{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:43:12Z","timestamp":1789846992492,"version":"4.0.1"},"reference-count":92,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"State of New Jersey"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The United States continues to be impacted by decades of an opioid misuse epidemic, worsened by the COVID-19 pandemic and by the growing prevalence of highly potent synthetic opioids (HPSO) such as fentanyl. In instances of a toxicity event, first-response administration of reversal medications such as naloxone can be insufficient to fully counteract the effects of HPSO, particularly when there is co-occurring substance use. In an effort to characterize and study this multi-faceted problem, the Camden Opioid Research Initiative (CORI) has been formed. The CORI study has collected and analyzed post-mortem toxicology data from 42 cases of decedents who expired from opioid-related toxicity in the South New Jersey region to characterize substance use profiles. Co-occurring substance use, whether by intent or through possible contamination of the illicit opioid supply, is pervasive among deaths due to opioid toxicity, and evidence of medication-assisted treatment is scarce. Nearly all (98%) of the toxicology cases show the presence of the HPSO, fentanyl, and very few (7%) results detected evidence of medication-assisted treatment for opioid use disorder, such as buprenorphine or methadone, at the time of death. The opioid toxicity reversal drug, naloxone, was detected in 19% of cases, but 100% of cases expressed one or more stimulants, and sedatives including xylazine were detected in 48% of cases. These results showing complex substance use profiles indicate that efforts at mitigating the opioid misuse epidemic must address the complications presented by co-occurring stimulant and other substance use, and reduce barriers to and stigmas of seeking effective medication-assisted treatments.<\/jats:p>","DOI":"10.1371\/journal.pone.0292674","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T17:34:00Z","timestamp":1698860040000},"page":"e0292674","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Postmortem toxicology findings from the Camden Opioid Research Initiative"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8432-9740","authenticated-orcid":true,"given":"Dara M.","family":"Kusic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Heil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Zajic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Brangan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluseun","family":"Dairo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Heil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Feigin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherri","family":"Kacinko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell J.","family":"Buono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas N.","family":"Ferraro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Rafeq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Haroz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlan","family":"Baston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliot","family":"Bodofsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sabia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Salzman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa","family":"Resch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jozef","family":"Madzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Scheinfeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre J.","family":"Issa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2533-0220","authenticated-orcid":true,"given":"Jaroslav","family":"Jelinek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,1]]},"reference":[{"issue":"43","key":"pone.0292674.ref001","first-page":"1487","article-title":"Vital signs: overdoses of prescription opioid pain relievers\u2014United States, 1999\u20132008.","volume":"60","author":"Centers for Disease C, Prevention","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"39","key":"pone.0292674.ref002","first-page":"849","article-title":"Increases in heroin overdose deaths\u201428 States, 2010 to 2012.","volume":"63","author":"RA Rudd","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"34","key":"pone.0292674.ref003","doi-asserted-by":"crossref","first-page":"897","DOI":"10.15585\/mmwr.mm6634a2","article-title":"Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region\u2014United States, 2006\u20132015.","volume":"66","author":"JK O\u2019Donnell","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"pone.0292674.ref004","author":"FB