fentanyl citrate / Generic mfg. - LARVOL DELTA

Naloxone and Buprenorphine Treatment for Adolescent Opioid Overdose and Opioid Use Disorder: A Review. (PubMed, JAMA Pediatr) - "The ongoing opioid-related overdose crisis in the US is increasingly affecting adolescents and is exacerbated by the widespread availability of illicitly manufactured fentanyl...Despite these changes, adolescents continue to have low access to these life-saving interventions. Ensuring that clinicians have the knowledge to provide both medications to adolescents is a key step to addressing the epidemic of adolescent drug overdoses and reducing opioid-related harms."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Substance Abuse

Induction strategies for preventing hemodynamic changes after intubation in non-cardiac surgery patients: a network meta-analysis of randomized controlled trials. (PubMed, Front Med (Lausanne)) - "According to the surface under the cumulative ranking curve, Oxycodone-Propofol-Lidocaine (87.4%) demonstrated superior efficacy in controlling fluctuations in MAP, followed by Fentanyl-Propofol-Dexmedetomidine (82.9%) and Fentanyl-Propofol-Clonidine (81.6%). Fen-Pro-Dex (94.8%) demonstrated superior efficacy in controlling fluctuations in HR, followed by Fentanyl-Propofol-Lidocaine (Epidural) (83.3%), Fentanyl-Propofol-Remifentanil (79.1%)...These findings may help guide the selection of induction pharmacological strategies, although more randomized controlled trials are needed to confirm these results and clarify optimal dosing. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024591333, identifier CRD42024591333."

Intubation • Journal • Retrospective data • Review • Anesthesia • Cardiovascular

Xylazine Use in Pregnancy: A Case Report and Narrative Review. (PubMed, J Addict Med) - "We present the case of a 25-year-old woman (G4P2113) with opioid use disorder who unknowingly used fentanyl adulterated with xylazine throughout pregnancy...We discuss management considerations for pregnant patients using xylazine-adulterated opioids, including challenges in diagnosis, withdrawal management, and the need for expanded harm-reduction strategies. This case and review highlight the urgent need for surveillance and evidence-based protocols to address xylazine in the perinatal setting."

Journal • Addiction (Opioid and Alcohol) • Anesthesia • Cardiovascular • CNS Disorders • Critical care • Depression • Gynecology • Hematological Disorders • Obstetrics • Psychiatry • Substance Abuse

Improving drug identification in overdose death surveillance by using clinical natural language processing models. (PubMed, J Forensic Sci) - "The rising rate of drug-related deaths in the United States, largely driven by fentanyl, requires timely and accurate surveillance...NLP models, particularly fine-tuned clinical variants like BioClinicalBERT, offer a highly accurate and scalable solution for overdose death classification from free-text reports. These methods can significantly accelerate surveillance workflows, overcoming the limitations of manual ICD-10 coding and supporting near real-time detection of emerging substance use trends."

Journal • Addiction (Opioid and Alcohol)

Assessing the real-world performance of xylazine test strips for community-based drug checking in Los Angeles. (PubMed, Harm Reduct J) - "In our sample, with a large percentage of low concentration xylazine samples, "first generation" Wisebatch XTS had a relatively low sensitivity, but higher specificity. This highlights the value of confirmatory testing and the complicated and often confusing nature of point-of-care test strips for novel substance detection. Lot testing and validation studies are needed to improve quality control in this area."

Journal • Real-world evidence

The prediction model of the prolonged length of stay in chronic acalculous cholecystitis patients after cholecystectomy and nursing recommendations. (PubMed, Asian Nurs Res (Korean Soc Nurs Sci)) - "The nomogram model, based on age, calcium, fentanyl, ciprofloxacin, and MLD, demonstrated moderate discrimination capacity in predictive PLOS in CAC patients after cholecystectomy. These findings may support the identification of at-risk patients and inform early nursing interventions."

Journal • Critical care • Gastroenterology • Hepatology

Fentanyl as an induction agent for tracheal intubation in critically ill patients: a systematic review and meta-analysis. (PubMed, J Intensive Care) - "The effect of fentanyl on peri-intubation cardiovascular instability remains highly uncertain, with pooled estimates compatible with substantial harm, substantial benefit, or no effect. Current randomized evidence is insufficient to guide routine clinical practice, given their very low or low certainty and susceptibility to random error."

