ArticleHarm reduction journal2018
Rigidity, dyskinesia and other atypical overdose presentations observed at a supervised injection site, Vancouver, Canada.
Article in Harm reduction journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed.
- Effects of fentanyl on diaphragm muscle force in patients undergoing knee arthroplasty: a randomised double-blind clinical trial.British journal of anaesthesia · 2026Trial
- New trends in the overdose epidemic: postural impact on abusers of fentanyl and xylazine and clinical and forensic implications.Forensic science, medicine, and pathology · 2026Review
- Acute fentanyl and xylazine co-exposure uniquely increase the excitability of dopamine type 2 receptor-expressing striatal medium spiny neurons.Journal of neurophysiology · 2026Article
- Fentanyl blockade of KThe Journal of physiology · 2026Article
- Overdose-Related Cardiac Arrest in the Era of the Opioid Epidemic.Critical care clinics · 2026Review
- The opioid flexion phenotype: postural flexion and nodding in the fentanyl era.Frontiers in neuroscience · 2026Article
- Frozen in Addiction: A New Wave of Drug-Induced Movement Disorders?Movement disorders : official journal of the Movement Disorder Society · 2025Article
- A sea of need: provider accounts of strategies used to manage admission demands to safer opioid supply programs in Ontario.Harm reduction journal · 2025Article
- Combining the alpha-2 adrenergic agonist clonidine with naloxone rescues fentanyl-induced physiologic dysfunction and increases survival.bioRxiv : the preprint server for biology · 2025Article
- Treating Opioid Use Disorder and Opioid Withdrawal in the Context of Fentanyl.Annual review of clinical psychology · 2025Review
- Respiratory Depression Associated with Opioids: A Narrative Review.Current treatment options in oncology · 2024Review
- New-onset movement disorder in the immediate postpartum period.BMJ case reports · 2023Article
- Cell-type specific molecular architecture for mu opioid receptor function in pain and addiction circuits.Neuropharmacology · 2023Review
- Article
- Atypical Fentanyl Transdermal Patch Consumption and Fatalities: Case Report and Literature Review.Toxics · 2022Article
- Effects of fentanyl overdose-induced muscle rigidity and dexmedetomidine on respiratory mechanics and pulmonary gas exchange in sedated rats.Journal of applied physiology (Bethesda, Md. : 1985) · 2022Article
- Respiratory effects of low and high doses of fentanyl in control and β-arrestin 2-deficient mice.Journal of neurophysiology · 2021Article
- Sex and Gender Differences in the Effects of Novel Psychoactive Substances.Brain sciences · 2020Review
- Fentanyl depression of respiration: Comparison with heroin and morphine.British journal of pharmacology · 2020Article
- The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies.Translational psychiatry · 2019Review
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveIn 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.
methodsA 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.
resultsInsite 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. DISCUSSION: 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.
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