1) Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme.

Tjagvad C, Skurtveit S, Linnet K, Andersen LV, Christoffersen DJ, Clausen T.

Eur Addict Res. 2016 Jun 1;22(5):249-258. [Epub ahead of print]

Comments: Patients on very high doses of methadone or also using benzodiazepines were at higher risk of death.

2) Heroin use.

Salani DA, Zdanowicz M, Joseph L.

J Psychosoc Nurs Ment Health Serv. 2016 Jun 1;54(6):30-7. doi: 10.3928/02793695-20160518-05.

Comments: Epidemiologic review.

3) Academic physicians’ and medical students’ perceived barriers toward bystander administered naloxone as an overdose prevention strategy.

Gatewood AK, Van Wert MJ, Andrada AP, Surkan PJ.

Addict Behav. 2016 May 17;61:40-46. doi: 10.1016/j.addbeh.2016.05.013. [Epub ahead of print]

Comments: Qualitative interviews with medical providers.

4) Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review.

Elzey MJ, Barden SM, Edwards ES.

Pain Physician. 2016 May;19(4):215-28.

Comments: Non-fatal events are far more common, not well-predicted by risk factors, and in need of additional research.

5) Incorporation of poison center services in a state-wide overdose education andnaloxone distribution program.

Doyon S, Benton C, Anderson BA, Baier M, Haas E, Hadley L, Maehr J, Rebbert-Franklin K, Olsen Y, Welsh C.

Am J Addict. 2016 Jun;25(4):301-6. doi: 10.1111/ajad.12384. Epub 2016 May 24.

Comments: Interesting case series of naloxone reversals reported to poison control. They report a 75.6% “response rate” although some of the remainder was “unknown” and was there were only 2 deaths among 78 cases, suggesting a rate closer to 97.5%. Response rate to heroin was higher than for prescription opioids. Of the 43 suspected heroin events, 31 went to the ED, 25 were discharged, and 5 required ICU care. Of 31 suspected prescription opioid 20 went to the ED, 9 were discharged, and 6 required ICU care. This is consistent with the more complicated nature of prescription opioid overdose.

6) Police Officers Can Safely and Effectively Administer Intranasal Naloxone.

Fisher R, O’Donnell D, Ray B, Rusyniak D.

Prehosp Emerg Care. 2016 May 24:1-6. [Epub ahead of print]

Comments: About a 65% response rate among 117 administrations and 1 combative individual.

7) Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

Sharma A, O’Grady KE, Kelly SM, Gryczynski J, Mitchell SG, Schwartz RP.

Subst Abuse Rehabil. 2016 Apr 27;7:27-40. doi: 10.2147/SAR.S81602. eCollection 2016. Review.

Comments: Overdose morality is through the roof when people leave correctional settings. Starting medications in-house is critical.

8) Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia.

Culbert GJ, Pillai V, Bick J, Al-Darraji HA, Wickersham JA, Wegman MP, Bazazi AR, Ferro E, Copenhaver M, Kamarulzaman A, Altice FL.

J Neuroimmune Pharmacol. 2016 May 24. [Epub ahead of print] Review.

Comments: Managing syndemics in Malaysia.

9) Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia.

Deonarine A, Amlani A, Ambrose G, Buxton JA.

Harm Reduct J. 2016 May 21;13(1):17. doi: 10.1186/s12954-016-0106-1.

Comments: Interesting qualitative study of drug users and police regarding naloxone.

10) [Overdose of heroin and influencing factors in intravenous drug users in parts of Yunnan].

Zhou Y, Luo W, Cao XB, Zhang B, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2016 May 10;37(5):648-52. doi: 10.3760/cma.j.issn.0254-6450.2016.05.012. Chinese.

Comments: 42% had ever overdosed and 16% had done so in the past year, a relatively low rate.

11) Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review.

Bauer LK, Brody JK, León C, Baggett TP.

J Health Care Poor Underserved. 2016;27(2):846-59. doi: 10.1353/hpu.2016.0075.

Comments: Of 219 homeless individuals who died of overdose in Boston, 81% of deaths involved opioids, 85% of decedents had substance use disorders, 61% had psychiatric illness, 45% had chronic pain, and 32% had all three of those issues. This is really complex clinical care.

