Talk:Opioid overdose

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This article was the subject of a Wiki Education Foundation-supported course assignment, between 27 September 2018 and 14 December 2018. Further details are available on the course page. Student editor(s): Xcindy huynh, Cindynguyeen, Albert63093, Fbchenn, Eyang92, Jennifershieh, Kathyle29, Anthony Lui. Peer reviewers: Kingandrea, Lynnlam2001, Victoriayi, Wjisksi007, Noragwam.

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Heading
ANYONE who's familiar with the super-potent NON-HUMAN synthetic opioids, even someone who just has minor experience with tranquilizing/etc rhinos/elephants/etc, please re-word/update anything I may've missed or wrote confusingly. I just wanted to get the "revivon for humans" out of the section before someone finds it at the zoo they're working at, grabs a vial and thinks they have a "safety shot", as it's NOT for humans - it DOES have mu-opioid-AGONIST properties as well as its antagonism, it is meant for getting animals out of, say, a tranquilized state induced by carfentanil or any of the other too-strong-for-human opioids. Revivon isn't even in hospitals for human usage, it comes WITH carfentanil and other super-strong large-animal opioids, to be used after the opioid agonist once moving/tranquilizing/whatever is complete. — Preceding unsigned comment added by SangerRainsford (talk • contribs) 21:29, 2 March 2011 (UTC)

Review
NEJM this week 10.1056/NEJMra1202561. JFW &#124; T@lk  11:57, 12 July 2012 (UTC)

Pharmacodynamics?
Should there be a section detailing what exactly happens during overdose on a cellular level? My knowledge is sophmoric at best, but is there anyone willing to take on that task? ThanksSuperbuttons (talk) 19:42, 3 July 2013 (UTC)

Opening paragraph weirdness
" Opioid overdose was responsible for more deaths in the United States from 1999-2008 than heroin or cocaine overdose combined.[1]"

Heroin is an opioid. This sentence doesn't make any sense. LiamSP (talk) 02:26, 9 October 2013 (UTC)

Updated charts. May need to refresh your cache to see 2015 column
http://refreshyourcache.com/en/cache

Windows: ctrl + F5 Mac/Apple: Apple + R or command + R Linux: F5 --Timeshifter (talk) 15:21, 29 October 2017 (UTC)

Editing an Existing Article
I am a nursing student and I have chosen to edit this article. I wanted to include a couple of edits that will ensure that the information presented will be cited properly, and will be much more clear and concise. These are the areas I've chosen to make edits to; "A longer-acting variant of naloxone is naltrexone." I will be citing this statement using the following reliable source. Lee, J. D., Nunes, E. V., Novo, P., & Bachrach, K. (2017, November). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. The Lancet. doi:10.1016/S0140-6736(17)32812-X "Other CNS depressants, or "downers", muscle relaxers, pain relievers, anti-convulsants, anxiolytics (anti-anxiety drugs), treatment drugs of a psychoactive or epileptic variety or any other such drug with its active function meant to calm or mitigate neuronal signaling (barbiturates, etc.) can additionally cause a worsened condition with less likelihood of recovery cumulative to each added drug." I will be citing this statement using the following reliable source. Filter, E., Gorczynkski, L., & Fernandes, J. Fatal Intoxication With a Selective Serotonin Reuptake Inhibitor, Lorazepam, and Codeine.[Report]. American Journal of Forensic Medicine & Pathology, 28(4), 361-363.

"Opioid use disorders resulted in 122,000 deaths globally in 2015 up from 18,000 deaths in 1990." This statement is cited correctly. However, I plan on making just a few changes to the wording of this statement. Initially when I read this statement I was confused, so I hope to rephrase this so it's clearer to the reader. MaddyEngelsma (talk) 18:18, 1 December 2017 (UTC)


 * Please read WP:MEDRS and WP:MEDMOS Doc James  (talk · contribs · email) 22:16, 1 December 2017 (UTC)

Peer Review of Article
This article is well-written and for the most part provides a comprehensive look at opioid overdoses. There are a few additions that I would suggest: the physiology of overdose and what drug-seeking behaviors are. There is mention of drug-seeking behaviors, but there are not examples. The addition of these two things would make this article more well-rounded and give readers a better grasp on the topic. Williann1 (talk) 16:40, 2 December 2017 (UTC)