Ahmad","year":"2021"},{"key":"pone.0292674.ref005","doi-asserted-by":"crossref","first-page":"202","DOI":"10.15585\/mmwr.mm7006a4","article-title":"Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths\u2014United States, 2013\u20132019.","volume":"70","author":"CL Mattson","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0292674.ref006","author":"H Hedegaard","year":"2021"},{"key":"pone.0292674.ref007","author":"(NIDA) NIoDA.","year":"2022","journal-title":"Overdose Death Rates"},{"key":"pone.0292674.ref008","article-title":"Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic","author":"CDCP","year":"2020","journal-title":"CDC Health Avisory"},{"issue":"S1","key":"pone.0292674.ref009","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1089\/pop.2020.0230","article-title":"The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020.","volume":"24","author":"JK Niles","year":"2021","journal-title":"Popul Health Manag."},{"issue":"5","key":"pone.0292674.ref010","doi-asserted-by":"crossref","first-page":"e29298","DOI":"10.2196\/29298","article-title":"Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study.","volume":"7","author":"D Khoury","year":"2021","journal-title":"JMIR Public Health Surveill."},{"issue":"14","key":"pone.0292674.ref011","article-title":"Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times.","volume":"19","author":"AT Vo","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0292674.ref012","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s13181-022-00910-6","article-title":"The Toxicology Investigators Consortium Case Registry-the 2021 Annual Report.","volume":"18","author":"JS Love","year":"2022","journal-title":"J Med Toxicol."},{"key":"pone.0292674.ref013","author":"Philadelphia SU.","journal-title":"Unintentional Overdose Deaths"},{"key":"pone.0292674.ref014","article-title":"Fentanyl an increasing barrier to New Jersey battling its opioid crisis","author":"S. Stirling","year":"2022","journal-title":"New Jersey Monitor."},{"key":"pone.0292674.ref015","doi-asserted-by":"crossref","first-page":"918197","DOI":"10.3389\/fpsyt.2022.918197","article-title":"Editorial: A Changing Epidemic and the Rise of Opioid-Stimulant Co-Use.","volume":"13","author":"S Ahmed","year":"2022","journal-title":"Front Psychiatry."},{"key":"pone.0292674.ref016","author":"P. Medicine","year":"2018","journal-title":"Cluster of Cocaine-Fentanyl Overdoses in Philadelphia Underscores Need for More \u201cTest Strips\u201d and Rapid Response"},{"key":"pone.0292674.ref017","author":"Administration USDE","journal-title":"Top Local Drug Threat"},{"issue":"1","key":"pone.0292674.ref018","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12954-018-0240-z","article-title":"Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD.","volume":"15","author":"JN Park","year":"2018","journal-title":"Harm Reduct J"},{"key":"pone.0292674.ref019","first-page":"1","article-title":"Understanding opioid overdose risk and response preparedness among people who use cocaine and other drugs: Mixed-methods findings from a large, multi-city study.","author":"JMW Hughto","year":"2021","journal-title":"Subst Abus."},{"key":"pone.0292674.ref020","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ajem.2020.12.002","article-title":"Fentanyl-contaminated cocaine outbreak with laboratory confirmation in New York City in 2019.","volume":"40","author":"P DiSalvo","year":"2021","journal-title":"Am J Emerg Med."},{"issue":"1","key":"pone.0292674.ref021","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12920-020-00837-3","article-title":"The Genomics of Opioid Addiction Longitudinal Study (GOALS): study design for a prospective evaluation of genetic and non-genetic factors for development of and recovery from opioid use disorder.","volume":"14","author":"J Heil","year":"2021","journal-title":"BMC Med Genomics."},{"issue":"1","key":"pone.0292674.ref022","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1136\/ewjm.172.1.11","article-title":"Toxicology and pathology of deaths related to methadone: retrospective review","volume":"172","author":"SB Karch","year":"2000","journal-title":"West J Med"},{"key":"pone.0292674.ref023","author":"C. Yau","year":"2022","journal-title":"Mann-Whitney-Wilcoxon Test: R Tutorial"},{"key":"pone.0292674.ref024","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.drugalcdep.2018.12.030","article-title":"Co-occurring substance use and mental disorders among adults with opioid use disorder","volume":"197","author":"CM Jones","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0292674.ref025","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/add.15116","article-title":"Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration.","volume":"116","author":"LA Lin","year":"2021","journal-title":"Addiction"},{"key":"pone.0292674.ref026","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.drugalcdep.2019.01.031","article-title":"Polydrug use disorders in individuals with opioid use disorder","volume":"198","author":"AN Hassan","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"pone.0292674.ref027","doi-asserted-by":"crossref","first-page":"244","DOI":"10.2105\/AJPH.2019.305412","article-title":"Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis.","volume":"110","author":"TJ Cicero","year":"2020","journal-title":"Am J Public Health."