Opioid Epidemic Resource Center
Free access to research, data, analyses and other resources
By the Elsevier Community Posted on 7 November 2017 Updated on 25 June 2019
The opioid epidemic is taking lives every day. In the United States, where President Trump has declared it a national public health emergency, prescription opioids and heroin killed more than 33,000 people in 2015, according to the Centers for Disease Control and Prevention (CDC).
Elsevier’s Opioid Epidemic Resource Center provides continually updated free resources from our content experts on multiple topics related to opioid use and addiction, nationally and internationally. This free offering gives our readers — including medical professionals, health researchers and members of the public — the ability to access the depth and breadth of Elsevier resources on the topic in one place.
The solution for this epidemic is complicated, but it starts with education.
Leslie Dye, MD
VP, Editor-in-Chief, Medical and Drug Content, Elsevier
Curator of Elsevier’s Opioid Epidemic Resource Center
What's in the Opioid Addiction Resource Center?
Elsevier's content includes online clinical solutions for physicians, nurses and students in the health professions; scientific and medical journals; textbooks; and educational products. This resource center will also feature original commentary from our clinicians.
Updated on 25 June 2019
The 3D animations Naloxone Mechanism of Action and Neurochemistry of Addiction: An Epidemic of Heroin Use and the Role of Naloxone are a part of the Elsevier Animation Library. They are created by Elsevier’s Multimedia Group in collaboration with the Clinical Solutions department.
Infographic: The Opioid Epidemic in America
The past 50 years have seen a growing epidemic of opioid addiction and abuse emerge in the United States; in 2015 alone, opioid medications, both legal and illegal, caused over 30,000 fatalities, triple the number of overdoses reported the entire 15 years prior.
Both opioids and the current epidemic have long been a focus of scientific research. With Scopus data from 2011-16, Elsevier's Research Intelligence team used SciVal to analyze scholarly output, research impact, trending topics, and top researchers on both topics. You can view the infographic below and find further information and data here.
- Evidence-Based Guidance: A Critical Strategy in the War Against Opioid Addiction Read and download Elsevier's white paper (Clinical Solutions Insights)
- Opioid Prescribing Rates Drop in Wake of CDC Guidelines, by Leslie Dye, MD (ClinicalKey blog)
- Education is the key to stop opioid abuse, by Leslie Dye, MD (Medical Economics blog)
- Elsevier’s Dr. Leslie Dye on recognizing addiction — and using technology to get health professionals the information they need at the point of care (Elsevier Connect)
- Q&A with Dr. David Neal: Is a "disease-free" world within reach? (Elsevier Connect)
Organ donation after overdose death
Is it time to have those at high risk for opioid overdose sign an organ donation card when prescribing naloxone?
By Leslie Dye, MD | 25 June 2019
While the news seems to focus on the next presidential election or the newest political scandal, people continue to die from overdoses across the United States. It is hard to imagine a positive side to the opioid epidemic, but this study does find one.
Published by the Society of Thoracic Surgeons, the information looks at hearts available for donation from overdose deaths. The data were obtained from adult cardiac transplants from 2010 to 2017, excluding hearts used in multiple-organ transplantations; therefore, data include transplanted hearts in patients who received a heart with no other organs. The donors analyzed in this paper died from overdose. While the authors did not examine the specific drugs used by the patients who overdosed, the increase in overdose deaths corresponds with the rise in opioid use and related deaths. One can infer that many of the deaths, and therefore those hearts available for donation, resulted from opioid toxicity; however, this was not conclusively proven.
Despite advances in medicine overall, including circulatory support and transplant surgery, there continues to be a limited supply of hearts for those in need of transplantation. The best donor candidates are those who are younger and whose hearts are donated after brain death, which are criteria that often apply to victims of death from overdose. One of the main concerns in using organs from this population is the concomitant presence of infections related to intravenous drug use, like hepatitis C virus (HCV), and subsequent transmission to the recipient. However, recipients of a heart from a donor with HCV do not always contract the virus; if they do, they can be successfully treated. For many, the alternative to refusing the infected heart is death. Often, hearts are transplanted even though the donor is HCV positive.
This study looked at two different groups of hearts from overdose deaths that were available for donation: the hearts placed in recipients and the discarded hearts. Compared with donors who did not overdose, donors who did overdose were more frequently younger than 40 years, white and more likely to have a history of cocaine use. The overdose-victim donors were more frequently positive for HCV; however, they were less likely to have diabetes or hypertension. The stroke rates after transplantation were similar in both groups, as were hospital stay length and overall survival rate.
The discarded hearts from overdose deaths were more frequently positive for HCV; however, there were limitations in the analysis of the discarded hearts, as detailed information was only provided for instances in which at least one other organ was transplanted. Approximately 20 percent to 46 percent of intravenous drug users are HCV positive within 5 years. While there are no long-term studies of HCV and HIV in patients after transplantation of hepatitis C–positive hearts, it is likely that the restrictions on transplanting these organs may continue to be relaxed as the demand for donated hearts increases.