Caption should describe image


Have adjusted it back to this. This content "Of the 64,070 overdose deaths in the US in 2016,[30] opioids were involved in 42,249.[31" is not supported by the image in question and belongs in the text of the article. We have color coding that tells us the 5 states with the highest number Doc James  (talk · contribs · email) 08:35, 15 October 2018 (UTC)


 * That info is supported by the references. And the total overdose deaths provides context to the map. As do the specific numbers for the highest states. Especially since the map legend ranges are wide it is important to see some specific numbers for the highest states.


 * But I prefer your placement of the text just above the chart and map, because it makes the chart and map fit better aesthetically on the page.


 * If the map was by itself then combining the map legend and text as shown below is much more informative. People often go back to such maps to get the big picture fast.


 * For various examples of combining the map legend and map caption see the description on the Commons page:
 * Commons:File:US map of drug overdose deaths per 100,000 population by state.gif
 * I link to that Commons map page from Commons:Map resources


 * Here is my original format below (from this diff):

Epidemiology

Of the more than 72,000 overdose deaths in the US in 2017, opioids were involved in over 49,000. This is a dramatic increase from 2016 where over 64,000 died from drug overdose, and opioids were involved in over 42,000.





--Timeshifter (talk) 10:19, 15 October 2018 (UTC)


 * This text "Drug overdose deaths in the US per 100,000 people by state" is already at the top of the image. Am trying to get things to fit better. Doc James  (talk · contribs · email) 14:17, 15 October 2018 (UTC)

Prevention
In terms of prevention, my group of pharmacy students would like to add information regarding legislature that tackles opioid prevention. We wanted to research ones that perhaps looked into high-risk individuals, see what other programs are being performed or proposed in other states, a pharmacist's roll in curbing opioid use, and policies similar to or that have stemmed from Florida's pill mill law. Cindynguyeen (talk) 04:08, 16 October 2018 (UTC)

Pharmacy Students: Proposed Wiki Edits
After reviewing the contents of this article, we would like to make some improvements in the following sections: My teammates will each tackle a different section. -Include a section about CYP inducers/inhibitors[Albert Yang] -Update the Mechanism section(specifically how opioids cause overdose and the science behind it)[Cindy Huynh] -Including information about children and adolescents[Frances Chen] -Adding other opioid overdose treatment (supportive care/therapies etc)[Anthony Lui] Xcindy huynh (talk) 00:43, 17 October 2018 (UTC)

What ref and wording supports?
"Because signs of respiratory depression are delayed in toddlers, this puts them at an increased risk for cerebral hypoxia and death. "

Doc James (talk · contribs · email) 14:25, 3 November 2018 (UTC)

This is way out of date...
"Codeine is commonly prescribed to treat pain postpartum for mothers who have undergone cesarean section. Breastfeeding while on codeine is deemed generally safe by American Academy of Pediatrics though typically low levels of codeine and morphine can cross into breast milk. However, there has been a report of an accidental infant opioid overdose that was linked to the ingestion of breastmilk from a mother taking codeine. Postmortem toxicology analysis discovered lethal levels of morphine in the infant’s blood. The mother had been prescribed Tylenol 3 (Codeine 30 mg/Acetaminophen 500mg) who took 2 tablets twice a day on day 1 and took to half the dose on day 2. Genetic analysis showed that the mother had three functional CYP2D6 alleles that would categorize her as a CYP2D6 ultrarapid metabolizer. This phenotype led to an increase in conversion of codeine to active morphine, which can increase the risk of toxicity and overdose. "

All the refs are before 2010. A simple pubmed search finds this review from 2015. Doc James  (talk · contribs · email) 14:29, 3 November 2018 (UTC)
 * Have added the fact that codeine is NOT recommended. Doc James  (talk · contribs · email) 14:41, 3 November 2018 (UTC)

This is all based on primary sources
"Prescription monitoring program allow physicians to view individuals' history of prescribed opioids and other controlled substances to prevent risky behaviors, such as doctor shopping and drug diversion. These programs are operational in 49 states and the District of Columbia, and have generally been found to decrease prescribing of opioids.

