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Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden.

https://arctichealth.org/en/permalink/ahliterature90613
Source
Accid Anal Prev. 2009 Jan;41(1):129-36
Publication Type
Article
Date
Jan-2009
Author
Ahlm Kristin
Bjõrnstig Ulf
Ostr�¶m Mats
Author Affiliation
Section of Forensic Medicine, Department of Community Medicine and Rehabilitation, Umeå University, UmeÃ?Â¥, Sweden. kristin.ahlm@formed.umu.se
Source
Accid Anal Prev. 2009 Jan;41(1):129-36
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - mortality - statistics & numerical data
Adolescent
Adult
Aged
Aged, 80 and over
Alcoholic Intoxication - complications - epidemiology
Analgesics, Opioid - adverse effects
Antidepressive Agents - adverse effects
Benzodiazepines - adverse effects
Female
Humans
Male
Middle Aged
Pharmaceutical Preparations - adverse effects
Prospective Studies
Risk factors
Street Drugs - adverse effects
Substance-Related Disorders - complications - epidemiology
Sweden - epidemiology
Young Adult
Abstract
Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.
PubMed ID
19114147 View in PubMed
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Alcohol and smoking behavior in chronic pain patients: the role of opioids.

https://arctichealth.org/en/permalink/ahliterature92152
Source
Eur J Pain. 2009 Jul;13(6):606-12
Publication Type
Article
Date
Jul-2009
Author
Ekholm Ola
Grønbaek Morten
Peuckmann Vera
Sjøgren Per
Author Affiliation
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Source
Eur J Pain. 2009 Jul;13(6):606-12
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Alcohol Drinking - epidemiology - psychology
Alcoholism - epidemiology - psychology
Analgesics, Opioid - adverse effects - therapeutic use
Chronic Disease
Complementary Therapies
Delivery of Health Care - utilization
Denmark - epidemiology
Female
Health status
Humans
Logistic Models
Male
Middle Aged
Pain - complications - drug therapy
Quality of Life
Questionnaires
Sex Factors
Sleep Disorders - epidemiology
Smoking - epidemiology - psychology
Socioeconomic Factors
Tooth
Young Adult
Abstract
The primary aim of this epidemiological study was to investigate associations between chronic non-cancer pain with or without opioid treatment and the alcohol and smoking behavior. The secondary aims were to investigate self-reported quality of life, sleeping problems, oral health and the use of different health care providers. The Danish health survey of 2005 was based on a region-stratified random sample of 10.916 individuals. Data were collected via personal interviews and self-administrated questionnaires. Respondents suffering from chronic pain were identified through the question 'Do you have chronic/long-lasting pain lasting 6 months or more?' The question concerning alcohol intake assessed the frequency of alcohol intake and binge drinking. Smoking behavior assessed the daily number of cigarettes. Individuals reporting chronic pain were stratified into two groups (opioid users and non-opioid users). In all, 7275 individuals completed a personal interview and 5552 individuals completed and returned the self-administrated questionnaire. Responders with a self-reported earlier or present cancer diagnosis were excluded from the study. Hence, the final study population consisted of 5292 individuals. We found, that individuals suffering from chronic pain were less likely to drink alcohol. In opioid users alcohol consumption was further reduced. Cigarette smoking was significantly increased in individuals suffering from chronic pain and in opioid users smoking was further increased. Poor oral health, quality of life and sleep were markedly associated with chronic pain and opioid use. The use of opioids was associated with significantly more contacts to healthcare care providers.
PubMed ID
18774317 View in PubMed
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An update on the role of opioids in the management of chronic pain of nonmalignant origin.

https://arctichealth.org/en/permalink/ahliterature94028
Source
Curr Opin Anaesthesiol. 2007 Oct;20(5):451-5
Publication Type
Article
Date
Oct-2007
Author
Højsted Jette
Sjøgren Per
Author Affiliation
Multidisciplinary Pain Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
Source
Curr Opin Anaesthesiol. 2007 Oct;20(5):451-5
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Analgesics, Opioid - adverse effects - therapeutic use
Animals
Chronic Disease
Denmark
Female
Humans
Male
Opioid-Related Disorders - etiology - psychology
Pain - drug therapy
Time Factors
Abstract
PURPOSE OF REVIEW: To summarize and reflect over primarily recent epidemiological and randomized controlled trials in opioid-treated chronic nonmalignant pain patients, focusing on effects, side effects, risks and long-term consequences of the treatment. RECENT FINDINGS: In the western world opioids are increasingly being used for long-term treatment of chronic nonmalignant pain. While the long-term benefits of opioids regarding pain relief, functional capacity and health-related quality of life still remain to be proven, studies are emerging that describe serious long-term consequences such as addiction, opioid-induced hyperalgesia, cognitive disorders, and suppression of the immune and reproductive systems. SUMMARY: Much more research is needed concerning long-time effects and consequences of opioid therapy in chronic nonmalignant pain patients; however, some clear warning signals have been sent out within recent years.
PubMed ID
17873598 View in PubMed
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Are infants exposed to methadone in utero at an increased risk for mortality?

