take up in 2015 , physician in Massachusetts begannoticinga undulation of typically young patients coming down with unexplained , sometimes lasting poor - terminal figure memory loss . The only connection found between these patients was a history of unpaid drugs ; either heroin or cocaine . But these drugs almost never cause the sort of nous hurt that lead in amnesia , leading the doctors to believe something else had to explain why so many people were losing their storage at the same time .
A newcase study , published today in the Annals of Internal Medicine , might reset the puzzler once and for all : It suggests that a powerful , antecedently rare opioid — fentanyl — is most responsible for the symptom .
The report details a 30 - twelvemonth - quondam Maryland man with a chronicle of diacetylmorphine role who had lately retrovert home from a residential addiction treatment program . He had been sober for over a month , but one morning , family members found him in his room with drug paraphernalia . At first , the piece was hard to wake up , and once he awoke , he could n’t stop ask the same questions over and over , which worried his folk enough to take him to a local hospital . After being transplant to another hospital in West Virginia with “ relentless memory impairment , ” the man was tested for drugs and his brain was scanned via MRI .
The man evince the same sort of lesion along his hippocampus ( and basal ganglia ) that others have had . He tested positive for cocain , but his weewee also contained the broken - down remnants of Sublimaze . It ’s the first case of this “ amnesiac syndrome ” that has been definitively connect to Sublimaze ; other victims have only been tested for or cover cosmopolitan opioid employment .
“ We are have more and more evidence that fentanyl plays an all important role in this syndrome , ” Alfred Demaria , an epidemiologist and medical conductor of the Bureau of Infectious Disease at the Massachusetts Department of Public Health ( MDPH ) , tell apart me . Demaria is not associate with the current study , but he and his fellow worker at the MDPH have worked with some of its co - authors to track cases in the state .
The lesions seen in these patient were caused when the head ’s atomic number 8 flow to the genus Hippocampus was temporarily edit out off . A cocaine or heroin overdose can stop a person ’s breathing and heart . But fentanyl , its parallel , and other synthetic opioids are much more stiff than diacetylmorphine , making an overdose likelier . Fentanyl might also act independently on the hippocampus to help get the syndrome .
“ It seems to rev up the metabolism of the hippocampus , ” Demaria explicate . This advance then might make the effect of any atomic number 8 deprivation to the area induce by an overdose all the more damaging . “ But the exact mechanisms of how this take place is going to be beyond [ what we can find ] from survelliance , ” he added . “ We need more inquiry . ”
Fentanyl being the primary culprit also lines up well with the timeline of face . In 2016 , the MDPHlooked throughold infirmary records , eventually finding 14 the great unwashed within the state whose symptoms accommodate the bill for the syndrome . But the cases only dated back to 2012 , with most having pass after 2014 . decent around that same time , fentanyl use started becoming more mutual .
The drug is on a regular basis prescribed by doctors as a powerful analgesic following major surgery , but the kind available illicitly has been mostly ship over from China . The drug and its cheeseparing cousins are typically cheaper to produce than heroin , and less is needed to execute the same senior high school , so dealers are incentivized to sell it . Oftentimes , though , users don’teven knowthey’re taking fentanyl , since many bargainer secretly cut their marketed diacetylmorphine or other drugs with it . This surge in fentanyl and other celluloid opioids has also led to more last . In 2016 , theywere responsiblefor more than one-half of the fateful overdoses encounter across at least 10 states and around20,000 deaths totalthat year .
According to Demaria , the counting of known amnesia grammatical case is now somewhere around 20 . But while the current report details a Maryland patient , he has n’t hear of any consecrate movement to trail cases elsewhere . doctor and health departments have sure become more aware of the syndrome and even progress to out to the MDPH for advice , Demaria say , but it ’s unmanageable for anyone to justify devoting special resources to study an interesting , but seemingly rare side - outcome of fentanyl overdoses when there are much more pressing thing to worry about .
“ We ’re faced with this dilemma that we have M of people dying of overdoses , ” he say . “ We ’re struggling with a huge epidemic ; we ’re contend to keep people alive . ”
That is n’t to say that those afflicted by the syndrome have needs been fortunate . At least two of the 14 patient the MDPH initially studied in 2016 were found to have retentivity and learning stultification more than a year after their initial amnesia . So it ’s likely that many overdose survivors ’ on-going noesis problems have gone unnoticed by doctors .
“ It ’s another consequence of this dread epidemic of opioid function , specially with the entry of Sublimaze , ” Demaria said “ We ’re see more overdose death and more frequent injections , which leads to more bloodborne infections … it ’s really a bad setting we ’re in powerful now . ”
[ Annals of Internal Medicine ]
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