Regulative policies, such as Florida’s pill mill law, have also been found to decrease opioid prescribing and use, which are both correlated with opioid overdoses. Florida's pill mill law addressed pill mills, or rogue pain management clinics where prescription drugs are inappropriately prescribed and dispensed, and required these clinics to register with the state, have a physician-owner, created inspection requirements, and established prescribing and dispensing requirements and prohibitions for physicians at these clinics. Additionally, Minnesota has approved approximately $1 million in funding for establishing opioid abuse community prevention pilot projects, focusing on such things like coordination of care, increased provider and prescriber education, and ensuring appropriate opioid use. The Minnesota Legislature provided communite prevention teams with grants to assist controlled substance care teams in implementing CHI St. Gabriel's tested model of decreasing inappropriate opioid use. "

Please look for secondary sources on the topic. Plus material should be broader in scope. Approving money for pilot projects in one small area in one country is not really notable. Doc James (talk · contribs · email) 14:36, 3 November 2018 (UTC)
 * The question is does PMP decrease opioid overdoses? Doc James  (talk · contribs · email) 14:42, 3 November 2018 (UTC)
 * This is an EXCELLENT source.
 * It is a review article.
 * It is published in a major well respected and peer reviewed pubmed indexed journal.
 * It is from 2018. Doc James  (talk · contribs · email) 14:55, 3 November 2018 (UTC)

@Doc James
You might want to ping the corresponding students in each section so that they know you've left feedback for them. Also, if you'd like me to help with this like I did last year, let me know. I'm willing to do the same for the student edits in the oxymorphone, methadone, substance dependence, opioid use disorder, opioid epidemic, and indication (medicine) articles as well.  Seppi  333  (Insert 2¢) 07:26, 7 November 2018 (UTC)

Peer Review (group 6's edits)
By Group 10

Prompt: Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…

I think this group's edits seem to fit Wikipedia's manual of style - the subheadings are appropriately capitalized, they use proper punctuation, and stay consistent with the language throughout the article. Their citations to references also go after the punctuation, as is appropriate. One thing that I think could be improved on is linking to an article that goes more in-depth about a topic. For example, in their "Treatment" section, it seems like the main treatment is naloxone, so have a link at the top saying to refer to the main article of naloxone, as is consistent with Wikipedia's MoS suggestion ("If the topic of a section is covered in more detail in a dedicated article (see Wikipedia:Summary style), insert { {main|Article name} } immediately under the section heading."). FYI: In this quotation, I included spaces between the butterfly brackets or else if would have formatted it in my post. -Shirley Ng Shirderp (talk) 23:03, 7 November 2018 (UTC)

Prompt: Are the points included verifiable with cited secondary sources that are freely available? If not, specify.

The points included were verifiable with cited secondary sources. In the newly added section, “Genetic Risk Factors”, sources [18] and [19] “Methadone – metabolism, pharmacokinetics, and interactions”, are the same, so they should be under one number. Source [16], which was recently used for adding more information about peds dosing, is the same as source [3], so these should also be under the same number. Source [12], “Methadone and Buphrenorphine Toxicity in Children”, is not freely available to the general public, so another source should be used to reference the points about opioid overdose in children. Lynnlam2001 (talk) 03:26, 8 November 2018 (UTC)Lynn Lam

Prompt: Is there any evidence of plagiarism or copyright violation? If yes, specify.

There are no signs of plagiarism or copyright violation. All points added pulled key points from the various sources and made helpful additions to the page. Each citation is appropriately placed at the end of each sentence. Victoriayi (talk) 17:46, 8 November 2018 (UTC)

Prompt: Does the draft submission reflect a neutral point of view? If not, specify.