Intubation • Journal • Retrospective data • Cardiovascular • Hypotension

PAIN MANAGEMENT PRACTICES DURING PAEDIATRIC ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION: A RETROSPECTIVE COHORT STUDY (EBMT 2026) - "During days 1–30, median duration of opioid use was 18 days (IQR 9–25) for morphine, 11 days (IQR 4–19) for fentanyl, and 2 days (IQR 1–4) for oxycodone...Common adjuvant agents included ketamine (112/190, 59.0%; median 10 days, IQR 4–15.5) and gabapentin (35/190, 18.4%; median 12 days, IQR 0–22).Although most pain assessments indicated no or mild pain (88%), 137 children (72%) experienced at least one episode of severe pain... Children undergoing HSCT experience a substantial and enduring pain burden requiring complex multimodal analgesia, with severe pain episodes remaining common despite widespread pharmacological and supportive care use. Specialist pain and palliative care services were accessed in a subset of patients and were often initiated later in the transplant course. These findings provide important real-world evidence of current pain management practices during paediatric HSCT and identify opportunities to optimise the timing, coordination, and..."

Retrospective data • Acute Myelogenous Leukemia • Bone Marrow Transplantation • Hematological Malignancies • Leukemia • Mucositis • Pain • Palliative care • Pediatrics • Transplantation

PAIN MANAGEMENT WITH NARCOTIC INFUSION IN PEDIATRIC HEMATOPOIETIC STEM CELL TRANSPLANTATION: A SINGLE-CENTER RETROSPECTIVE STUDY (EBMT 2026) - "Infusion was discontinued in one patient due to tampering with the infusion pump.Switching from morphine to fentanyl infusion was required in fifteen patients, primarily due to uncontrolled pain (n=9) or pruritus (n=4). Only two patients required the addition of ketamine infusion for refractory pain.The median time to initiation of narcotic infusion was 5 days post-transplant (range: 2–580 days), and the median duration of infusion was 8 days (range: 3–35 days). Mucositis was the most prevalent cause of pain during the post-transplant period in pediatric HSCT recipients. Narcotic infusion proved to be a safe and well-tolerated strategy for pain management, with a low incidence of significant adverse effects and no life-threatening complications observed."

Retrospective data • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Aplastic Anemia • Bone Marrow Transplantation • Dermatology • Eye Cancer • Hematological Malignancies • Hemophagocytic lymphohistiocytosis • Immunology • Leukemia • Lymphoma • Mucositis • Musculoskeletal Pain • Myelodysplastic Syndrome • Neuroblastoma • Pain • Pediatrics • Primary Immunodeficiency • Pruritus • Rare Diseases • Retinal Disorders • Retinoblastoma • Solid Tumor • Transplantation

Machine learning-driven sedation-analgesia optimization in mechanically ventilated sepsis patients: a retrospective MIMIC-IV analysis. (PubMed, Front Pharmacol) - "The concurrent administration of fentanyl and midazolam was associated with lower ICU mortality and shorter length of ICU stay among septic patients necessitating endotracheal intubation and invasive mechanical ventilation, suggesting potential clinical benefit. Furthermore, the LightGBM algorithm exhibited superior predictive accuracy for ICU mortality within this cohort, suggesting its potential utility as a tool for supporting data-driven clinical decision-making."

Journal • Retrospective data • Acute Kidney Injury • Anesthesia • Critical care • Infectious Disease • Renal Disease • Septic Shock

Dopamine signatures of excessive and compulsive cocaine and fentanyl use. (PubMed, bioRxiv) - "To identify common principles underlying these observations, we developed a computational model grounded in an Actor-Critic temporal-difference (TD) learning framework that incorporates internal states, agent's uncertainty, and drug-specific effects. Remarkably, this model captures the observed diversity in DA dynamics across drug classes and among mice with variable drug taking propensities, hereby providing a unified interpretation of NAc DA signals as encoding TD reward prediction errors."