From 2010 to 2017, 10.8 percent of the heart transplants from adult donors were from overdose victims. The number continues to increase as the opioid epidemic worsens. It is estimated that donated hearts from overdose deaths have provided over 4,000 post-transplant years of life to recipients since 2010.
While it is hard to find a silver lining in something as tragic as the opioid epidemic, perhaps this is it. As we prescribe naloxone to those at high risk for opioid overdose so those near them can administer this life-saving antidote, should we also ask them to sign an organ donation card? While that sounds cruel, it may allow something good to result from this ongoing tragedy.
Are emergency responders at risk from Fentanyl exposure?
By Leslie Dye, MD | 22 January 2018
There has been recent press about emergency responders being exposed to fentanyl with adverse effects. However, skin exposure is unlikely to result in toxicity. Using gloves is generally the only protection required. All responders should be educated about the signs of opioid toxicity and the use of naloxone. This topic is addressed by a position statement from the American College of Medical Toxicology.
Fentanyl's role in the opioid crisis
By Leslie Dye, MD | 13 December 2017
Fentanyl is a synthetic opioid that is 50 times more potent than heroin and 100 times more potent than morphine. It is legally prescribed, usually for those with severe cancer-related pain. An intravenous form is used in the operating room and other controlled medical environments for pain relief during procedures.
Unfortunately, most of the heroin in the US has varied amounts of fentanyl mixed with it, and some may be peddled as heroin yet contain only fentanyl. The fentanyl misused is illegally obtained and often illegally produced. Regrettably, it is relatively easy to make.
The purpose of adding fentanyl is to increase the high from the drug. As many users are unaware that the products contain fentanyl, when they use the “normal” dose of heroin, overdose and death often occur. In addition, reversal of the drug’s effects may require much higher doses of naloxone.
The CDC website is a good source for information on fentanyl. There are also articles in The International Journal of Drug Policy, the Journal of Substance Abuse Treatment, and Research in Social and Administrative Pharmacy in the Access to research section below.
Elsevier has a variety of resources that provide evidence-based clinical guidelines at the point of care:
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Clinical Overviews on ClinicalKey
Clinical Overviews are easy-to-scan, clinically focused medical topic summaries designed to match the clinician workflow. They will replace the most frequently searched and used First Consult topics on ClinicalKey, and they have been added as a new content type on ClinicalKey for Nursing. Elsevier's Point-of-Care Editorial team develops Clinical Overviews through a process that includes review and revision by a medical editor; peer reviews performed by subject matter experts; a production review to ensure consistency in style, grammar, and punctuation; and a final evaluation by the editor-in-chief.
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- Opioid Overdose
- Opioid Withdrawal
- What You Need to Know About Opioid Prescription Pain Medicine
- Pain Medicine Instructions
The following videos were created by our video medication education partner, VUCA Health.
How to use Narcan nasal spray
Opioid medicines — risks, side effects and safety steps
Opioid medicines — How to recognized warning signs of abuse
Access to research
These papers have been carefully selected by Elsevier’s journal teams and made freely available.
- Prescription opioids prior to injection drug use: Comparisons and public health implications
- The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence — An assessment of demographic and substance use trends, United States, 2003–2014
- Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014
- Medical and nonmedical use of prescription sedatives and anxiolytics: Adolescents' use and substance use disorder symptoms in adulthood
- Trends in average days' supply of opioid medications in Medicaid and commercial insurance
- Association of childhood abuse and prescription opioid use in early adulthood
- Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain
- Non-medical opioid use in youth: Gender differences in risk factors and prevalence
Addictive Behaviors Reports
American Journal of Preventive Medicine
- Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates
- Addressing the Nation’s Opioid Epidemic: Lessons from an Unsanctioned Supervised Injection Site in the U.S.
