Manini AF

5/ Bottom line: fentanyl still rules, but the “other stuff” — novel benzos, veterinary sedatives, synthetic cannabinoids — is the stealthy threat changing overdose care. Full report: npsdiscovery.org #DrugTrends

The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing View substances detected in samples from patients experiencing a suspected opioid-involved overdose.

4/ Clinically, this underscores why standard opioid panels miss the mark. LC-QTOF-MS detected >1,200 substances, catching dangerous adulterants missed by routine screens. Treatment must anticipate multi-drug toxicity. #EmergencyMedicine
www.cdc.gov/overdose-pre...

3/ Public health takeaway: street drugs are increasingly poly-drug cocktails. Testing found opioids + stimulants + sedatives in the same patient; this complicates outreach, naloxone use, and treatment planning. #OverdosePrevention

Benzodiazepine Co‐Exposure Among Patients Presenting to the Emergency Department With a Confirmed Opioid Overdose Background Simultaneous exposure to both benzodiazepines and opioids can lead to synergistic respiratory depression, complicating overdose management. Our objective was to report on the detection of...

2/ A related Fentalog publication last week in AEM noted how lab-made benzos are reshaping #overdose risk. Our data back it up: bromazolam is showing up in multiple cities — often alongside #fentanyl onlinelibrary.wiley.com/doi/10.1111/...

1/ 🚨 New TOXIC Fentalog quarterly report on multi-city toxicology testing shows fentanyl & other synthetic drugs dominate suspected overdose cases in US ERs. Findings offer a near real-time look at the street drug market. #medsky #PublicHealth 🧵
www.cfsre.org/nps-discover...

Publication: Black patients less likely than white patients to receive outpatient treatment referrals after #opioid #overdose ED visits, per ToxIC Fentalog study. Findings underscore need to address disparities in post-overdose care. ➡️ bit.ly/4l1hFE2
@jamanetworkopen.com @maninialex.bsky.social

🚨Publication Alert🚨 bit.ly/46U3nl6
#Xylazine found in 1 in 5 nonfatal #opioid #overdoses across 10 U.S. EDs, mostly alongside #fentanyl. Exposure highest in NE vs. rare in the West. Regional trends underscore need for targeted public health responses. #MedToxTuesday
@maninialex.bsky.social

🚨Publication Alert🚨These findings focused on the presence of para-fluorofentanyl (PFF) point to important differences in OD response/treatment linked to fentanyl analogs w/ sex-specific effects that merit further investigation. 📖https://bit.ly/3Gv0gp3
@ziadkazzi.bsky.social @maninialex.bsky.social

Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients

Among patients with opioid overdose in emergency departments, Black patients received outpatient referrals less frequently than White patients, with rates of 5.7% versus 9.6%. https://ja.ma/44kiKjO

July 1. Day One.
- You will feel overwhelmed (That’s normal)
- Courage isn't the absence of fear
- Ask for help early and often
- Nobody expects you to know everything
- Efficiency comes with time
- Trust the process
💙 Welcome. We’ve got your back. #InternYear #Medsky

🚨HUGE SCIENCE WIN ALERT🚨

NIH Grants to be restored en masse!!! Thank you Judge Young for standing up for science!

#StandUpforScience
#SummerFightforScience

Tianeptine, or ‘gas station heroin,’ can be addictive and cause serious side effects

WASHINGTON (AP) — Health officials want you to think twice before buying one of those brightly colored little bottles often sold at gas stations, convenience stores and smoke shops. Sometimes called “gas station…

6/
Over the long term, proactive surveillance could shift care from reactive triage to prediction and prevention—offering a model for future responses to dynamic drug crises. #overdoseprevention

Fentanyl Analog Study Fentanyl and its analogs (fentalogs) are increasingly contributing to opioid overdoses and deaths across the United States. Since 2017, ToxIC sites have reported multiple case data of such overdoses i...

5/
Collaboration within the Toxicology Investigators Consortium (ToxIC) ensures a national, multisite approach—boosting generalizability and helping track evolving overdose trends across diverse regions. #toxicology
www.acmt.net/fentanyl-ana...

4/
Clinically, this research will explore whether current naloxone dosing suffices against these potent synthetics. ED docs may need new protocols if higher or novel reversal agents prove necessary. #EDpreparedness

The Fentalog Study: A Subset of Nonfatal Suspected Opioid-Involved Overdoses with Toxicology Testing View substances detected in samples from patients experiencing a suspected opioid-involved overdose.

