Vancouver Coastal Health, Vancouver, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
Harm Reduct J. 2018 Dec 22;15(1):64. doi: 10.1186/s12954-018-0271-5.
In midst of the overdose crisis, the clinical features of opioid overdoses seem to be changing. Understanding of the adverse effects of synthetic opioids such as fentanyl is currently limited to clinical settings. Insite, a supervised injection site in Vancouver, Canada, provides an opportunity to better understand illicit drug overdose presentations.
A review of clinical records at Insite for October 2016 to April 2017 was undertaken to quantify atypical overdose presentations. Overdose reports were reviewed for the number of atypical opioid overdose presentations, temporal trends over the study period, concurrent symptoms, and interventions employed by staff.
Insite staff responded to 1581 overdoses during the study period, including 497 (31.4%) that did not fit a typical presentation for opioid overdoses. Of these, 485 fit into five categories of atypical features: muscle rigidity, dyskinesia, slow or irregular heart rate, confusion, and anisocoria. Muscle rigidity was the most common atypical presentation, observed in 240 (15.2%) of the overdose cases, followed by dyskinesia, observed in 150 (9.2%). Slow or irregular heart rate was observed in 69 (4.4%) cases, confusion in 24 (1.5%), and anisocoria in 2 (0.1%) of overall overdose cases.
The similarity of atypical overdose cases at Insite with anesthesiology case reports supports the understanding that the illicit drug supply is contaminated by fentanyl and other synthetic opioids. Atypical overdose presentations can affect clinical overdose response. The experience at Insite highlights the potential for supervised consumption sites to be innovative spaces for community learning and knowledge translation.
在过量用药危机中，阿片类药物过量的临床特征似乎正在发生变化。目前，对于芬太尼等合成阿片类药物的不良反应的了解仅限于临床环境。加拿大温哥华的监督注射场所 Insite 提供了一个更好地了解非法药物过量表现的机会。
对 2016 年 10 月至 2017 年 4 月期间 Insite 的临床记录进行了回顾性分析，以量化非典型过量表现。对过量报告进行了审查，以确定非典型阿片类药物过量表现的数量、研究期间的时间趋势、同时出现的症状以及工作人员采用的干预措施。
在研究期间，Insite 工作人员共应对了 1581 例过量用药，其中 497 例（31.4%）不符合典型阿片类药物过量表现。在这些病例中，有 485 例符合五种非典型特征类别：肌肉僵硬、运动障碍、心率缓慢或不规则、意识混乱和瞳孔大小不等。肌肉僵硬是最常见的非典型表现，在 240 例（15.2%）过量病例中观察到，其次是运动障碍，在 150 例（9.2%）中观察到。在 69 例（4.4%）病例中观察到心率缓慢或不规则，24 例（1.5%）病例中观察到意识混乱，2 例（0.1%）病例中观察到瞳孔大小不等。
Insite 的非典型过量病例与麻醉学病例报告相似，这支持了非法药物供应受到芬太尼和其他合成阿片类药物污染的理解。非典型过量表现会影响临床对过量反应的处理。Insite 的经验强调了监督消费场所成为社区学习和知识转化的创新空间的潜力。
