In honor of the New Year … we have 38 papers for you in just one month!
There’s some sophisticated work here – innovative epidemiology, interventions, and reviews of overdose. We’ve come a long way from the 1990s, but clearly not quickly enough for the dynamic urgency of this issue.
Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.
PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.
Comments: Interesting approach and data.
Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.
Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30.
Comments: Yeah … this is really complicated.
Plescia CJ, Manu P.
Am J Ther. 2017 Nov 14. doi: 10.1097/MJT.0000000000000692. [Epub ahead of print]
Comments: This is an iatrogenic methadone and benzodiazepine overdose during simultaneous alcohol and opioid detoxification.
JEMS. 2016 Nov;41(11):46-8. No abstract available.
Comments: No abstract. Can’t access.
JEMS. 2016 Nov;41(11):14-5. No abstract available.
Comments: Same journal, again no abstract, and can’t access.
Story CR; Members of the Southern Harm Reduction Coalition, Kao WK, Currin J, Brown C, Charles V.
Health Promot Pract. 2017 Nov 1:1524839917742850. doi: 10.1177/1524839917742850. [Epub ahead of print]
Comments: Paper on the advocacy efforts for harm reduction.
Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M.
Expert Opin Pharmacother. 2017 Dec;18(18):1987-1999. doi: 10.1080/14656566.2017.1409722. Epub 2017 Dec 3.
Comments: We have good medications. Use them.
Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O’Reilly C, Grusing S, Daya M.
Ann Intern Med. 2017 Dec 19;167(12):867-875. doi: 10.7326/M17-2224. Epub 2017 Nov 28.
Comments: As with many systematic reviews, there are insufficient data to really answer the questions. Open access.
Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM.
Pain Med. 2017 Jun 15. doi: 10.1093/pm/pnx140. [Epub ahead of print]
Comments: This is a unique survey at Mayo Clinic in Minnesota. Kudos to the authors. Most providers weren’t comfortable with the care they provided. Few (2%) routinely prescribed naloxone. Many weren’t registered with the PDMP. We’re kind of in a mess.
Molfenter T, Sherbeck C, Starr S, Kim JS, Zehner M, Quanbeck A, Jacobson N, McCarty D.
J Addict Med. 2017 Nov 15. doi: 10.1097/ADM.0000000000000369. [Epub ahead of print]
Comments: Everyone pays for opioids for pain but treating opioid use disorder is not paid for unless paired with behavioral therapy and duration of treatment is limited. These are not evidence-based decisions. There are strong data that buprenorphine treatment are effective with or without behavioral therapy. And stopping treatment is always associated with increased mortality. How about we put a limit on the duration of insulin for diabetes?
Glick SN, Burt R, Kummer K, Tinsley J, Banta-Green CJ, Golden MR.
Drug Alcohol Depend. 2017 Nov 16;182:86-92. doi: 10.1016/j.drugalcdep.2017.10.011. [Epub ahead of print]
Comments: The opioid epidemic is also a stimulant issue.
Huxley-Reicher Z, Maldjian L, Winkelstein E, Siegler A, Paone D, Tuazon E, Nolan ML, Jordan A, MacDonald R, Kunins HV.
Addict Behav. 2017 Nov 16. pii: S0306-4603(17)30437-9. doi: 10.1016/j.addbeh.2017.11.029. [Epub ahead of print]
Comments: Great results from an innovative program to reach those at risk for overdose. Impressive work from NYC!
Edwards J, Bates D, Edwards B, Ghosh S, Yarema M.
Can Pharm J (Ott). 2017 Jul 7;150(4):259-268. doi: 10.1177/1715163517711960. eCollection 2017 Jul-Aug.
Comments: Pharmacists in Alberta highly supportive of screening patients and providing naloxone.
Petterson AG, Madah-Amiri D.
Harm Reduct J. 2017 Nov 21;14(1):74. doi: 10.1186/s12954-017-0200-z.
Comments: Training in naloxone prior to release was associated with improved knowledge.
Huang X, Keyes KM, Li G.
Am J Public Health. 2018 Jan;108(1):131-136. doi: 10.2105/AJPH.2017.304142. Epub 2017 Nov 21.
Comments: Fascinating results. Two cohorts are involved. Baby boomers 1947 through 1964 have elevated rates of prescription opioid as well as heroin overdose death. A second cohort, born 1979-1992, is at elevated risk of heroin overdose death. I can’t access full article unfortunately.
