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Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature

Purpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl associa...

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Main Authors:	Cheema, Ejaz, McGuinness, Khalil, Abdul Hadi, Muhammad, Paudyal, Vibhu, Elnaem, Mohamed Hassan Abdelaziz, Alhifany, Abdullah A, Elrggal, Mahmoud E, Al Hamid, Abdullah
Format:	Article
Language:	English English English
Published:	Dove Medical Press 2020
Subjects:	RM300 Drugs and their action RS Pharmacy and materia medica
Online Access:	http://irep.iium.edu.my/85978/1/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl.pdf http://irep.iium.edu.my/85978/2/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_SCOPUS.pdf http://irep.iium.edu.my/85978/3/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_WoS.pdf http://irep.iium.edu.my/85978/ https://www.dovepress.com/articles.php?article_id=60077 https://doi.org/10.2147/JPR.S280462
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spelling	my.iium.irep.859782022-07-15T02:11:52Z http://irep.iium.edu.my/85978/ Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature Cheema, Ejaz McGuinness, Khalil Abdul Hadi, Muhammad Paudyal, Vibhu Elnaem, Mohamed Hassan Abdelaziz Alhifany, Abdullah A Elrggal, Mahmoud E Al Hamid, Abdullah RM300 Drugs and their action RS Pharmacy and materia medica Purpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl associated deaths using case studies and case series in peer-reviewed published literature. Methods: Four electronic databases including Embase, Medline (via Ovid), Scopus, and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl-related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively. Results: Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, <1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 μg/mL. Conclusion: Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths. Dove Medical Press 2020-12-07 Article PeerReviewed application/pdf en http://irep.iium.edu.my/85978/1/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl.pdf application/pdf en http://irep.iium.edu.my/85978/2/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_SCOPUS.pdf application/pdf en http://irep.iium.edu.my/85978/3/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_WoS.pdf Cheema, Ejaz and McGuinness, Khalil and Abdul Hadi, Muhammad and Paudyal, Vibhu and Elnaem, Mohamed Hassan Abdelaziz and Alhifany, Abdullah A and Elrggal, Mahmoud E and Al Hamid, Abdullah (2020) Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature. Journal of Pain Research, 2020 (13). pp. 3281-3294. ISSN 1178-7090 https://www.dovepress.com/articles.php?article_id=60077 https://doi.org/10.2147/JPR.S280462
institution	Universiti Islam Antarabangsa Malaysia
building	IIUM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	International Islamic University Malaysia
content_source	IIUM Repository (IREP)
url_provider	http://irep.iium.edu.my/
language	English English English
topic	RM300 Drugs and their action RS Pharmacy and materia medica
spellingShingle	RM300 Drugs and their action RS Pharmacy and materia medica Cheema, Ejaz McGuinness, Khalil Abdul Hadi, Muhammad Paudyal, Vibhu Elnaem, Mohamed Hassan Abdelaziz Alhifany, Abdullah A Elrggal, Mahmoud E Al Hamid, Abdullah Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
description	Purpose: Fentanyl poisoning has been widely reported, yet there is a lack of systematic evaluation of the nature and toxicology of associated deaths in the published literature. This article aims to systematically review the nature, causes, routes of administration and toxicology of fentanyl associated deaths using case studies and case series in peer-reviewed published literature. Methods: Four electronic databases including Embase, Medline (via Ovid), Scopus, and Google Scholar were searched from inception until October 2019 to identify the studies reporting fentanyl-related deaths. Two independent reviewers screened and selected the titles and then evaluated the full texts. Only case studies and case series were included. A structured data extraction tool was used to extract data on the number of deaths, routes of administration, concomitant drug use and toxicological data. The Joanna Briggs Institute quality assessment tool was used to evaluate the quality of included studies. Data were synthesized narratively. Results: Of 1251 articles identified during initial search, 8 case reports and 9 case series met the inclusion criteria. A total of 1969 deaths were reported in the included studies. Deaths were concentrated in the north American region (n = 1946) and the Nordic region (n = 22). Reported causes of death included fentanyl overdose (n = 321, 56.4%), mixed drug toxicity (n = 196, 34.5%), natural (n = 28, 4.9%), other drug toxicity (n = 10, 1.8%), fentanyl and ethanol intoxication (n = 8, 1.4%), incidental (n = 5, <1%) and aspiration (n = 1). Most common routes of use were intravenous (70.5%) and transdermal routes (23.0%). Deaths came swiftly via the intravenous route. Mean level of blood fentanyl amongst all reported deaths was 0.024 μg/mL. Conclusion: Literature related to fentanyl-associated deaths predominantly come from North America. Deaths are comparatively lower or not reported in peer-reviewed publications from the rest of the world. Abuse through intravenous administration, mixed drug toxicities and self-treatment of breakthrough pain are mainly responsible for majority of the reported deaths.
format	Article
author	Cheema, Ejaz McGuinness, Khalil Abdul Hadi, Muhammad Paudyal, Vibhu Elnaem, Mohamed Hassan Abdelaziz Alhifany, Abdullah A Elrggal, Mahmoud E Al Hamid, Abdullah
author_facet	Cheema, Ejaz McGuinness, Khalil Abdul Hadi, Muhammad Paudyal, Vibhu Elnaem, Mohamed Hassan Abdelaziz Alhifany, Abdullah A Elrggal, Mahmoud E Al Hamid, Abdullah
author_sort	Cheema, Ejaz
title	Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
title_short	Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
title_full	Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
title_fullStr	Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
title_full_unstemmed	Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
title_sort	causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature
publisher	Dove Medical Press
publishDate	2020
url	http://irep.iium.edu.my/85978/1/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl.pdf http://irep.iium.edu.my/85978/2/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_SCOPUS.pdf http://irep.iium.edu.my/85978/3/85978_Causes%2C%20nature%20and%20toxicology%20of%20fentanyl_WoS.pdf http://irep.iium.edu.my/85978/ https://www.dovepress.com/articles.php?article_id=60077 https://doi.org/10.2147/JPR.S280462
_version_	1738510107741782016
score	13.211869

Causes, nature and toxicology of fentanyl- associated deaths: a systematic review of deaths reported in peer-reviewed literature

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