https://arctichealth.org/en/permalink/ahliterature124450
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e160-5
Publication Type
Article
Date
2012
Author
Lauren E Kelly
Michael J Rieder
Karen Bridgman-Acker
Albert Lauwers
Parvaz Madadi
Gideon Koren
Author Affiliation
The University of Western Ontario, Department of Physiology and Pharmacology, London, ON.
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e160-5
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Analgesics, Opioid - adverse effects
Cause of Death
Female
Humans
Infant
Infant mortality
Infant, Newborn
Male
Methadone - adverse effects
Neonatal Abstinence Syndrome - mortality
Odds Ratio
Ontario - epidemiology
Opiate Substitution Treatment - adverse effects
Opioid-Related Disorders - epidemiology - rehabilitation
Pregnancy
Prenatal Exposure Delayed Effects
Prevalence
Risk assessment
Risk factors
Time Factors
Young Adult
Abstract
The prevalence of opioid abuse is increasing in North America. Opioid abuse during pregnancy can cause medical, obstetric and psychosocial complications. Neonates exposed to opioids in utero often develop the neonatal abstinence syndrome. Methadone maintenance therapy is the treatment of choice for maternal opioid dependency. There have been unsupported concerns that infants cared for by mothers treated with methadone have higher mortality rates during the first year of life than in the general population.
To compare the mortality rates of infants exposed to methadone in utero to those of general population in Ontario, Canada.
We utilized several provincial and national databases including those of the Office of the Chief Coroner of Ontario, the Canadian Institute for Health Information, and the Ontario Infant Mortality Rate Report. Reference organ weights were obtained from the peer reviewed literature.
The Office of the Chief Coroner of Ontario has reported 8 deaths in children under one associated with in utero methadone exposure between January 1, 2006 and December 31, 2010. Over the same period there have been a total of 1103 cases of neonatal abstinence syndrome recorded in the province. The mean infant mortality rate in Ontario for children under the age of 1year over the same period was 5.2 per 1000 live births. The odds ratio for mortality among children with neonatal abstinence syndrome was not different from that in the general population [OR 1.45 (95% confidence interval 0.471-4.459)] (p=0.56).
The available data do not support the concerns that children under the age of one year, born to mothers on methadone maintenance therapy (MMT) are at an increased risk for mortality.
PubMed ID
22580362 View in PubMed
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Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in Northern Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature307857
Source
PLoS One. 2019; 14(12):e0225548
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2019
Author
Cayley Russell
Maria Neufeld
Pamela Sabioni
Thepikaa Varatharajan
Farihah Ali
Sarah Miles
Joanna Henderson
Benedikt Fischer
Jürgen Rehm
Author Affiliation
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
Source
PLoS One. 2019; 14(12):e0225548
Date
2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Analgesics, Opioid - adverse effects
Cocaine - adverse effects
Community-Based Participatory Research - methods
Crack Cocaine - adverse effects
Female
Focus Groups - methods
Health Services Accessibility
Humans
Male
Needs Assessment
Ontario
Rural Health Services
Substance-Related Disorders - psychology - therapy
Surveys and Questionnaires
Young Adult
Abstract
Illicit drug use rates are high among Canadian youth, and are particularly pronounced in Northern Ontario. The availability and accessibility of effective substance use-related treatments and services are required to address this problem, especially among rural and remote Northern communities. In order to assess specific service and treatment needs, as well as barriers and deterrents to accessing and utilizing services and treatments for youth who use illicit drugs in Northern Ontario, we conducted the present study.
This study utilized a mixed-methods design and incorporated a community-based participatory research approach. Questionnaires were administered in conjunction with audio-recorded semi-structured interviews and/or focus groups with youth (aged 14-25) who live in Northern Ontario and use illicit drugs. Interviews with 'key informants' who work with the youth in each community were also conducted. Between August and December 2017, the research team traveled to Northern Ontario communities and carried out data collection procedures.
A total of 102 youth and 35 key informants from eleven different Northern Ontario communities were interviewed. The most commonly used drugs were prescription opioids, cocaine and crack-cocaine. Most participants experienced problems related to their drug use, and reported 'fair' mental and physical health status. Qualitative analyses highlighted an overall lack of services; barriers to accessing treatment and services included lack of motivation, stigmatization, long wait-lists and transportation/mobility issues. Articulated needs revolved around the necessity of harm reduction-based services, low-threshold programs, specialized programming, and peer-based counselling.
Although each community varied in terms of drug use behaviors and available services, an overall need for youth-specific, low-threshold services was identified. Information gathered from this study can be used to help inform rural and remote communities towards improving treatment and service system performance and provision.
PubMed ID
31805082 View in PubMed
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The association between opioid analgesics and unsafe driving actions preceding fatal crashes.