Heavey SC, Chang YP, Vest BM, Collins RL, Wieczorek W, Homish GG.
Int J Drug Policy. 2017 Nov 17;51:27-35. doi: 10.1016/j.drugpo.2017.09.015. [Epub ahead of print]
Comments: This is a qualitative study (N=20) at a residential treatment center (presumably in Buffalo NY where authors are based). Authors report that some respondents reported behaviors related to naloxone that may put them at higher risk. The is the first research to suggest this finding. The examples they provide, however, are not entirely concordant with the purported themes, with the exception of one example in which a respondent reported using something that he thought was fentanyl because there was someone with naloxone present in case it was in fact fentanyl. The other examples include: a person who overdosed three days in a row and was reversed by paramedics each time which is described as “opioid use after naloxone”, and “naloxone behaviors that may increase overdose mortality risk” which include mistaking an overdose for a nod (this doesn’t seem relevant to naloxone) and people who tend to use alone (again, unclear how this is related to naloxone). Finally, conducting this study in a residential treatment center brings extensive biases that affect how people (re)interpret their own history.
Curtin SC, Tejada-Vera B, Warmer M.
NCHS Data Brief. 2017 Aug;(282):1-8.
Comments: Wow. Increased heroin deaths among kids. This suggests that we are dealing with increased opioid use, not just increased risk with the shift to heroin and emergence of fentanyl.
Lee JD, Nunes EV Jr, Novo P, Bachrach K, Bailey GL, Bhatt S, Farkas S, Fishman M, Gauthier P, Hodgkins CC, King J, Lindblad R, Liu D, Matthews AG, May J, Peavy KM, Ross S, Salazar D, Schkolnik P, Shmueli-Blumberg D, Stablein D, Subramaniam G, Rotrosen J.
Lancet. 2017 Nov 14. pii: S0140-6736(17)32812-X. doi: 10.1016/S0140-6736(17)32812-X. [Epub ahead of print]
Comments: In randomized-controlled trials, we care about the intent-to-treat analysis. The per-protocol analysis is a distant second that doesn’t usually get a place of prominence in the abstract of a major paper, making this abstract unusual. Moreover, describing the intent-to-treat findings as “it is harder to initiate patients” is very unusual. The most important finding from this study is, of course, that those assigned to XR-NTX had higher rates of relapse and more opioid-positive urines – and this should be the conclusion by traditional RCT standards. While the authors are likely correct that this finding is because it is harder (and presumably more dangerous) to induct people onto XR-NTX, from a clinical perspective this makes XR-NTX inferior to buprenorphine. That does not mean it’s not valuable, but it does mean that relying exclusively on it is inconsistent with quality care. I really hope they are following people longer than 24 weeks, given that this is a lifelong disease and, while buprenorphine is usually provided longterm, XR-NTX is rarely provided for more than 6 months. Of note, there are several author COIs related to Alkermes which I consider relevant given the unusual presentation of intent-to-treat results.
Lagard C, Malissin I, Indja W, Risède P, Chevillard L, Mégarbane B.
Clin Toxicol (Phila). 2017 Nov 17:1-7. doi: 10.1080/15563650.2017.1401080. [Epub ahead of print]
Comments: Works, but increases seizure risk.
Greenberg K, Kohl B.
Am J Emerg Med. 2017 Nov 8. pii: S0735-6757(17)30928-2. doi: 10.1016/j.ajem.2017.11.020. [Epub ahead of print]
Comments: ARDS is a nasty lung disease that is difficult to ventilate, with a high mortality rate.
Mack KA, Jones CM, Ballesteros MF.
Am J Transplant. 2017 Dec;17(12):3241-3252. doi: 10.1111/ajt.14555.
Comments: Why is this in a transplantation journal? Also, an earlier paper in this review suggests that youth opioid use has picked up since the end of the study period for this article.
McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, Strang J.
Addiction. 2017 Nov 16. doi: 10.1111/add.14033. [Epub ahead of print]
Comments: 2mg IN similar to 0.4mg IM … as one would expect!
Molfenter T, Knudsen HK, Brown R, Jacobson N, Horst J, Van Etten M, Kim JS, Haram E, Collier E, Starr S, Toy A, Madden L.
Implement Sci. 2017 Nov 15;12(1):135. doi: 10.1186/s13012-017-0665-x.
Comments: Description of an impending implementation science study to increase provision of addiction treatment for opioid use disorder.