},{"key":"pone.0292674.ref028","doi-asserted-by":"crossref","first-page":"778992","DOI":"10.3389\/fpsyt.2021.778992","article-title":"A Smartphone-Smartcard Platform for Implementing Contingency Management in Buprenorphine Maintenance Patients With Concurrent Stimulant Use Disorder.","volume":"12","author":"A DeFulio","year":"2021","journal-title":"Front Psychiatry."},{"issue":"3","key":"pone.0292674.ref029","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3109\/15360288.2015.1063559","article-title":"Opioid Analgesics and Nicotine: More Than Blowing Smoke.","volume":"29","author":"JH Yoon","year":"2015","journal-title":"J Pain Palliat Care Pharmacother"},{"issue":"1\u20133","key":"pone.0292674.ref030","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.forsciint.2009.09.019","article-title":"Multidrug poisoning involving nicotine and tramadol.","volume":"194","author":"B Solarino","year":"2010","journal-title":"Forensic Sci Int"},{"issue":"3","key":"pone.0292674.ref031","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1158\/1055-9965.EPI-19-1212","article-title":"Opiate and Tobacco Use and Exposure to Carcinogens and Toxicants in the Golestan Cohort Study","volume":"29","author":"A Etemadi","year":"2020","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"4","key":"pone.0292674.ref032","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s11414-020-09712-6","article-title":"Nicotine and Opioids: a Call for Co-treatment as the Standard of Care.","volume":"47","author":"CD Morris","year":"2020","journal-title":"J Behav Health Serv Res"},{"issue":"2","key":"pone.0292674.ref033","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/00952990.2016.1209513","article-title":"Interactions between nicotine and drugs of abuse: a review of preclinical findings","volume":"43","author":"SJ Kohut","year":"2017","journal-title":"Am J Drug Alcohol Abuse"},{"key":"pone.0292674.ref034","doi-asserted-by":"crossref","first-page":"102845","DOI":"10.1016\/j.drugpo.2020.102845","article-title":"\"I couldn\u2019t live with killing one of my friends or anybody\": A rapid ethnographic study of drug sellers\u2019 use of drug checking.","volume":"87","author":"A Betsos","year":"2021","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0292674.ref035","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/0033354919887741","article-title":"The Emerging Role of Toxic Adulterants in Street Drugs in the US Illicit Opioid Crisis","volume":"135","author":"VM Singh","year":"2020","journal-title":"Public Health Rep"},{"key":"pone.0292674.ref036","author":"Administration DE","year":"2021","journal-title":"2020 National Drug Threat Assessment (NDTA)."},{"issue":"37","key":"pone.0292674.ref037","doi-asserted-by":"crossref","first-page":"12706","DOI":"10.1021\/acs.analchem.2c02057","article-title":"Development of a Graphene-Oxide-Deposited Carbon Electrode for the Rapid and Low-Level Detection of Fentanyl and Derivatives","volume":"94","author":"D Jun","year":"2022","journal-title":"Anal Chem"},{"key":"pone.0292674.ref038","volume-title":"2018 Annual Surveillance Report of Drug-Related Risks and Outcomes\u2014United States.","author":"CDCP","year":"2018"},{"issue":"4","key":"pone.0292674.ref039","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/ajad.13018","article-title":"Case Series: Rapid Induction Onto Long Acting Buprenorphine Injection for High Potency Synthetic Opioid Users.","volume":"29","author":"JJ Mariani","year":"2020","journal-title":"Am J Addict."},{"key":"pone.0292674.ref040","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.drugpo.2019.04.010","article-title":"Fentanyl shock: The changing geography of overdose in the United States","volume":"70","author":"M. Zoorob","year":"2019","journal-title":"Int J Drug Policy"},{"key":"pone.0292674.ref041","author":"DEA","year":"2020","journal-title":"NFLIS-DRUG 2020 ANNUAL REPORT"},{"issue":"8","key":"pone.0292674.ref042","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/BF03016672","article-title":"Serotonin toxicity caused by an interaction between fentanyl and paroxetine","volume":"55","author":"ST Rang","year":"2008","journal-title":"Can J Anaesth"},{"key":"pone.0292674.ref043","volume-title":"Benzodiazepine Toxicity.","author":"M