Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Algren DA[original query] |
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Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006)
Algren DA , Monteilh CP , Punja M , Schier JG , Belson M , Hepler BR , Schmidt CJ , Miller CE , Patel M , Paulozzi LJ , Straetemans M , Rubin C . J Med Toxicol 2013 9 (1) 106-15 BACKGROUND: During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroin-associated fatalities (FHFs) with non-fentanyl, heroin-associated fatalities (NFHFs) among illicit drug users. METHODS: Baseline prevalence of fentanyl- and heroin-associated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status. RESULTS: Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p = 0.003). Women aged over 44 years (OR = 4.67;95 % CI = 1.29-16.96) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n = 96; 95 %): fentanyl was detected in most (n = 91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n = 37; 40.7 %). About half of these samples had detectable cocaine concentrations (n = 20; 54 %). Median fentanyl concentration in central blood samples was 0.02 mcg/ml (n = 91, range <0.002-0.051 mcg/ml) and 0.02 mcg/ml (n = 32, range <0.004-0.069 mcg/ml) in peripheral blood samples. The geometric mean of the ratio of central to peripheral values was 2.10 (median C/P = 1.75). At autopsy, pulmonary edema was the most frequently encountered finding for both groups (77 %). CONCLUSION: Illicit drugs may contain undeclared ingredients that may increase the likelihood of fatality in users. Gender differences in fentanyl-related mortality may be modified by age and/or marital status. These findings may help inform public health and prevention activities if fatalities associated with fentanyl-contaminated illicit drugs reoccur. |
The role of a poison control center in identifying and limiting an outbreak of foodborne botulism
Brown J , Sutter ME , Algren DA , Thomas JD , Ragone S , Schier JG , Geller RJ . Am J Prev Med 2010 38 (6) 675-8 Many poison control centers partner with public health agencies to handle weekend and after-hours consultations and emergencies. This event describes the effective use of poison control center capabilities in identifying and limiting an outbreak of foodborne botulism. On September 8, 2006, the poison control center received a call regarding a man aged 77 years admitted to a hospital neurology service with dysarthria, dysphagia, and weakness. The poison control center was contacted regarding a concern for botulism. Further information revealed that the patient's wife and a friend had similar symptoms and had eaten together on the previous night. All three sought treatment at different hospitals. The poison control center successfully located the other two patients and provided information regarding the treatment of botulism. In addition, the poison control center notified the on-call local public health official and the CDC for the release of botulinum antitoxin. Public health officials were informed of our concerns for a foodborne outbreak given the common meal. Their investigation determined that the source of botulism was carrot juice. |
Transportation-related hazardous materials incidents and the role of poison control centers
Sutter ME , Hon SL , Chang AS , Schwartz MD , Algren DA , Schier JG , Lando J , Lewis LS . Am J Prev Med 2010 38 (6) 663-6 BACKGROUND: Department of Transportation (DOT) mandates reporting of all serious hazardous materials incidents. Hazardous material exposures may result in secondary contamination of emergency departments, or delayed clinical effects. Poison control centers specialize in the management of patients exposed to toxic substances; however, poison control center notification is not required. PURPOSE: The objective is to determine the frequency of poison control center notification after serious hazardous materials incidents when patients were transported to a hospital. METHODS: A retrospective analysis was conducted of serious hazardous materials incidents as reported by DOT, matched with data from the American Association of Poison Control Centers from 2002 through 2006 that involved patient transport. Incidents were divided into four groups: those reported to a poison control center within 0-360 minutes of the incident; those reported within 361-1440 minutes of the incident; those reported within 1441-4320 minutes of the incident; and no poison control center notification. Analyses were performed on variables including date, time, substance, and time to notification. Data were received in January 2008. RESULTS: One hundred fifty-four serious incidents met inclusion criteria. One hundred thirty-four incidents (87%) occurred without poison control center notification. Poison control centers were notified in 20 incidents (12.9%); 15 incidents (9.7%) were reported within 0-360 minutes of the incident (M=115 minutes, range=5-359 minutes); four incidents (2.6%) were reported within 361-1440 minutes of the incident (M=652 minutes, range=566-750 minutes); and one incident (0.7%) was reported after 4320 minutes following the incident. CONCLUSIONS: Most serious hazardous materials incidents involving patient transport are not reported to poison control centers. Opportunities exist to increase utilization of poison control center resources without increasing financial burdens of the hazardous materials incident. |
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