Ostwal SP, Salins N, Deodhar J.
Indian J Palliat Care. 2017 Oct-Dec;23(4):484-486. doi: 10.4103/IJPC.IJPC_117_17.
Comments: Case report of a person on palliative opioids successfully reversed with naloxone.
Khoshideh B, Arefi M, Ghorbani M, Akbarpour S, Taghizadeh F.
Epidemiol Health. 2017 Nov 8. doi: 10.4178/epih.e2017050. [Epub ahead of print]
Comments: Rhabdomyolysis is a disease produced by breakdown of muscle cells, resulting in buildup of creatine kinase which is toxic to the kidneys. Usually it occurs when someone is “down” for a prolonged period (i.e. unconscious on the floor), resulting in pressure on muscles. Sometimes we see it with extreme exposure to stimulants, such as cocaine or methamphetamine, with excessive tensing of muscles for prolonged periods. We also see it as a rare side effect of statin exposure, and several other causes.
Freeman LK, Bourque S, Etches N, Goodison K, O’Gorman C, Rittenbach K, Sikora CA, Yarema M.
Can J Public Health. 2017 Nov 9;108(4):e398-e402. doi: 10.17269/cjph.108.5989.
Comments: 9572 kits distributed and 472 reversals reported in Alberta’s 953 naloxone sites in 2016.
Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN.
CMAJ Open. 2017 Nov 8;5(4):E779-E784. doi: 10.9778/cmajo.20170123.
Comments: Half of pharmacies had naloxone available in British Columbia, one-third in Maritimes, a quarter in Ontario and central and northern Canada; 0.9% in Quebec.
O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM.
MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1197-1202. doi: 10.15585/mmwr.mm6643e1.
Comments: I’m still stuck on “this sucks.”
Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT; REDAN Group.
PLoS One. 2017 Oct 31;12(10):e0186833. doi: 10.1371/journal.pone.0186833. eCollection 2017.
Comments: 40% of people who inject opioids that received naloxone used it to reverse an overdose.
Coffin PO, Santos GM, Matheson T, Behar E, Rowe C, Rubin T, Silvis J, Vittinghoff E.
PLoS One. 2017 Oct 19;12(10):e0183354. doi: 10.1371/journal.pone.0183354. eCollection 2017.
Comments: Motivational interviewing-based intervention among naloxone recipients resulted in substantial reduction in occurrence of subsequent overdose events.
BMJ. 2017 Aug 21;358:j3941. doi: 10.1136/bmj.j3941. No abstract available.
Comments: Ugh. Overdose death is way more complicated than a simple reversal agent. There are clearly economic and social elements to the epidemic we are facing today.
Moore PQ, Weber J, Cina S, Aks S.
Am J Emerg Med. 2017 Nov;35(11):1706-1708. doi: 10.1016/j.ajem.2017.05.003. Epub 2017 May 8.
Comments: We are still a long way from effectively utilizing clinical data systems.
Science. 2017 Mar 31;355(6332):1364-1366. doi: 10.1126/science.355.6332.1364. No abstract available.
Comments: Fentanyl and analogues.
Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD.
Addict Sci Clin Pract. 2017 Feb 28;12(1):7. doi: 10.1186/s13722-017-0072-2.
Comments: Home induction works well, even in low resource settings.
Chetty M, Kenworthy JJ, Langham S, Walker A, Dunlop WC.
Addict Sci Clin Pract. 2017 Feb 24;12(1):6. doi: 10.1186/s13722-017-0071-3. Review.
Comments: 18 models in total, with widely varying approaches and quality, a tiny number given the impact of opioid use disorder and treatment.
Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD.
Harm Reduct J. 2017 Feb 20;14(1):13. doi: 10.1186/s12954-017-0139-0.
Franklyn AM, Eibl JK, Gauthier G, Pellegrini D, Lightfoot NE, Marsh DC.
Harm Reduct J. 2017 Jan 26;14(1):6. doi: 10.1186/s12954-017-0134-5. Erratum in: Harm Reduct J. 2017 Mar 28;14 (1):15.
Comments: Benzodiazepine use complicated opioid use disorder treatment, for sure. One of the questions is why? Is it comorbid use disorder? Is it anxiety? Depression?
Kerensky T, Walley AY.
Addict Sci Clin Pract. 2017 Jan 7;12(1):4. doi: 10.1186/s13722-016-0068-3. Review.
Comments: Nice review of key issues related to naloxone provision.