Kang","year":"2022"},{"issue":"1","key":"pone.0292674.ref044","doi-asserted-by":"crossref","first-page":"19","DOI":"10.23907\/2017.003","article-title":"Opioid Toxicity","volume":"7","author":"D. Dolinak","year":"2017","journal-title":"Acad Forensic Pathol"},{"issue":"3","key":"pone.0292674.ref045","first-page":"242","article-title":"Postmortem and Toxicological Findings in a Series of Furanylfentanyl-Related Deaths","volume":"41","author":"D Guerrieri","year":"2017","journal-title":"J Anal Toxicol"},{"key":"pone.0292674.ref046","volume-title":"Prescription of Controlled Substances: Benefits and Risks","author":"CV Preuss","year":"2022"},{"key":"pone.0292674.ref047","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jflm.2018.12.005","article-title":"Metabolism and metabolomics of opiates: A long way of forensic implications to unravel","volume":"61","author":"RJ Dinis-Oliveira","year":"2019","journal-title":"J Forensic Leg Med"},{"key":"pone.0292674.ref048","doi-asserted-by":"crossref","first-page":"108147","DOI":"10.1016\/j.drugalcdep.2020.108147","article-title":"Protracted renal clearance of fentanyl in persons with opioid use disorder","volume":"214","author":"AS Huhn","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"pone.0292674.ref049","doi-asserted-by":"crossref","first-page":"103169","DOI":"10.1016\/j.drugpo.2021.103169","article-title":"An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods.","volume":"93","author":"MK Laing","year":"2021","journal-title":"Int J Drug Policy"},{"issue":"34","key":"pone.0292674.ref050","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.15585\/mmwr.mm7034a2","article-title":"Trends in Nonfatal and Fatal Overdoses Involving Benzodiazepines\u201438 States and the District of Columbia, 2019\u20132020.","volume":"70","author":"S Liu","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"8","key":"pone.0292674.ref051","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1093\/jat\/bkac049","article-title":"Xylazine: Pharmacology Review and Prevalence and Drug Combinations in Forensic Toxicology Casework","volume":"46","author":"SL Kacinko","year":"2022","journal-title":"J Anal Toxicol"},{"issue":"4","key":"pone.0292674.ref052","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1136\/injuryprev-2020-043968","article-title":"Increasing presence of xylazine in heroin and\/or fentanyl deaths, Philadelphia, Pennsylvania, 2010\u20132019.","volume":"27","author":"J Johnson","year":"2021","journal-title":"Inj Prev"},{"key":"pone.0292674.ref053","doi-asserted-by":"crossref","first-page":"109380","DOI":"10.1016\/j.drugalcdep.2022.109380","article-title":"Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis","volume":"233","author":"J Friedman","year":"2022","journal-title":"Drug Alcohol Depend"},{"key":"pone.0292674.ref054","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.cca.2021.07.010","article-title":"High prevalence of xylazine among fentanyl screen-positive urines from hospitalized patients, Philadelphia, 2021","volume":"521","author":"WR Korn","year":"2021","journal-title":"Clin Chim Acta"},{"issue":"2","key":"pone.0292674.ref055","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/fcp.12738","article-title":"Antidepressants abuse in subjects with opioid use disorders: A 10-year study in the French OPPIDUM program","volume":"36","author":"RG Dumonceau","year":"2022","journal-title":"Fundam Clin Pharmacol"},{"issue":"3","key":"pone.0292674.ref056","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.21m14001","article-title":"Association Between Receipt of Antidepressants and Retention in Buprenorphine Treatment for Opioid Use Disorder: A Population-Based Retrospective Cohort Study.","volume":"83","author":"K Zhang","year":"2022","journal-title":"J Clin Psychiatry."},{"issue":"7","key":"pone.0292674.ref057","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1007\/s00213-022-06125-5","article-title":"Treatment of opioid overdose: current approaches and recent advances","volume":"239","author":"SC Britch","year":"2022","journal-title":"Psychopharmacology (Berl)."},{"issue":"3","key":"pone.0292674.ref058","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/add.14033","article-title":"Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study.","volume":"113","author":"R McDonald","year":"2018","journal-title":"Addiction"},{"issue":"1","key":"pone.0292674.ref059","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1177\/2042098617744161","article-title":"Naloxone dosage for opioid reversal: current evidence and clinical implications.","volume":"9","author":"R Rzasa Lynn","year":"2018","journal-title":"Ther Adv Drug Saf"},{"issue":"9","key":"pone.0292674.ref060","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1038\/s41386-019-0368-x","article-title":"Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects","volume":"44","author":"J