12) The SOMATICS collaborative: Introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings.

Chandler RK, Finger MS, Farabee D, Schwartz RP, Condon T, Dunlap LJ, Zarkin GA, McCollister K, McDonald RD, Laska E, Bennett D, Kelly SM, Hillhouse M, Mitchell SG, O’Grady KE, Lee JD.

Contemp Clin Trials. 2016 May;48:166-72. doi: 10.1016/j.cct.2016.05.003. Epub 2016 May 11.

Comments: Extended-release naltrexone studies.

13) Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.

Bogdanowicz KM, Stewart R, Chang CK, Downs J, Khondoker M, Shetty H, Strang J, Hayes RD.

Drug Alcohol Depend. 2016 Jul 1;164:82-8. doi: 10.1016/j.drugalcdep.2016.04.036. Epub 2016 May 6.

Comments: Overdose death was associated with unsafe injecting and clinically-appraised suicidality.

14) Extended-release naltrexone opioid treatment at jail re-entry (XOR).

McDonald RD, Tofighi B, Laska E, Goldfeld K, Bonilla W, Flannery M, Santana-Correa N, Johnson CW, Leibowitz N, Rotrosen J, Gourevitch MN, Lee JD.

Contemp Clin Trials. 2016 May 10. pii: S1551-7144(16)30059-3. doi: 10.1016/j.cct.2016.05.002. [Epub ahead of print]

Comments: Description of a planned study.

15) Opioid Overdose Prevention Through Pharmacy-based Naloxone Prescription Program: Innovations in Healthcare Delivery.

Bachyrycz A, Shrestha S, Bleske BE, Tinker D, Bakhireva LN.

Subst Abus. 2016 May 10:0. [Epub ahead of print]

Comments: First paper I’ve seen on the uptake of naloxone from pharmacies. Promising data!

16) Opioid agonist treatment for pharmaceutical opioid dependent people.

Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N.

Cochrane Database Syst Rev. 2016 May 9;5:CD011117. doi: 10.1002/14651858.CD011117.pub2. Review.

Comments: Agonist treatment works, maintenance is best.

17) Naloxone access increases, as does price.

Thompson CA.

Am J Health Syst Pharm. 2015 Sep 1;72(17):1426-7. doi: 10.2146/news150056. No abstract available.

Comments: Nothing new here. Unfortunately, for the most effective approach – giving the medication away at low-threshold programs – the cost needs to be in the low single digits.

18) Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City.

Guarino H, Marsch LA, Deren S, Straussner SL, Teper A.

J Addict Dis. 2015;34(2-3):162-77. doi: 10.1080/10550887.2015.1059711.

Comments: Many participants got syringes only from a pharmacy to avoid being “outed” as a drug injector and did not receive any information about overdose – or other safety messaging – from that source.

19) Opioid abuse in the United States and Department of Health and Human Services actions to address opioid-drug-related overdoses and deaths.

U S Department Of Health And Human Services.

J Pain Palliat Care Pharmacother. 2015 Jun;29(2):133-9. doi: 10.3109/15360288.2015.1037530.

Comments: Yup.

1) The Whole Is Just the Sum of Its Parts: Limited Polydrug Use Among the “Big Three” Expensive Drugs in the United States.

Caulkins JP, Everingham S, Kilmer B, Midgette G.

Curr Drug Abuse Rev. 2013 Dec 5. [Epub ahead of print]

Comments: Somewhat surprising data suggesting relatively separate markets for heroin, cocaine and methamphetamine.

2) A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Larney S, Gowing L, Mattick RP, Farrell M, Hall W, Degenhardt L.

Drug Alcohol Rev. 2013 Dec 3. doi: 10.1111/dar.12095. [Epub ahead of print]

Comments: A systematic review concluding that the data for naltrexone implants for opioid dependence are insufficient for use outside of clinical trials.

3)  Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009.

Bohnert AS, Ilgen MA, Trafton JA, Kerns RD, Eisenberg A, Ganoczy D, Blow FC.

Clin J Pain. 2013 Nov 25. [Epub ahead of print]

Comments: What happened with opioid analgesic overdose deaths in the United States also happened in among veterans receiving care in the Veterans’ Administration.

4) The Dueling Obligations of Opioid Stewardship.

Coffin P, Banta-Green C.