- The Benefits and Potential Drawbacks in the Approval of EVZIO for Lay Reversal of Opioid Overdose
- Emergency Department Visits and Overdose Deaths From Combined Use of Opioids and Benzodiazepines
- Trends in the Concomitant Prescribing of Opioids and Benzodiazepines, 2002−2014
Annals of Epidemiology
- Opioid Dosing Trends over Eight Years Among US Veterans with Musculoskeletal Disorders after Returning from Service in Support of Recent Conflicts (September 2017)
- Emergency Department Utilization and Subsequent Prescription Drug Overdose Death (August 2015)
- Associations of Place Characteristics with HIV and HCV Risk Behaviors Among Racial/Ethnic Groups of People who Inject Drugs in the United States (September 2016)
Annals of Thoracic Surgery
- Impact of the Opioid Epidemic on Heart Transplantation: Donor Characteristics and Organ Discard (June 2019)
Archives of Physical Medicine and Rehabilitation
- Decreasing Opioid Utilization in Rehabilitation Patients Using a Clinical Nurse Specialist Pain Consultant Program (June 2017)
- Less Exercise and More Drugs: How a Low-Income Population Manages Chronic Pain (November 2017)
Archives of Psychiatric Nursing
- Comparison of Outcomes of Illicit Drug Users and Nonusers Hospitalized With Heart Failure
- Racial susceptibility for QT prolongation in acute drug overdoses
- Genome-wide Association Study Identifies a Regulatory Variant of RGMA Associated With Opioid Dependence in European Americans (January 2018)
Brain Research Bulletin
- Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature (September 2016)
Kratom, a plant that is available over the counter and on the internet, is chewed, smoked or consumed as a tea. The substance has both stimulant and opioid-like effects and is used by many to self-treat pain and opioid withdrawal. Dependence occurs with long term use. The FDA recently warned consumers that Kratom should not be used to treat opioid withdrawal and re-classification is being considered. — Leslie Dye, MD
Disability and Health Journal
- Recent trends in substance abuse among persons with disabilities compared to that of persons without disabilities (April 2013)
Explore: The Journal of Science and Healing
- America’s Deadly Opioid Epidemic From Which Everyone But the Users Profits (July-August 2017)
The Journal for Nurse Practitioners
- Acute Pain Management in Opioid-tolerant Individuals
- Opioid-induced Constipation
- Safe Opioid Prescribing for Adults by Nurse Practitioners: Part 1. Patient History and Assessment Standards and Techniques
- Safe Opioid Prescribing for Adults by Nurse Practitioners: Part 2. Implementing and Managing Treatment
The International Journal of Drug Policy
- US Heroin in Transition: Supply Changes, Fentanyl Adulteration and Consequences (Special Edition: August 2017)
Journal of the American Academy of Child & Adolescent Psychiatry
Journal of the American Pharmacists Association
- Demonstrated value in the public health arena: Pharmacist roles in addressing the current opioid crisis (September-October 2017)
- Opioid dispensing and overlap in veterans with non-cancer pain eligible for Medicare Part D (May-June 2017)
- Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone (March-April 2017)
- A nationwide pharmacy chain responds to the opioid epidemic (March-April 2017)
- An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills (March-April 2017)
- Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015 (March-April 2017)
- Opioid exit plan: A pharmacist's role in managing acute postoperative pain (March-April 2017)
- Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program (March-April 2017)
- Opioids, naloxone, and beyond: The intersection of medication safety, public health, and pharmacy (March-April 2017)
- Pharmacists' readiness to provide naloxone in community pharmacies in West Virginia (March-April 2017)
- Pharmacists’ role in opioid overdose: Kentucky pharmacists’ willingness to participate in naloxone dispensing (March-April 2017)
- Strategies and policies to address the opioid epidemic: A case study of Ohio (March-April 2017)
- The development and feasibility of a pharmacy-delivered opioid intervention in the emergency department (March-April 2017)
- The impact of pharmacy services on opioid prescribing in dental practice (March-April 2017)
- Prescription opioid use: Patient characteristics and misuse in community pharmacy (May-June 2016)
Journal of Substance Abuse Treatment
- Prevalence of restless legs syndrome during detoxification from alcohol and opioids (February 2017)
- Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement (February 2017)
- Buprenorphine prescribing practice trends and attitudes among New York providers (March 2017)
- Drug safety and adverse drug reaction reporting behavior related to outpatient opioid replacement therapy: Results from a survey among physicians (March 2017)
- Long-term retention in Office Based Opioid Treatment with buprenorphine (March 2017)
- Characterizing fentanyl use in methadone-maintained clients (April 2017)
- Retention in buprenorphine treatment is associated with improved HCV care outcomes (April 2017)
- Onsite treatment of HCV infection with direct acting antivirals within an opioid treatment program (April 2017)
- Urine drug testing results and paired oral fluid comparison from patients enrolled in long-term medication-assisted treatment in Tennessee (May 2017)
- Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region (May 2017)
- Examination of the Hepatitis C Virus care continuum among individuals with an opioid use disorder in substance use treatment (May 2017)
- Chronic pain among patients with opioid use disorder: Results from electronic health records data (June 2017)
- Past-year prevalence of prescription opioid misuse among those 11 to 30 years of age in the United States: A systematic review and meta-analysis (June 2017)
- Factors associated with ongoing criminal engagement while in opioid maintenance treatment (June 2017)