Johansson","year":"2019","journal-title":"Neuropsychopharmacology"},{"issue":"2","key":"pone.0292674.ref061","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s13346-021-01096-0","article-title":"Naloxone and nalmefene absorption delivered by hollow microneedles compared to intramuscular injection.","volume":"12","author":"MG Papich","year":"2022","journal-title":"Drug Deliv Transl Res"},{"issue":"1","key":"pone.0292674.ref062","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13722-022-00326-1","article-title":"Buprenorphine\/naloxone versus methadone opioid rotation in patients with prescription opioid use disorder and chronic pain: study protocol for a randomized controlled trial","volume":"17","author":"H Ellerbroek","year":"2022","journal-title":"Addict Sci Clin Pract"},{"issue":"1","key":"pone.0292674.ref063","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2018.01.054","article-title":"Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose","volume":"72","author":"FX Scheuermeyer","year":"2018","journal-title":"Ann Emerg Med"},{"key":"pone.0292674.ref064","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.drugpo.2019.01.006","article-title":"Correlates of seeking emergency medical help in the event of an overdose in British Columbia, Canada: Findings from the Take Home Naloxone program.","volume":"71","author":"M Karamouzian","year":"2019","journal-title":"Int J Drug Policy."},{"key":"pone.0292674.ref065","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.drugalcdep.2019.03.014","article-title":"Sociodemographic factors and social determinants associated with toxicology confirmed polysubstance opioid-related deaths","volume":"200","author":"JA Barocas","year":"2019","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"pone.0292674.ref066","doi-asserted-by":"crossref","first-page":"e223821","DOI":"10.1001\/jamanetworkopen.2022.3821","article-title":"Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019","volume":"5","author":"PM Mauro","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"6","key":"pone.0292674.ref067","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1007\/s40263-019-00637-z","article-title":"Buprenorphine Treatment for Opioid Use Disorder: An Overview.","volume":"33","author":"M Shulman","year":"2019","journal-title":"CNS Drugs."},{"issue":"6","key":"pone.0292674.ref068","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1080\/00952990.2018.1461876","article-title":"Characteristics and experiences of buprenorphine-naloxone use among polysubstance users","volume":"44","author":"R Walker","year":"2018","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"1","key":"pone.0292674.ref069","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00952990.2018.1546862","article-title":"Development of a Cascade of Care for responding to the opioid epidemic","volume":"45","author":"AR Williams","year":"2019","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"5","key":"pone.0292674.ref070","first-page":"313","article-title":"Buprenorphine Therapy for Opioid Use Disorder.","volume":"97","author":"R Zoorob","year":"2018","journal-title":"Am Fam Physician."},{"key":"pone.0292674.ref071","volume-title":"Medications for Opioid Use Disorder Save Lives.","author":"M Mancher","year":"2019"},{"issue":"2S Suppl 1):","key":"pone.0292674.ref072","first-page":"1","article-title":"The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update","volume":"14","year":"2020","journal-title":"J Addict Med."},{"issue":"1","key":"pone.0292674.ref073","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.biopsych.2019.06.020","article-title":"Medication Treatment of Opioid Use Disorder","volume":"87","author":"J Bell","year":"2020","journal-title":"Biol Psychiatry"},{"key":"pone.0292674.ref074","first-page":"1","article-title":"Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit.","author":"W Kepner","year":"2022","journal-title":"Subst Use Misuse."},{"key":"pone.0292674.ref075","first-page":"11782218221103859","article-title":"\"You\u2019re Not Supposed to be on it Forever\": Medications to Treat Opioid Use Disorder (MOUD) Related Stigma Among Drug Treatment Providers and People who Use Opioids.","volume":"16","author":"J Dickson-Gomez","year":"2022","journal-title":"Subst Abuse."