Latest Articles and News - Jul 3, 2025

Emergency medical system response, emergency department visits, and hospital admissions in response to non-fatal opioid overdoses reported by a cohort of overdose survivors in San Francisco and Boston, 2019 - 2022.

Non-fatal opioid overdoses that do not result in an emergency medical system (EMS), emergency department or hospital encounter are not tracked. We aimed to understand the proportion of non-fatal overdoses with and without a healthcare encounter. We used data from the REpeated-dose Behavioral intervention to reduce Opioid Overdose inTervention (REBOOT) trial among opioid overdose survivors in San Francisco and Boston. Participants reported the number of non-fatal overdoses over the prior 4-months at baseline and follow-up visits over 16 months. We asked details about the three most recent overdoses, including naloxone administration, EMS attendance, transport to an emergency department, or hospitalization. A total of 268 individuals completed 1163 assessments. Across the assessments, 150 participants reported a total of 504 overdoses. Complete details were collected for 384 of the overdose events. Naloxone was administered at 306 out of 384 (80 %) overdose events. EMS attended the scene in 177 out of 384 (46 %) of events, with naloxone administration occurring in 159 of these events (90 %); 130 of the 384 (34 %) events resulted in transportation to the emergency department, and only 18 (5 %) led to hospital admission. Among opioid overdose survivors in urban settings, EMS were present at less than half of self-reported overdoses, emergency department visits occurred in about one third, and admission to the hospital occurred in one of twenty overdoses. Most overdoses involved naloxone administration, frequently by lay responders. Estimating non-fatal overdose prevalence should not rely solely on measures of EMS attendance, emergency department or hospital admissions.

https://pubmed.ncbi.nlm.nih.gov/40606798/

Spatial analysis of county-level determinants of overdose mortality in the United States using spatial machine learning.

In recent years, there has been a growing body of literature on identifying effective determinants for modeling the spatial variation of overdose rates, addressing this emerging public health concern globally. We compiled a range of widely recognized factors to examine spatial heterogeneity and its associations with overdose mortality using a non-linear geographically weighted random forest approach. The model outperformed conventional ones with (R² = 0.83 and MAE = 0.26). We found that, on average, the population rate of Asians (12.8%) is the most important determinant of the model, followed by the population rate of African Americans (10.1%) and the rate of cost-burdened housing units (9.9%). Although the results indicate that climatic determinants have had a lesser impact on overdose mortality rates, locally, their importance is greater in central and eastern counties. The spatial analysis revealed that the significance of determinants varies greatly by location. These findings could inform the development of localized spatial models, enabling more efficient allocation of resources to control overdose mortality rates at the community level.

https://pubmed.ncbi.nlm.nih.gov/40604633/

Polysubstance-Involved Opioid Overdose Deaths Among US Youths: 2020 to 2023.

https://pubmed.ncbi.nlm.nih.gov/40602787/

Description of a fatal case of acute Phytolacca americana poisoning due to leaf ingestion in China.

Phytolacca americana L. (American pokeweed), an alien plant species in China, has become widely distributed in both rural and urban areas. American pokeweed contains toxic substances such as saponins and oxalates, which have led to multiple poisoning incidents in recent years. Here, we describe a fatal case of acute American pokeweed leaf poisoning in China, emphasizing the clinical progression, toxin concentration, and implications for public health interventions. To our knowledge, no such description currently exists in the literature. A comprehensive epidemiological investigation, morphological identification, and ultra-performance liquid chromatography-triple quadrupole/linear ion trap mass spectrometry (UPLC-Qtrap MS) analysis were conducted to confirm toxin exposure. Esculentoside A (EsA) and its metabolite phytolaccagenin (hEsA) were quantified in plant specimens and patient blood. A 50-year-old woman developed severe gastrointestinal symptoms 2 hours after ingesting stir-fried pokeweed leaves (≈150 g raw), progressing to multi-organ failure and death within 33 hours. Laboratory findings revealed metabolic acidosis (pH 7.11), hypovolemic shock, cardiac injury (troponin I: 12.70 ng/mL), and coagulopathy (D-dimer: 83.8 mg/L). UHPLC-Qtrap MS detected high concentrations of hEsA (the whole plant: 2.50 mg/kg, blood: 2.37 ng/mL) and EsA (the whole plant: 133 mg/kg, blood: 0.1 ng/mL). The present case highlights the fact that the lethal potential of improperly prepared pokeweed leaves. The predominance of hEsA in blood highlights the importance of metabolite detection in toxin analysis. This study has important reference value for the prevention and clinical treatment of similar poisoning incidents in the future.

https://pubmed.ncbi.nlm.nih.gov/40602544/