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Controversies and carfentanil: We have much to learn about the present state of opioid poisoning

  • Jon B. Cole
    Correspondence
    Corresponding author at: 701 Park Ave, Mail Code: RL.240, Minneapolis, MN 55415, United States.
    Affiliations
    Minnesota Poison Control System, Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, United States
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  • Lewis S. Nelson
    Affiliations
    Department of Emergency Medicine, Division of Medical Toxicology, Rutgers New Jersey Medical School, New Jersey Poison Information & Education System, Newark, NJ, United States
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Published:August 23, 2017DOI:https://doi.org/10.1016/j.ajem.2017.08.045
      Over the last 30 years North America has witnessed a tremendous rise in prescription opioid abuse, addiction, overdose, and death [
      • Nelson L.S.
      • Juurlink D.N.
      • Perrone J.
      Addressing the opioid epidemic.
      ]. It is now clear that this was in large part an iatrogenic epidemic with a multifaceted etiology with contributions made from nearly every specialty in medicine [
      • Hoppe J.A.
      • Kim H.
      • Heard K.
      Association of emergency department opioid initiation with recurrent opioid use.
      ,
      • Rudd R.A.
      • Seth P.
      • David F.
      • Scholl L.
      Increases in drug and opioid-involved overdose deaths - United States, 2010–2015.
      ,
      • Shah A.
      • Hayes C.J.
      • Martin B.C.
      Characteristics of initial prescription episodes and likelihood of long-term opioid use - United States, 2006–2015.
      ,
      • Barnett M.L.
      • Olenksi A.R.
      • Jena A.B.
      Opioid prescribing by emergency physicians and risk of long-term use.
      ,
      • Brummett C.M.
      • Waljee J.F.
      • Goesling J.
      • et al.
      New persistent opioid use after minor and major surgical procedures in US adults.
      ]. In response, the medical establishment moved to reduce opioid prescribing, create abuse deterrent formulations, implement prescription drug monitoring programs, and expand access to medication-assisted therapy, all with limited success. Simultaneously, the falling price and increasing purity of heroin and the reduced availability and high cost of prescription opioids caused some with prescription opioid use disorder to transition to heroin [
      • Cicero T.J.
      • Ellis M.S.
      • Surratt H.L.
      Effect of abuse-deterrent formulation of OxyContin.
      ].

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