https://arctichealth.org/en/permalink/ahliterature147570
Source
Accid Anal Prev. 2010 Jan;42(1):30-7
Publication Type
Article
Date
Jan-2010
Author
Sacha Dubois
Michel Bédard
Bruce Weaver
Author Affiliation
St. Joseph's Care Group, Thunder Bay, Ontario, Canada. DuboisS@tbh.net
Source
Accid Anal Prev. 2010 Jan;42(1):30-7
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - mortality
Adult
Age Factors
Analgesics, Opioid - adverse effects
Automobile Driving
Canada
Case-Control Studies
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Task Performance and Analysis
Abstract
Currently, most epidemiological research into the impact of opioid analgesics on road safety has focused on the association between opioid use and traffic crash occurrence. Yet, the role of opioid analgesics on crash responsibility is still not properly understood. Therefore, we examined the impact of opioid analgesics on drivers (all had a confirmed BAC=0) involved in fatal crashes (1993-2006) using a case-control design based on data from the Fatality Analysis Reporting System. Cases had one or more crash-related unsafe driving actions (UDA) recorded; controls had none. We calculated adjusted odds ratios (ORs) of any UDA by medication exposure after controlling for age, sex, other medications, and driving record. Compared to drivers who tested negative for opioid analgesics, female drivers who tested positive demonstrated increased odds of performing an UDA from ages 25 (OR: 1.35; 95% CI: 1.05; 1.74) to 55 (OR: 1.30; 95% CI: 1.07; 1.58). For male drivers this was true from ages 25 (OR: 1.66; 95% CI: 1.32; 2.09) to 65 (OR: 1.39; 95% CI: 1.17; 1.67). The detection of opioid analgesics was not associated with greater risk of an UDA for older drivers. Research is necessary to examine why these age differences exist, and if possible, to ensure that opioid analgesics do not contribute to crashes.
PubMed ID
19887141 View in PubMed
Less detail

Case report of severe bradycardia due to transdermal fentanyl.

https://arctichealth.org/en/permalink/ahliterature117010
Source
Palliat Med. 2013 Sep;27(8):793-5
Publication Type
Article
Date
Sep-2013
Author
Pippa Hawley
Author Affiliation
Pain and Symptom Management/Palliative Care Program, BC Cancer Agency, Vancouver, BC, Canada. pippahawley@shaw.ca
Source
Palliat Med. 2013 Sep;27(8):793-5
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Analgesics, Opioid - adverse effects - therapeutic use
Bradycardia - etiology
Canada
Female
Fentanyl - adverse effects - therapeutic use
Humans
Middle Aged
Ovarian Neoplasms - complications - therapy
Transdermal Patch - adverse effects
Abstract
This case report describes a patient who developed severe bradycardia due to transdermal fentanyl. There have been no prior case reports of this occurring in palliative care, but the frequency of association of fentanyl with bradycardia in the anesthesia setting suggests it may be more common than realized. Palliative care settings often have a policy of not routinely checking vital signs, and symptoms of bradycardia could be misinterpreted as the dying process.
A patient with recurrent ovarian cancer was admitted with nausea and abdominal pain due to bowel obstruction and fever from a urinary tract infection. A switch from injectable hydromorphone to transdermal fentanyl resulted in symptomatic severe bradycardia within 36 h, without any other signs of opioid toxicity and with good analgesic effect. CASE MANAGEMENT: The fentanyl patch was removed. Atropine was not required. CASE OUTCOME: The patient made an uneventful recovery. Transdermal buprenorphine was subsequently used satisfactorily for long-term background pain control, with additional hydromorphone when needed.
The delayed absorption of fentanyl via the transdermal route makes early identification of fentanyl-induced bradycardia key to prompt reversal. Patients with resting or relative bradycardia may be at higher than average risk.
PubMed ID
23341102 View in PubMed
Less detail

Characteristics of chronic pain patients in a rural teaching practice.

https://arctichealth.org/en/permalink/ahliterature129637
Source
Can Fam Physician. 2011 Nov;57(11):e436-40
Publication Type
Article
Date
Nov-2011
Author
W E Osmun
Julie Copeland
Jennifer Parr
Leslie Boisvert
Author Affiliation
Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London. ted@smhc.net
Source
Can Fam Physician. 2011 Nov;57(11):e436-40
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol-Related Disorders - complications
Analgesics, Opioid - adverse effects - therapeutic use
Back Pain - complications
Chronic Pain - complications - drug therapy
Female
Health status
Humans
Male
Middle Aged
Musculoskeletal Pain - complications
Office visits - statistics & numerical data
Ontario
Opioid-Related Disorders - etiology
Oxycodone - adverse effects - therapeutic use
Primary Health Care - statistics & numerical data
Retrospective Studies
Rural Health Services - statistics & numerical data
Tobacco Use Disorder - complications
Abstract
To describe the characteristics of chronic noncancer pain (CNCP) patients taking oxycodone or its derivatives in a rural teaching practice.
Characteristics of CNCP patients taking oxycodone over a 5-year period (September 2003 to September 2008) were compared with those of patients not taking opioid medications using a retrospective chart audit.
A rural teaching practice in southwestern Ontario.
A total of 103 patients taking chronic oxycodone therapy for CNCP and a random sample of 104 patients not taking opioid medication.
Number of visits, health problems, sex, and previous history of addiction and mental illness.
Patients with CNCP taking oxycodone had significantly more health problems (P
Notes
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PubMed ID
22084473 View in PubMed
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93 records – page 1 of 10.