How Emergency Departments Could Combat Fentanyl Overdoses

In 2022, Philadelphia reported more than 1,400 overdose deaths, with fentanyl as one of the leading causes. “It’s pretty much impossible to find heroin in Philadelphia anymore — it’s all fentanyl,” says harm reduction researcher Megan Reed, PhD, MPH. In a new study published in Substance Use & Misuse, Dr. Reed and colleagues show that hospitals could be pragmatic, common sense locations to incorporate harm reduction tools.

These tools focus on preventing overdoses, deaths and health complications by promoting safe drug use practices and offering support services for addiction treatment and recovery. “A harm reduction approach doesn’t minimize or diminish the real risks associated with drug use,” says Dr. Reed. “But it also recognizes there are ways that people can be using more safely.”

One harm reduction tool that’s gaining attention is fentanyl test strips. These strips can determine if drugs being sold as heroin or pharmaceutical opioid pills are actually just fentanyl — which is much more potent and more likely to cause an overdose — or if a non-opioid drug such as cocaine is contaminated with fentanyl. While harm reduction organizations often help distribute fentanyl test strips, not all people who use drugs interact with these organizations.

Dr. Reed’s research shows that emergency departments (EDs) could be effective as fentanyl test strip distributors to combat rising overdose rates. She conducted a survey in two EDs that see people who use drugs. She found that most participants were concerned about fentanyl in their drugs, but few had used fentanyl test strips before. Many also reported regular ED visits, making the ED a practical location for test strip distribution.

Dr. Reed says the next step is ensuring the recipients of fentanyl test strips know how to use them. She’s developed an instructional video for the general public, which has been viewed 37,000 times so far. She plans to study the effectiveness of these videos in future studies. She has also created a video for healthcare professionals who are interested in learning how to distribute the test strips.

By Marilyn Perkins

Reassessing Liver Donors Supported by ECMO

Livers are one of the most in-demand organs for transplantation. Despite increasing numbers of transplants occurring annually, there remains a significant organ shortage. In 2021 alone over 13,000 patients were added to the waitlist and over 1,000 patients died awaiting a donor organ. Adam Bodzin, MD, is a transplant surgeon at Jefferson Health and is looking to close the gap by assessing outcomes of patients who received a liver from a donor who was considered high risk, such as a donor who had been on life support.

Extracorporeal membrane oxygenation (ECMO) is a form of life support for patients whose lungs or heart are not functioning correctly. It’s reserved for patients who are suffering a life-threatening illness or injury to the heart and lungs but are otherwise healthy. While ECMO can be lifesaving, the disruption in oxygen circulation may harm other organs. This leads many physicians to consider organ donations from ECMO-supported patients as high risk and are much less likely to transplant these organs.

Reporting in Liver Transplantation, Dr. Bodzin’s team compared the outcomes of patients who had received livers from ECMO-supported donors and non-ECMO-supported donors. They found that there was no significant difference in survival for the recipients from each donor group. This indicates that rarely used livers from ECMO-supported donors may be safe to use for certain patient populations.

Future research can help us better understand the impact of ECMO support on liver function in a larger sample. But Dr. Bodzin hopes that this research might encourage physicians to consider these organs in select cases. “I think that when you get a call about a donor on ECMO, it’s worth considering whether this might be a donor who could work for the right recipient, even though they’re a bit higher risk.”

By Makhari Dysart

Improving Clinical Trial Design with Trauma-informed Interventions for Black Mothers

The numbers are stark: Black women die from pregnancy-related causes at nearly three times the rate of their white counterparts. A Thomas Jefferson University researcher and her colleagues planned to launch a clinical trial to address one aspect of this disparity, cardiovascular disease. But to lay groundwork for that study, the team first sought feedback on the study’s design and implementation from those who would be involved.

Writing in Obstetrics & Gynecology, the team gathered perspectives from patients, community-based providers, medical residents, nurses, support staff, physicians and midwives on the lasting effects of harm they had experienced or witnessed in the healthcare system and in the surrounding community. The study was highlighted by the journal in a podcast and an upcoming special issue on racism in obstetrics.

“Even though we were focused on talking about the intervention in the focus groups, what we really learned the most about was trauma. By dialoguing with them about Black health and birthing, that theme came out very clearly,” says Kirby Wycoff, PsyD, MPH, an associate professor in the Department of Health Sciences and Clinical Practice at Jefferson who led this community engagement project.

Because the researchers, a diverse team that includes community partners and Black birthing people, planned to conduct the trial at Temple University Hospital, they recruited participants who sought or provided care there. In focus groups with 38 people, the team described their plans for the clinical trial, which will assess whether an additional layer of support provided by professionals who primarily identify as Black women can reduce risks for pregnancy-related cardiovascular disease.

Dr. Wycoff and her team organized the participants’ responses into four themes, with trauma emerging as the dominant one. That trauma came from many sources — the historical mistreatment of Black people by the medical establishment, for example, and participants’ experiences of marginalization and violence. Healthcare providers who participated mentioned the strain of the COVID-19 pandemic, and witnessing death and the effects of violence.

With this insight, Dr. Wycoff and her colleagues adjusted their approach to the clinical trial, which is now underway. The changes include using language intended to support those who have experienced trauma, offering support groups for patients and others, and adapting the setting for antiracism training so participants feel safer.

Dr. Wycoff emphasizes that the pervasive trauma they uncovered is not unique. “It’s tough to hear and to read,” she says. “But we expect that this pattern shows up over and over again across the country. It’s high time we invest in developing effective supports to address the pervasive trauma in and around healthcare systems.”

By Wynne Parry