Journal

Fentanyl decreases blood oxygen more than furanylfentanyl despite similar effects on breathing. (PubMed, Res Sq) - "The discrepancy between effects on breathing and oxygen saturation may be explained by a greater number of apneas induced by fentanyl. These results highlight the complexity of fentanyl-induced respiratory depression and indicate that recreational use of 2-furanylfentanyl in humans may pose a greater risk of overdose than morphine but lesser than fentanyl."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Psychiatry

An engineered nanobody inhibitor for molecular-to-circuit control of opioid receptor function. (PubMed, bioRxiv) - "Cell-type-specific expression of Nb64 in VTA interneurons attenuates fentanyl-evoked dopamine release and behavioral responses in mice, demonstrating targeted control of opioid actions in vivo. Nb64 provides a versatile strategy for dissecting OR biology and establishes a generalizable framework for precision inhibition of native GPCR signaling in vivo."

Journal • Addiction (Opioid and Alcohol) • Pain

Navigating an Unpredictable Supply: Lived Experiences of Xylazine Exposure Among People Who Use Drugs. (PubMed, Res Sq) - "Syringe service program clients in Massachusetts commonly reported xylazine-adulterated fentanyl exposure, recognized through heavy sedation and skin wounds. Their experiences highlight the urgent need for real-time xylazine detection, safer supply, overdose and sedation risk mitigation, and improved wound prevention and care."

Journal • Addiction (Opioid and Alcohol) • Anesthesia

Charting the Decline of the Fourth Wave: US Overdose Deaths by Race, Geography, and Substance Involvement. (PubMed, medRxiv) - "Decreases reflected declining illicit fentanyl-involved deaths (with and without stimulants); however, increasing trends through 2024 were still seen in deaths involving stimulants without fentanyl, and those involving xylazine...The geography of the overdose crisis has shifted, with the West now the most affected region, which may have implications for the targeting of funding. The nature of the crisis is also shifting, as stimulants and xylazine continue to represent increasingly important public health challenges, and renewed attention to nonfatal aspects of addiction in the US is needed."

Journal • CNS Disorders • Psychiatry

Intranasal naloxone reversal of opioid-induced respiratory depression in opioid-naïve individuals and self-reported daily opioid users. (PubMed, Anesthesiology) - "A single Narcan® dose reversed moderate fentanyl- and sufentanil-induced respiratory depression, though effectiveness varied by endpoint and opioid receptor affinity. Rapid V̇E-recovery suggests clinical utility of intranasal naloxone, but delayed and sometimes incomplete recovery of end-tidal pCO2, particularly during exposure to the high-affinity opioid sufentanil, indicating reversal inefficacy and persistence of respiratory instability. Further studies are needed to address optimal naloxone doses and alternative formulations to address high-dose potent opioid threats."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Mood Disorders • Psychiatry

General Anesthesia With Remimazolam in Fontan Procedure: A Case Report. (PubMed, A A Pract) - "We present a 2-year-old boy with a single-right ventricle and pulmonary valve stenosis who underwent the Fontan procedure under anesthesia with remimazolam (3-8 mg kg-1 h-1) and fentanyl (21.8 μg/kg). Hemodynamics remained stable under electroencephalographic monitoring, and the patient was extubated in the operating room without any complications. Therefore, remimazolam may be a feasible sedative option during the Fontan procedure."

Journal • Anesthesia • CNS Disorders • Depression • Psychiatry

Prevalence of Illicit Drug Detection in 5 US Cities Among Out-of-Treatment People Who Inject Drugs. (PubMed, JAMA Netw Open) - "In all, 414 participants (93.2%) tested positive for fentanyl, 328 (73.9%) for cocaine, 299 (67.3%) for amphetamine-type stimulants, and 234 (52.7%) for xylazine. This cross-sectional study found widespread fentanyl and polysubstance detection, with rising xylazine and stimulant detection that varied by sociodemographic and structural vulnerabilities and may be due to adulteration within the unregulated drug supply. These findings highlight urgent public health needs for real-time drug supply surveillance, targeted harm-reduction services, and integrated treatment approaches to reduce overdose risk and address social and structural vulnerabilities."

Clinical • Journal • Addiction (Opioid and Alcohol) • Human Immunodeficiency Virus • Infectious Disease

Impact of Anesthesia on Otoacoustic Emissions and Blood Oxygen Saturation in Rats (ARO 2026) - "Anesthesia was successively induced using i.p. administration of either Zoletil/Xylazine 20-40/3.5-5 mg/kg or Fentanyl/Midazolam/Medetomidine 0.005/2.0/0.15 mg/kg. These data suggest that DPOAEs and SFOAEs are highly sensitive to blood oxygen saturation and middle ear transmission. The Zoletil-Xylazine mixture seems better suited for this aging model. The choice of the anesthetics appears to have a significant, direct impact on the amplitude and the stability of these measurements and should be carefully determined for each animal model, perhaps depending on the sex and the age of the species, to facilitate analysis and comparison over time and across experimental groups."