},{"key":"pone.0292674.ref076","doi-asserted-by":"crossref","first-page":"108828","DOI":"10.1016\/j.jsat.2022.108828","article-title":"Simulating the experience of searching for LGBTQ-specific opioid use disorder treatment in the United States.","volume":"140","author":"MM Paschen-Wolff","year":"2022","journal-title":"J Subst Abuse Treat"},{"key":"pone.0292674.ref077","doi-asserted-by":"crossref","first-page":"103703","DOI":"10.1016\/j.drugpo.2022.103703","article-title":"\u2019Red Flags\u2019 and \u2019Red Tape\u2019: Telehealth and pharmacy-level barriers to buprenorphine in the United States.","volume":"105","author":"L Textor","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0292674.ref078","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13722-022-00313-6","article-title":"Jail-based treatment for opioid use disorder in the era of bail reform: a qualitative study of barriers and facilitators to implementation of a state-wide medication treatment initiative.","volume":"17","author":"N Krawczyk","year":"2022","journal-title":"Addict Sci Clin Pract"},{"issue":"5","key":"pone.0292674.ref079","doi-asserted-by":"crossref","first-page":"e2211363","DOI":"10.1001\/jamanetworkopen.2022.11363","article-title":"Comparative Effectiveness Associated With Buprenorphine and Naltrexone in Opioid Use Disorder and Cooccurring Polysubstance Use","volume":"5","author":"KY Xu","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pone.0292674.ref080","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s13181-020-00795-3","article-title":"Opioid Overdose Deaths with Buprenorphine Detected in Postmortem Toxicology: a Retrospective Analysis","volume":"17","author":"RS Wightman","year":"2021","journal-title":"J Med Toxicol"},{"key":"pone.0292674.ref081","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jsat.2019.10.005","article-title":"Association between methamphetamine use and retention among patients with opioid use disorders treated with buprenorphine.","volume":"109","author":"JI Tsui","year":"2020","journal-title":"J Subst Abuse Treat"},{"key":"pone.0292674.ref082","article-title":"Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study.","author":"M Burns","year":"2022","journal-title":"Addiction"},{"issue":"1","key":"pone.0292674.ref083","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4103\/0976-3147.91934","article-title":"Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds","volume":"3","author":"PJ Whelan","year":"2012","journal-title":"J Neurosci Rural Pract"},{"issue":"5","key":"pone.0292674.ref084","first-page":"e25477","article-title":"Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates.","volume":"14","author":"NJ Peterman","year":"2022","journal-title":"Cureus"},{"issue":"1","key":"pone.0292674.ref085","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1186\/s12913-019-4282-z","article-title":"Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: a national register study.","volume":"19","author":"AB Bech","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0292674.ref086","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2147\/NDT.S129480","article-title":"The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study.","volume":"13","author":"T Rosic","year":"2017","journal-title":"Neuropsychiatr Dis Treat"},{"key":"pone.0292674.ref087","doi-asserted-by":"crossref","first-page":"j1550","DOI":"10.1136\/bmj.j1550","article-title":"Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies","volume":"357","author":"L Sordo","year":"2017","journal-title":"BMJ"},{"issue":"2","key":"pone.0292674.ref088","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/dar.13173","article-title":"Opioid overdose risk during and after drug treatment for heroin dependence: An incidence density case-control study nested in the VEdeTTE cohort","volume":"40","author":"F Faggiano","year":"2021","journal-title":"Drug Alcohol Rev"},{"issue":"16","key":"pone.0292674.ref089","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1001\/jama.2015.3474","article-title":"Emergency department-initiated buprenorphine\/naloxone treatment for opioid dependence: a randomized clinical trial","volume":"313","author":"G D\u2019Onofrio","year":"2015","journal-title":"JAMA"},{"key":"pone.0292674.ref090","article-title":"NJ First State to Let Paramedics Offer Prime Opioid-Withdrawal Drug.","author":"LH Stainton","year":"2019","journal-title":"NJ Spotlight News"},{"key":"pone.0292674.ref091","article-title":"In a nationwide first, New Jersey authorizes paramedics to start addiction treatment at the scene of an overdose.","author":"L. Facher","year":"2019","journal-title":"STAT"},{"key":"pone.0292674.ref092","article-title":"Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services","author":"G Carroll","year":"2022","journal-title":"Ann Emerg Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292674","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T17:36:03Z","timestamp":1698860163000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292674"}},"subtitle":[],"editor":[{"given":"Kimberly","family":"Page","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":92,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292674","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,1]]}}}