterrupted access to OUD care after discharge, which requires special consideration and coordination. Finally, improving hospital-based addiction care requires dedicated infrastructure and expertise. Preparing hospitals across the US and Canada to deliver OUD best practices requires investments in clinical champions, staff education, leadership commitment, community partnerships, quality metrics, and financing. CONCLUSIONS AND RELEVANCE: The findings of this review indicate that fentanyl creates increased urgency and new challenges for hospital OUD care. Hospital clinicians and systems have a central role in addressing the current drug crisis.
This study examines discharge trends for opioid-related admissions from 2016-2020 with a focus on admissions with opioid use disorder and an injection-related infection.
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