The submissions made by all group members reflected a neutral point of view. I liked how words and phrases used were impartial and the information presented was unbiased. Reliable resources were cited and did not reflect the author's viewpoints in any of the sections (i.e. risk factors, cause, treatment, mechanisms). Only one minor suggestion: sentences such as "Programs to provide drug users and their caregivers with naloxone are recommended" (under Treatment) should maybe include who recommends that. This way it isn't making claims on behalf of unnamed groups of people. Noragwam (talk) 00:42, 9 November 2018 (UTC)

Pharmacy Student Peer Reviews (Group 6's edits)
Peer Review by Group 30

1. Does the draft submission reflect a neutral point of view? If not, specify…

Overall, the draft submission appears to reflect a neutral point of view. Pertinent information regarding the mechanisms, genetic risk factors, and treatment options were integrated into the article in a clear, concise manner without having a biased undertone. Their facts were drawn from reliable resources, and they did not exclude sources that did not conform to their view points on opioid overdose. The article structure included headers that allows readers to swiftly navigate through the different sections, which is quite useful because readers can then equally assess all related viewpoints of opioid overdose. The revisions were well written and enhanced the overall quality of this article. Carolyntang1 (talk) 23:18, 8 November 2018 (UTC)

2. Are the points included verifiable with cited secondary sources that are freely available? Overall, all of the edits can be traced back to a secondary source that is cited. Jasperhai (talk) 01:57, 9 November 2018 (UTC)

3. Are the edits formatted consistent with Wikipedia’s manual of style? If not, specify…
 * Under Mechanism section, I think this sentence should be revised for grammar "Opioids inhibit the medulla's by mu and delta receptors."
 * In the Risk Factors section, I would define "CYP" in the previous sentence before using the abbreviation because it's not obvious what CYP is
 * Otherwise, the edits follow Wiki's Manual of Style 76.126.33.84 (talk) 11:31, 10 November 2018 (UTC)

4. Is there any evidence of plagiarism or copyright violation? If yes, specify…

I found no evidence of plagiarism or copyright violations in the article's new edits and additions. The group did an exceptional job at presenting the material in an original manner with proper citations from reputable resources. Tiffanygu (talk) 04:50, 9 November 2018 (UTC)

5. Has the group achieved its overall goals for improvement? If not, specify… Yes, the group has achieved its overall goal for improvement. The edits are unbiased in nature, follow the wiki manual of style and avoid plagiarism. Justin Sims

Peer Review by Group 8:

1. Does the draft submission reflect a neutral point of view?

Group 4 did a great job at providing beneficial edits! The information was all important and presented in a neutral way. It seems as though some of the information about Buprenorphine got deleted. I thought it was meant to be neutral because it is providing information, but maybe it was not taken that way because advantages were stated but no disadvantages. --Avucsf (talk) 00:10, 9 November 2018 (UTC)

2. Are the points included verifiable with cited secondary sources that are freely available?

Overall, the edits have verifiable secondary sources. They are mainly journal articles, government resources, and webpage from reputable institution that are freely available.Pharmacystudent1 (talk) 01:48, 9 November 2018 (UTC)

3. Are the edits formatted consistent with Wikipedia’s manual of style?

The edits made by Group 4 on opioid prevention were very polished and added more insight into opioid prevention. The grammar and spelling are all appropriate. In addition, the image added to the article is appropriately placed in the section titled “Co-ingestion.”

The only comment I have is that the paragraph on national public health organizations does not necessarily directly tie into prevention methods. I would suggest creating a separate subsection, perhaps titled “Awareness,” and expand on National Prevention Week. It is important to make the articles straightforward and easy to read, so I think having a separate section for this topic will shed even more light on the importance sharing stories of mental health and spreading awareness. --Ashleyyam (talk) 23:57, 8 November 2018 (UTC)

4. Is there any evidence of plagiarism or copyright violation?

No evidence of plagiarism/copyright violation: Group 4 used reputable sources and applying concepts without any evidence of plagiarism or copyright violation. Group 4 made a significant contribution with appropriate and unique way to conveying a very difficult and sensitive subject into lay language for every Wikipedia user to understand. The edit’s had the appropriate citation for users to find with the original source. I applaud Group 4 for making a significant contribution to Opioid Overdose.Mindyucsf (talk) 00:17, 9 November 2018 (UTC)

Group 13's Peer Edits
1. Does the draft submission reflect a neutral point of view?

