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[PubMed: 15523682] 234

There are multiple contributing factors influencing this trend, including aggressive prescribing of opioids in the past decade, the emergence of synthetic opioids such as fentanyl, and the increasing adulteration of street drugs with other substances such as xylazine (70)(71)

Patients with renal impairment may require dosage adjustment to prevent accumulation of vitamin B12

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