Ann Intern Med. 2013 Dec 10. doi: 10.7326/M13-2781. [Epub ahead of print] No abstract available.

Comments: Commentary on the reliance on opioids and minimizing the potential harms of stewardship efforts.

5) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2013 Nov 25. [Epub ahead of print] No abstract available.

Comments: This is really a news report in CMAJ about Canada’s BC naloxone program.

6) Preventing deaths from rising opioid overdose in the US – the promise of naloxoneantidote in community-based naloxone take-home programs.

Straus MM, Ghitza UE, Tai B.

Subst Abuse Rehabil. 2013 Sep 2;2013(4). doi: 10.2147/SAR.S47463.

Comments: Good review of major initiatives to respond to increasing rates of opioid overdose mortality in the United States, including take-back programs, prescription drug monitoring programs, and naloxone distribution.

7) Drug-induced deaths – United States, 1999-2010.

Mack KA; National Center for Injury Prevention and Control, CDC.

MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-3.

Comments: Review of drug-related deaths of the past decade.

8) From oxycodone to heroin: Two cases of transitioning opioid use in young Australians.

Dertadian GC, Maher L.

Drug Alcohol Rev. 2013 Nov 21. doi: 10.1111/dar.12093. [Epub ahead of print]

Comments: Interesting case reports of transitions from oral prescription opioid consumption to illicit opioid injection. Unable to access for details.

9) Common causes of poisoning: etiology, diagnosis and treatment.

Müller D, Desel H.

Dtsch Arztebl Int. 2013 Oct;110(41):690-9; quiz 700. doi: 10.3238/arztebl.2013.0690. Epub 2013 Oct 11.

Comments: Interesting analysis of all acute poisonings in the German poison control center over 26 years.

10) Opiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A Study on Gender Differences.

Origer A, Lopes da Costa S, Baumann M.

Eur Addict Res. 2013 Oct 31;20(2):87-93. [Epub ahead of print]

Comments: Interesting gender-based analysis suggesting that women may be at higher risk earlier in their drug use careers.

11) Safe methadone induction and stabilization: report of an expert panel.

Baxter LE Sr, Campbell A, Deshields M, Levounis P, Martin JA, McNicholas L, Payte JT, Salsitz EA, Taylor T, Wilford BB.

J Addict Med. 2013 Nov-Dec;7(6):377-86. doi: 10.1097/01.ADM.0000435321.39251.d7.

Comments: Guidelines addressing methadone starting dose, dose escalation, and concomitant medications/drugs.

12) Opioid substitution treatment in pretrial prison detention: a case study from Geneva, Switzerland.

Favrod-Coune T, Baroudi M, Casillas A, Rieder JP, Gétaz L, Barro J, Gaspoz JM, Broers B, Wolff H.

Swiss Med Wkly. 2013 Nov 1;143:w13898. doi: 10.4414/smw.2013.13898.

Comments: No overdoses.

13) [Distribution of naloxone to prevent death from heroin overdose. Study of opioid dependent patients’ attitudes to be part of the antidote program].

Håkansson A, Vedin A, Wallin C, Kral AH.

Lakartidningen. 2013 Jul 17-Aug 6;110(29-31):1340-2. Swedish. No abstract available.

Comments: Unable to access, but it would be fascinating to see the Swedish response to lay naloxone.

14) Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran.

Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A.

Clin Toxicol (Phila). 2013 Sep-Oct;51(8):777-82. doi: 10.3109/15563650.2013.830732. Epub 2013 Aug 23.

Comments:

15) Project Lazarus: an innovative community response to prescription drug overdose.

Brason FW 2nd, Roe C, Dasgupta N.

N C Med J. 2013 May-Jun;74(3):259-61. No abstract available.

Comments: Unable to access.

16) Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.

Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM.

Can J Public Health. 2013 Apr 18;104(3):e200-4.

Comments: Report from the first 8 months of naloxone trainings in Toronto!

17) The pathogenetic role of adulterants in 5 cases of drug addicts with a fatal outcome.

Barbera N, Busardò FP, Indorato F, Romano G.

Forensic Sci Int. 2013 Apr 10;227(1-3):74-6. doi: 10.1016/j.forsciint.2012.08.041. Epub 2012 Sep 20.