- Mortality trends among heroin users treated between 1975 and 2013 in Northern Italy: Results of a longitudinal study (June 2017)
- Coping with the enduring unpredictability of opioid addiction: An investigation of a novel family-focused peer-support organization (June 2017)
- Beliefs about the consequences of using benzodiazepines among persons with opioid use disorder (June 2017)
- Why aren't physicians prescribing more buprenorphine? (July 2017)
- Pharmacokinetics and pharmacodynamics of a buprenorphine subcutaneous depot formulation (CAM2038) for once-weekly dosing in patients with opioid use disorder (July 2017)
- The relationship between diversion-related attitudes and sharing and selling buprenorphine (July 2017)
- Baseline risk factors for drug use among African-American patients during first-month induction/stabilization on methadone (July 2017)
- Addiction consultation services – Linking hospitalized patients to outpatient addiction treatment (August 2017)
- Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine (August 2017)
- A naturalistic study of predictors of retention in treatment among emerging adults entering first buprenorphine maintenance treatment for opioid use disorders (September 2017)
- Association of methadone dose with substance use and treatment retention in pregnant and postpartum women with opioid use disorder (September 2017)
- Use of on-site detoxification services co-located with a supervised injection facility (November 2017)
- Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance (November 2017)
- Experiences of three states implementing the Medicaid health home model to address opioid use disorder — Case studies in Maryland, Rhode Island, and Vermont (December 2017)
- Factors associated with naloxone administration in an opioid dependent sample (January 2018)
- Trump administration begins to confront the opioid crisis (November 2017)
- The opioid crisis in the USA: a public health emergency (November 2017)
- Avoiding globalisation of the prescription opioid epidemic
- Untangling the web of opioid addictions in the USA
- Addressing addiction in the USA
- How the paediatric workforce can address the opioid crisis
- Self-medicating in the opioid crisis
- Addressing opioid drug misuse in America
- Addiction treatment in the USA: signs of change
The Lancet Gastroenterology & Hepatology
The Lancet Global Health
- Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study
- Prevalence of drug and alcohol use in urban Afghanistan: epidemiological data from the Afghanistan National Urban Drug Use Study (ANUDUS)
The Lancet HIV
- HIV and the criminalisation of drug use among people who inject drugs: a systematic review (August 2017)
- Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study (May 2017)
- HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial (October 2016)
- Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study (October 2015)
The Lancet Infectious Diseases
The Lancet Oncology
- From Jan 2016, Barriers to access to opioid medicines: a review of national legislation and regulations of 11 central and eastern European countries
The Lancet Psychiatry
- Changes in substance use in patients receiving opioid substitution therapy and resulting clinical challenges: a 17-year treatment case register analysis (February 2017)
- Alcohol problems need more attention in patients receiving long-term opioid substitution therapy (February 2017)
The Lancet Public Health
- Effects of naloxone distribution alone or in combination with addiction treatment with or without pre-exposure prophylaxis for HIV prevention in people who inject drugs: a cost-effectiveness modelling study
- Value for money in reducing opioid-related deaths
Nursing Outlook (the journal of the American Academy of Nursing)
- Opioid misuse epidemic: Addressing opioid prescribing and organization initiatives for holistic, safe and compassionate care
- The use of cannabis in response to the opioid crisis: A review of the literature
- Answering the call to address chronic pain in the military service members and veterans: Progress in improving pain care and restoring health
- State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states
Research in Social and Administrative Pharmacy
- Investigation of hospital opioid prescribing among opioid-naïve surgical patients (July-August 2017)
- Elimination of fentanyl patch use in opioid naïve patients in the outpatient environment (July-August 2017)
- Double threat: Concurrent use of opioids and benzodiazepines (July-August 2017)
- Fighting back addiction: Assessing the use of medication assisted treatment for opioid addiction (July-August 2017)
- Comparison of opioid safety measures to predict overdose (July-August 2017)
- Behavioral, mental, and physical health characteristics and opioid medication misuse among community pharmacy patients: A latent class analysis (November 2016)
- Developing a framework of care for opioid medication misuse in community pharmacy (March-April 2016)
- A pilot study assessing the frequency and complexity of methadone tapers for opioid abstinence syndrome in children discharged to home (October 2012)
In the media
- Walmart offers way to turn leftover opioids into useless gel (The Columbus Dispatch, January 17, 2018)
- Addiction Inc: Marketing wizards and urine-testing millionaires: Inside the lucrative business of America’s opioid crisis (The New York Times, January 2, 2018)
- It's far more than overdoses: IV opioid users' diseases overwhelm hospitals (USA Today, November 8, 2017)
- Pharmacies, PBMs, insurers call for opioid prescription policy changes (Modern Healthcare, November 8, 2017)
- Opioid basics (CDC)
- Prescription Opioid Overdose Data (CDC)
- Opioid epidemic toolkit (American Hospital Association - AHA)
- Treatment of opioid dependence (World Health Organization)
- Safety issues regarding prescription opioids (American College of Medical Toxicology)
- The Opioid Epidemic in America (Research Intelligence, Elsevier)