Preclinical • Alzheimer's Disease • Anesthesia • CNS Disorders • Dementia • Otorhinolaryngology

Pt single-atom catalyst-Enhanced aerogenous reaction for pressure signal-based immunochromatographic test strip. (PubMed, Talanta) - "Fentanyl in urine, saliva, and electronic cigarette liquid was detected with recoveries of 82.10 %-117.5 %, verifying its reliability for real sample detection. It is a pioneer work for usage of SAC in boosting aerogenous reaction for pressure sensing, and opens a pathway for field screening of abused drug."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Psychiatry • CAT

Ketamine as primary anesthetic for upper limb trauma during war: a case series of 100 surgeries at Rafik Hariri University Hospital, Lebanon's National War Trauma Referral Center. (PubMed, Future Sci OA) - "Patients initially received fentanyl intraoperatively and opioids postoperatively. Ketamine was associated with significantly lower VAS scores (3.2 vs 7.8; p < 0.001), no respiratory complications (0 vs 18 cases), stable mean arterial pressure in 94% of patients, and reduced postoperative opioid use (5% vs 65%). Ketamine is a safe, effective, opioid-sparing anesthetic and should be prioritized in conflict and resource-limited trauma settings."

Journal • Anesthesia • Mood Disorders • Pain

Repeated fentanyl abstinence intensifies opioid withdrawal and induces a proinflammatory state in striatal microglia. (PubMed, Psychopharmacology (Berl)) - "Together these results suggest that mouse striatal microglia initiate a proinflammatory response following five, but not one, opioid exposure and withdrawal experiences and suggest that drug therapies targeting microglial innate immune responses may mitigate the severe withdrawal associated with repeated opioid tolerance and withdrawal."

Journal • Inflammation

Potentiation of fentanyl-induced respiratory depression by alcohol is not fully reversed by naloxone. (PubMed, JCI Insight) - "Fentanyl-dependent rats were partially tolerant to fentanyl- and fentanyl+alcohol-induced respiratory depression, but alcohol-dependent rats exhibited sensitization to alcohol- and fentanyl+alcohol-induced apnea. These findings highlight physiological parameters of severe respiratory risks with fentanyl+alcohol co-use, which are inadequately reversed by naloxone, underscoring the need for targeted strategies to manage opioid+alcohol overdoses."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Mood Disorders • Psychiatry

Neurologic Complications of Drug and Alcohol Use. (PubMed, Continuum (Minneap Minn)) - "Substance use and overdose mortality, largely associated with fentanyl, rose sharply during the COVID-19 pandemic...The use of cannabis and hallucinogens is rising as more states legalize or decriminalize their use, and some studies suggest an independent association between cannabis use and ischemic stroke. Neurologists often encounter severe complications of substance use and have an opportunity to guide patients with substance use disorders toward treatment."

Journal • Review • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Epilepsy • Infectious Disease • Ischemic stroke • Novel Coronavirus Disease • Psychiatry

Opioid-based versus opioid-sparing patient-controlled analgesia using ketorolac and nefopam after total knee arthroplasty: a randomized, double-blind, non-inferiority trial. (PubMed, Korean J Anesthesiol) - "In this prospective, randomized, double-blind, non-inferiority study, 98 patients undergoing TKA under spinal anesthesia received either opioid-based PCA (continuous infusion of 1200 μg fentanyl, n = 49) or opioid-sparing PCA (continuous infusion of 150 mg ketorolac tromethamine and 100 mg nefopam hydrochloride, n = 49). Nausea and vomiting on POD 1 were more frequent with opioid-based group (34.7% vs. 12.2%, P = 0.009). Opioid-sparing PCA with ketorolac and nefopam provides non-inferior analgesia to opioid-based PCA, while reducing opioid consumption and drug-related adverse effects after TKA."

Clinical • Head-to-Head • Journal • Addiction (Opioid and Alcohol) • Anesthesia • Musculoskeletal Pain • Orthopedics • Pain