Heroin

Diamorphine

Growth of Fentanyl Related Deaths in the US

"Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016 (1,2). Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase (3,4). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths (5,6) and the illicit opioid drug supply (7).

Provisional Counts of Overdose Deaths Can Be Misleading

The federal Centers for Disease Control reported on December 21, 2017, that there had been a total of 63,600 deaths attributed to drug overdose in the US in 2016. Based on data available for analysis on Oct. 1, 2017, the CDC's provisional count of drug overdose deaths in the US for the 12-month period ending in December 2016 had been 71,135. The difference is attributed to data quality: provisional counts are by definition incomplete, which means they can be misleading.

Factors That May Skew Estimates of Overdose Deaths Attributed to Specific Drugs, Particularly Opioids

"First, factors related to death investigation might affect rate estimates involving specific drugs. At autopsy, the substances tested for, and circumstances under which tests are performed to determine which drugs are present, might vary by jurisdiction and over time. Second, the percentage of deaths with specific drugs identified on the death certificate varies by jurisdiction and over time. Nationally, 19% (in 2014) and 17% (in 2015) of drug overdose death certificates did not include the specific types of drugs involved.

Deaths from Drug Overdose in the United States in 2015

"During 2015, drug overdoses accounted for 52,404 U.S. deaths, including 33,091 (63.1%) that involved an opioid. There has been progress in preventing methadone deaths, and death rates declined by 9.1%. However, rates of deaths involving other opioids, specifically heroin and synthetic opioids other than methadone (likely driven primarily by illicitly manufactured fentanyl) (2,3), increased sharply overall and across many states."

911 Calls, Good Samaritan Laws, And Opiate Overdoses

(911 Calls, Good Samaritan Laws, And Opiate Overdoses) "Among heroin users, research indicates fear of police response as the most common barrier to not calling 911 during overdoses.12,13 In a Baltimore study, 37 % of injection drug users who did not call 911 during an overdose endorsed concerns about police as the most important reason they did not call.13 Several states have enacted laws, commonly called Good Samaritan laws, to encourage calling 911 during overdoses on controlled substances; these laws are in part modeled on college campus alco

Impact Of Good Samaritan Laws On Arrests

(Impact Of Good Samaritan Laws On Arrests) "Ninety-three percent of police respondents had attended a serious opioid overdose (defined in the survey) in their career, with 64 % having attended one in the past year. While 77 % of officers felt it was important they were at the scene of an overdose to protect medical personnel, a minority, 34 %, indicated it was important they were present for the purpose of enforcing laws. Arrest during the last overdose officers encountered was rare, with only 1 % of overdose victims and 1 % of bystanders being arrested.

Comparison of Client Satisfaction Between Those Treated for Opioid Dependence With Oral Methadone Versus Injectable Heroin

(Comparison of Client Satisfaction Between Those Treated for Opioid Dependence With Oral Methadone Versus Injectable Heroin) "Among long-term chronic opioid injectors participating in a randomized clinical trial prescribing injectable diacetylmorphine or hydromorphone and oral methadone, those receiving injectable medications were more satisfied with treatment. Independent of treatment group, treatment satisfaction was also an indicator of retention in treatment, as well as treatment response, including a reduction in substance use.

Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

(Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance) "Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each time horizon studied (Table 2). Over a lifetime horizon, people in the methadone cohort lived 14.54 years on average following entry into the model, spending 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. They accumulated 7.46 discounted QALYs and generated a societal cost of $1.14 million.

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