3/
From a public health lens: amid >108,000 overdose deaths in 2023 and 70 % opioid-related, this study aims to integrate real-time data into the CDC Fentalog Nonfatal OD dashboard—enabling region‑specific alerts and proactive intervention. #publichealthalert
www.cdc.gov/overdose-pre...

newsGP - GPs warned amid ‘worrying spike’ in nitazenes The ‘illicit and dangerous’ synthetic opioid has been found in fake pain medication, as GPs ramp up calls for pill testing to be expanded.

2/
The work sports strong media resonance: outlets are highlighting how fentanyl analogues and ultra-potent nitazenes—often missed by standard tests—are fueling overdose spikes. #medsky #fentanylepidemic
www1.racgp.org.au/newsgp/clini...

Mount Sinai Receives $3.8 Million Grant to Study New Synthetic Drugs and Opioid Overdoses in Emergency Departments to Prevent Deaths

1/
Exciting news: Our team has been awarded a NIDA R01 grant to fund "Fentalog II", a continuation of our groundbreaking collaboration to detect novel fentanyl analogue overdoses in EDs across ten major hospitals over five years. #syntheticopioids
#Medsky 🧵
www.mountsinai.org/about/newsro...

Clinical Factors Associated With Ventricular Dysrhythmia in Emergency Department Patients With Severe QTc Prolongation After Drug Overdose - PubMed In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.

7/
Clinicians: if your overdose patient is bradycardic, acidotic, or in shock and has a QTc ≥500 ms, think ECMO, not observation. #resus #ToxTwitter
pubmed.ncbi.nlm.nih.gov/40492421/

6/
From a public health perspective, these findings underscore the hidden cardiovascular danger of common drugs like diphenhydramine, quetiapine, and loperamide in overdose. #poisonprevention #opioidepidemic

5/
QTc ≥500 ms alone isn’t the full picture. This paper gives clinicians a sharper triage lens: focus on the sickest patients, not just the longest intervals. #EDmedicine #riskstratification

Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs (Published 2016) The opioid epidemic has led to a form of drug abuse that few experts saw coming: the use of Imodium and other anti-diarrhea medications to get high.

4/
This work builds on growing public concern over OTC and Rx misuse. Years ago, @nytimes covered loperamide (“poor man’s methadone”) causing fatal arrhythmias. This study directly validates that risk. #medsky
www.nytimes.com/2016/05/11/h...

3/
All three signs had strong associations with arrest, death, and ECMO need. Absence of all three? 98.2% NPV for dysrhythmia. #FOAMed #toxicology

2/
Only 3.8% of these patients developed ventricular dysrhythmias. But three simple ED findings—bradycardia, acidosis, and shock—were powerful red flags. #clinicaltox #ekgpearls

Clinical Factors Associated With Ventricular Dysrhythmia in Emergency Department Patients With Severe QTc Prolongation After Drug Overdose - PubMed In this large international data registry, we identified predictors of ventricular dysrhythmia in patients presenting to the ED after overdose in the setting of severe QTc prolongation.

1/
Our new study in Academic Emergency Medicine analyzed 1,265 ED patients with severe QTc prolongation (≥500 ms) after drug overdose. What predicts dangerous ventricular dysrhythmias in this high-risk group? #cardiotoxins #overdose
#Medsky 🧵
pubmed.ncbi.nlm.nih.gov/40492421/

NIH staff and biomedical community sound alarm about agency politicization, funding slowdown In test of NIH director’s support of dissent, NIH staff sign Bethesda Declaration urging reversal of grant cuts and freezes

“In an unusual act of public protest, more than 340 scientists and staff at the National Institutes of Health today released a statement charging NIH officials and their superiors with politicizing science.”

www.science.org/content/arti...

#StandUpForScience
#BethesdaDeclaration

Even he agrees with me!
#medsky
abcnews.go.com/amp/Health/r...

Liberate Methadone: An Introduction for the Emergency Medicine Physician - ACEP Now ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an...

Great primer and review of the landscape on Methadone for EM docs and emergency care providers #opioidcrisis #Medsky www.acepnow.com/article/libe...

6/
NIH doesn’t go silent without a reason.
Two weeks of radio silence isn’t just a glitch—it’s a tremor.
Pay attention.

5/
Bottom line:
If you’re waiting on a reissue, planning a resubmission, or coaching a trainee—don’t assume timelines are stable.
Now is the time to email your PO and ask if your anticipated FOA is still on track. Quiet weeks can signal loud changes.