Additions to the article reflected a neutral point of view. Significant edits involved the discussion of genetic polymorphisms as a risk factor of opioid overdose, as well as the mechanism of opioid overdose. The draft submission provided was informational and did not present with any bias. Kingandrea (talk) 03:32, 9 November 2018 (UTC)

2. Are the points included verifiable with cites secondary sources that are freely available? All the edits made by the group included citations of secondary sources that are freely available. The citations are very thorough, and the material cited were of high quality. Beatrice1223 (talk) 03:35, 9 November 2018 (UTC)

3. Are the edits formatted consistent w/Wiki’s manual of style?

For the most part, yes, the edits are formatted consistent with Wiki’s manual of style. I think you should move the Epidemiology section to the beginning. --Sseav (talk) 04:15, 9 November 2018 (UTC)

4. Is there evidence of plagiarism or copyright violation? --WikiAKing (talk) 03:40, 9 November 2018 (UTC) -I answered the following questions to determine evidence of plagiarism or copyright violation:

Do you notice any irregularities in formatting that might suggest the copying of material directly from another source?

-No. Formatting is consistent throughout.

Did the editors correctly cite the edited material?

-Yes, the editors did a great job of citing. Good citations all around. Everyone gave credit where it was due.

Are there any sections with long blocks of quotes in quotation marks?

-None at all.

Is the writing full of unusually complex or sophisticated jargon?

-No. The edits were not difficult to follow at all. Diction is appropriate for the intended audience, and all of the current edits seemed written at a level you would expect of pharmacy school students.

Overall verdict: I did not notice any evidence of plagiarism or copyright violation.

Recent rapid increase in percentage of Fentanyl in opioids imported from Mexico
Here is something that might be fleshed out better in the article. Someone else will have to do it. I don't have the time. I will leave more references here if I happen to find them.

7 May 2019: Mexican drug cartels, poppy farmers and the US fentanyl crisis. By John Holman. Al Jazeera. From the article (emphasis added): -- Timeshifter (talk) 19:37, 26 May 2019 (UTC)

CP133 2019 Group 14 proposed edits

 * In the Treatment section, add what the current access to Naloxone is. Add where patients can get naloxone and that pharmacists can dispense it. Add the mechanism in which naloxone reverses opioid overdose Vuongazole (talk) 02:00, 17 October 2019 (UTC)
 * Consider expanding Naloxone access in the United States under "Prevention" or under "Treatment" and consolidating under either heading or put in a new one. Add that naloxone is not a long term prevention. Agustinjan (talk) 04:30, 17 October 2019 (UTC)
 * Include International Overdose Awareness Day Agustinjan (talk) 00:07, 30 October 2019 (UTC)


 * Add that clinicians should consult Prescription Drug Monitoring Programs to prevent opioid overdose under Prevention Vuongazole (talk) 10:15, 14 November 2019 (UTC)


 * Add data from other countries/continents in the Epidemiology section. Gacb1 (talk) 03:09, 17 October 2019 (UTC)


 * Include protocols at institutions that automatically prescribe naloxone for a certain amount of opioids dispensed to a patient. Datle96 (talk) 04:27, 17 October 2019 (UTC)
 * Add that naloxone co-prescription is also recommended based on patient risk factors Vuongazole (talk) 23:19, 20 November 2019 (UTC)

CP133 2019 Group 13 peer reviews

 * (Part 1) After looking at the edits made to the Wikipedia page, I believe that Group 14 has substantially improved the article with their additions. They added data about opioid overdoses outside of the United States, which I believe is very useful because initially there was only information about statistics in the United States. They also added recommendations for when to provide naloxone in the "Treatment" section, which is helpful to decide when to use. In addition, I like that they added information about International Opioid Awareness Day because it shows that this issue is on a global scale. (Part 2) The edits made by the group reflect a neutral point of view. Emilyyao (talk) 19:42, 5 November 2019 (UTC) Emily

Part 2: After reviewing the edits made I did find that they were consistent with Wikipedia's manual of style.
 * Upon reviewing the edits made by Group 14 to the Opioid Overdose Page, I also believe they have significantly improved the article. They have added multiple pertinent and valuable citations and have integrated important information into the Epidemiology section regarding the severity and prevalence of overdose in the United States. Furthermore, the Treatment section was also enhanced as members used concrete examples to reference how the city of San Francisco implements programs to increase community engagement and awareness of the opioid crisis. I also liked how the group included a section on International Overdose Awareness Day as well. Overall, the edits/information provided by Group 14 was factual, unbiased, and clear and they have achieved their overall goals for improvemnt. I think they did a great job!