Comments: Fascinating paper on the role of dextromethorphan, built upon evidence that dextromethorphan – an NMDA-recepter antagonist – decreases the expiratory phase of respiration and magnifies the respiratory depression induced by morphine. While adulterants may be more important than we’ve previously realized, how does one translate that to overdose prevention in the field?

18) Deadly heroin or the death of heroin – overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Horvath M, Dunay G, Csonka R, Keller E.

Neuropsychopharmacol Hung. 2013 Dec;15(4):253-9.

Comments: Very exciting to see a review of drug overdose deaths in Budapest, Hungary. The number of deaths is remarkably low, with just 464 deaths in 18 years (299 opioid-related). Surprisingly 58% of the deaths were heroin alone, a finding the authors suggest means that use patterns are distinct in Budapest.

19) [Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

Cui N, Cao XB, Wang CH, Luo W, Pang L, Rou KM, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Oct;34(10):961-3. Chinese.

Comments: Interesting analysis from China with the suggestion that adherence to methadone maintenance reduces overdose mortality.

20) Survey of naloxone legal status in opioid overdose prevention and treatment.

Hewlett L, Wermeling DP.

J Opioid Manag. 2013 Sep-Oct;9(5):369-77. doi: 10.5055/jom.2013.0179.

Comments: Review of naloxone access laws in the United States. There was so much activity in 2013, that this article is already a bit out of date!

21) Mortality among Methadone Maintenance Clients in China: A Six-Year Cohort Study.

Cao X, Wu Z, Li L, Pang L, Rou K, Wang C, Luo W, Yin W, Li J, McGoogan JM; National Methadone Maintenance Treatment Program Working Group.

PLoS One. 2013 Dec 12;8(12):e82476. doi: 10.1371/journal.pone.0082476.

Comments: Overdose was the leading cause of death among methadone patients, four times more likely among those with HIV, and longer time in methadone treatment reduced overdose mortality risk.

22) Associations among Pain, Non-Medical Prescription Opioid Use, and Drug Overdose History.

Bonar EE, Ilgen MA, Walton M, Bohnert AS.

Am J Addict. 2014 Jan;23(1):41-7. doi: 10.1111/j.1521-0391.2013.12055.x. Epub 2013 Jun 14.

Comments: Analysis among substance users at a treatment center of pain, non-medical prescription opioid use, and overdose.

23) Revisiting the role of the urban environment in substance use: the case of analgesicoverdose fatalities.

Cerdá M, Ransome Y, Keyes KM, Koenen KC, Tardiff K, Vlahov D, Galea S.

Am J Public Health. 2013 Dec;103(12):2252-60. doi: 10.2105/AJPH.2013.301347. Epub 2013 Oct 17.

Comments: This is a fascinating analysis that I’ve been waiting to see (AJPH does tend to take a while to publish!). However, what happened in NYC with opioid overdose may or may not be reflective of what happened in other areas of the country. NYC saw a clear increase in overdose on Staten Island, among those using prescription opioids, while heroin deaths were decreasing citywide. Staten Island then had an increase in heroin deaths as many transitioned to heroin and there were no services in place to limit the harms of heroin. In other areas there is less of a clear trend.

24) Opioid overdose mortality in Kansas, 2001-2011: toxicologic evaluation of intent.

Okic M, Cnossen L, Crifasi JA, Long C, Mitchell EK.

J Anal Toxicol. 2013 Nov-Dec;37(9):629-35. doi: 10.1093/jat/bkt085.

Comments: Again demonstrating the limited utility of drug concentration in opioid overdose deaths.

25) Naltrexone in the treatment of opioid-dependent pregnant women: the case for a considered and measured approach to research.

Jones HE, Chisolm MS, Jansson LM, Terplan M.

Addiction. 2013 Feb;108(2):233-47. doi: 10.1111/j.1360-0443.2012.03811.x. Epub 2012 Apr 4. Review.

Comments: The research field of obstetrics is generally way behind the rest of medicine. Because we are so concerned over the health of pregnant women and the well-being of the embryos and fetuses they carry, we tend to rely on decades of experience and new approaches progress glacially. As the authors point out, given the numerous potential downsides of naltrexone for opioid dependence, we are not near the point of recommending this therapy for pregnant women at this time – or even researching it directly.