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KEY POINTS • App-based contact tracing has the potential to address traditional contact tracing’s limitations of scalability, notification delays, recall errors and contact identification in public spaces. • The effectiveness of contact-tracing apps in identifying exposures depends on widespread use of individual apps and the ability of their underlying technologies to identify nearby phones. • Use of contact-tracing apps brings inherent trade-offs between privacy and effectiveness. • Before being released, apps must be field tested in real-world conditions to understand their sensitivity and specificity for identifying exposures. • Integrating app-based and traditional contact tracing may leverage the advantages, and mitigate the limitations, of each approach.

Tobacco use is a leading cause of preventable death in Canada, and it is time for governments to ensure that all people with provincial drug benefits have access to smoking cessation medications. Pharmacotherapies are effective for smoking cessation. In a phase-4 randomized controlled trial, people treated with varenicline for 12 weeks had cessation rates of 22% at 24 weeks compared with 9% among those receiving placebo. Meta-analyses have found that combination nicotine replacement therapy, which combines the nicotine patch with a short-acting nicotine formulation, has similar cessation rates to varenicline. Cytisine is a smoking cessation pharmacotherapy with similar effect sizes to varenicline. Bupropion has smaller effect sizes than varenicline but is superior to placebo in helping people stop smoking.

BackgroundDespite the focus on overdose deaths co-involving opioids and benzodiazepines, little is known about the epidemiologic characteristics of benzodiazepine-involved overdose deaths in the USA.ObjectiveTo characterize co-involved substances, intentionality, and demographics of benzodiazepine-involved overdose deaths in the USA from 2000 to 2019.DesignCross-sectional study using national mortality records from the National Vital Statistics System.SubjectsUS residents in the 50 states and District of Columbia who died from a benzodiazepine-involved overdose from 2000 to 2019.Main MeasuresDemographic characteristics, intention of overdose, and co-involved substancesKey ResultsA total of 118,208 benzodiazepine-involved overdose deaths occurred between 2000 and 2019 (median age, 43 [IQR, 32–52]; male, 58.6%; White, 93.3%; Black, 4.9%; American Indian and Alaska Native, 0.9%; Asian American and Pacific Islander, 0.9%; Hispanic origin, 6.4%). Opioids were co-involved in 83.5% of the deaths. Nine percent of benzodiazepine-involved overdose deaths did not involve opioids, cocaine, other psychostimulants, barbiturates, or alcohol. Overdose deaths were classified as suicides in 8.5% of cases with benzodiazepine and opioid co-involvement and 36.2% of cases with benzodiazepine but not opioid involvement. Rates of benzodiazepine-involved overdose deaths increased from 0.46 per 100,000 individuals in 2000 to 3.55 per 100,000 individuals in 2017 before decreasing to 2.96 per 100,000 individuals in 2019. Benzodiazepine-involved overdose mortality rates increased from 2000 to 2019 among all racial groups, both sexes, and individuals of Hispanic and non-Hispanic origin. Rates of benzodiazepine-involved overdose deaths decreased among White individuals, but not Black individuals, from 2017 to 2019.ConclusionsInterventions to reduce benzodiazepine-involved overdose mortality should consider the demographics of, co-involved substances in, and presence of suicides among benzodiazepine-involved overdose deaths.

A 35-year-old woman with multiple substance use disorders, including opioids, methamphetamine, cocaine, and alcohol, presented to the hospital with suicidal ideation and severe opioid withdrawal. She had a history of previous suicide attempts and unintentional opioid overdoses. The patient had recently stopped taking methadone and slow-release oral morphine and reported high use of intravenous fentanyl. She also had a history of various psychiatric disorders. The patient's withdrawal symptoms were initially managed with hydromorphone, and then methadone and slow-release oral morphine were initiated. The case highlights the challenges faced by patients with opioid use disorder in the hospital setting. There are no specific guidelines for managing fentanyl withdrawal in hospitals, and undertreated withdrawal symptoms and stigma often lead patients to leave the hospital prematurely. Short-acting opioids can be used as adjuncts to relieve withdrawal symptoms in these patients, but dosing must be tailored to individual patient factors. Further research is needed to improve the management of fentanyl withdrawal in hospitals.

Robert Kleinman and colleagues examine the efficacy and safety of reducing supervised dosing of sublingual buprenorphine-naloxone for opioid use disorder