Sharleengill (talk) 01:08, 6 November 2019 (UTC)

Part 1 I believe Group 14 has made a great improvement in improving the article through several good edits and providing additional details under major subcategories such as the Awareness section and the Prevention section for opioid overdose. An example of that was including International Opioid Awareness Day to help spread, remember, and pay respect for patients that may have had an opioid overdose episode in their lives. In addition, Group 14 also included an Epidemiology section that really helps portray the amount of opioid users there are and how big of a problem it is in our society today. While the group may add additional details in other sections such as risk factors or mechanism of action, the group certainly did a great job in including critical information in pertinent areas such as Treatment, Epidemiology, and Awareness to help improve the article overall.
 * Thank you for your input! Added examples of risk factors that increase recommendation of naloxone co-prescription under prevention section. Vuongazole (talk) 10:15, 14 November 2019 (UTC)

Part 2 Are the points included verifiable with cited secondary sources that are freely available?

Yes, all the points that Group 14 included were verifiable with cited secondary sources that are freely available. The sources come from credible sources varying from the CDC, the World Health Organization, and other reputable sources that had valuable content.Curtisyu93 (talk) 23:54, 6 November 2019 (UTC) — Preceding unsigned comment added by Curtisyu93 (talk • contribs) 23:51, 6 November 2019 (UTC)

Group 14’s edits definitely improved the article substantially by adding relevant details on basic international information from WHO, naloxone access in the U.S., International Overdose Awareness Day, naloxone prescribing, and awareness programs to prevent opioid overdose. Overall, their wording was neutral and concise which complies with Wikipedia’s manual of style. I did notice that some of their edits were revised/removed, such as the mechanism of naloxone and the recommendation of co-prescription. However, I do believe that group 14 has achieved their overall goals for improvement. There is no evidence of plagiarism or copyright violation. Great job! Judy.Vo (talk) 01:02, 7 November 2019 (UTC)

Blue's Clues Contributions
Hello! Our group's name is Blue's Clues and we are aiming to improve parts of this article over the coming months. We would like to start with editing the Lead writing style and structure to better facilitate a logical flow of thought while ensuring that the citations are appropriate. The largest contribution we hope to make is to the 'Mechanisms' subheading which currently lacks details about the biochemical pathways involved in opioid overdose. We aim to conduct thorough research on this subject and add to the information already found on the page. Finally, we hope to explore the concept of mental health as a risk factor in order to support the claims made in the Lead. This is our first editing endeavour so any help or comments are appreciated! Dayakgill (talk) 15:36, 23 October 2020 (UTC) Sahrishmasood (talk) 15:36, 23 October 2020 (UTC) NoThisIsPatrick3000 (talk) 15:44, 23 October 2020 (UTC)

Here's a link to our sandbox, in which we will be making our edits Blue's Clues Sandbox

Update: While conducting research for our contributions, we found a paper that suggests the GABA neurotransmitter study may not be associated with opioid-related respiratory depression. We have outlined our adjustments to this section in our sandbox (under Mechanisms edits > Proposed edits) and would appreciate any feedback before we publish our changes!

Sahrishmasood (talk) 17:15, 30 October 2020 (UTC) NoThisIsPatrick3000 (talk) 17:15, 30 October 2020 (UTC) Dayakgill (talk) 17:17, 30 October 2020 (UTC)

Wiki Education assignment: WikiMed Fall 2022
— Assignment last updated by Alexloopy (talk) 00:50, 31 October 2022 (UTC)

I made some changes to the Treatment section to split up naloxone vs basic life support vs other treatments. I added information about naloxone formulations for public use, some discussion about synthetic opioids, and cleaned up old sources to discuss access to naloxone. I'm also planning to make some edits to epidemiology to more clearly explain the epidemiological shift from heroin to synthetic opioids in the past ~5 years. --Alexloopy (talk) 22:00, 4 November 2022 (UTC)