1) Wearable Biosensors to Evaluate Recurrent Opioid Toxicity After Naloxone Administration: A Hilbert Transform Approach.

Chintha KK, Indic P, Chapman B, Boyer EW, Carreiro S.

Proc Annu Hawaii Int Conf Syst Sci. 2018 Jan;2018:3247-3252. Epub 2018 Jan 3.

Comment: Unable to access. Abstract indicates that authors studied 11 participants to identify physiologic signs that naloxone effect was wearing off.

2) Using medical examiner case narratives to improve opioid overdose surveillance.

Hurstak E, Rowe C, Turner C, Behar E, Cabugao R, Lemos NP, Coffin P.

Int J Drug Policy. 2018 Jan 17;54:35-42. doi: 10.1016/j.drugpo.2017.12.017. [Epub ahead of print]

Comment: Opioid overdose surveillance is remarkably limited in its ability to explain the issue. This paper involved manual review of medical examiner case narratives in an attempt to identify consistently reported elements that could help us establish the populations at highest risk for death. This issue arose in the early 2000s, when opioid overdose deaths transitioned from heroin to prescription opioids – was it the same population, just using different substances? Was it a new population? How much of a mix was it? This paper looked at evidence of drug injection as a marker for a “heroin use” population versus non-injection, which may represent a distinct risk population.

3) Drug involvement in fatal overdoses.

Ruhm CJ.

SSM Popul Health. 2017 Jan 31;3:219-226. doi: 10.1016/j.ssmph.2017.01.009. eCollection 2017 Dec.

Comment: Recounts the transition to heroin as causal opioid and reminds us of the importance of polydrug involvement – a critical issue that has proven notoriously challenging to study.

4) Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

Rafful C, Orozco R, Rangel G, Davidson P, Werb D, Beletsky L, Strathdee SA.

Addiction. 2018 Jan 14. doi: 10.1111/add.14159. [Epub ahead of print]

Comment: Heroin users with recent involuntary treatment were nearly twice as likely to overdose.

5) Promising roles for pharmacists in addressing the U.S. opioid crisis.

Compton WM, Jones CM, Stein JB, Wargo EM.

Res Social Adm Pharm. 2017 Dec 31. pii: S1551-7411(17)30977-4. doi: 10.1016/j.sapharm.2017.12.009. [Epub ahead of print]

Comment: As addiction medicine truly becomes part of the medical system, the role for pharmacists – as well as other health professionals – becomes paramount.

6) Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014.

Caupp S, Steffan J, Shi J, Wheeler KK, Spiller HA, Casavant MJ, Xiang H.

Clin Toxicol (Phila). 2018 Jan 11:1-8. doi: 10.1080/15563650.2018.1424889. [Epub ahead of print]

Comment: Demographics from the poison center.

7) Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy.

Glanz JM, Narwaney KJ, Mueller SR, Gardner EM, Calcaterra SL, Xu S, Breslin K, Binswanger IA.

J Gen Intern Med. 2018 Jan 29. doi: 10.1007/s11606-017-4288-3. [Epub ahead of print]

Comment: Nice work by this team. They developed a model of overdose risk among people prescribed opioids longterm and validated it. The validation was not as good as expected, as it seems the validation population was higher risk for overdose, so the model didn’t pick up all the at-risk people. It’s also not clear that this model would transfer to other settings where the demographics of opioid use and overdose are quite different (e.g. they found that patients aged 55-65 were at lowest risk, whereas we see the opposite in San Francisco). The authors also note the important caveat that most people with the model characteristics (on long-acting opioids, tobacco use, mental health diagnoses, substance use disorders, and age via a quadratic equation) do not experience overdose, so this model should not be used to target reduced prescribing. Most interesting perhaps, opioid dose did NOT make it into their model, which points to the fallacy of focusing on that outcome as the goal of opioid stewardship efforts. Finally, the authors suggest that this model could be used to target naloxone prescription; I would suggest that this model may be a minimum guideline, although this may not account for overdose in the immediate social circle of the patient (naloxone may be used by a patient on someone else who suffers an overdose, whether a family member or friend who uses opioids or someone who accidentally or intentionally accesses the patient’s medication).

8) Drug Overdose Deaths in the United States, 1999-2016.

Hedegaard H, Warner M, Miniño AM.

NCHS Data Brief. 2017 Dec;(294):1-8.

Comment: Over 63,600 deaths in 2016, a further 21% more than 2015, and highest in West Virginia, Ohio, New Hampshire, DC, and Pennsylvania.

9) Naloxone dosage for opioid reversal: current evidence and clinical implications.

Rzasa Lynn R, Galinkin JL.

Ther Adv Drug Saf. 2018 Jan;9(1):63-88. doi: 10.1177/2042098617744161. Epub 2017 Dec 13. Review.

Comment: The naloxone dose controversy. It’s pretty clear that medical personnel should use the lowest dose they can to get effect. Lay use is more complex because it has to be simpler. The jerry-rigged nasal devise is pretty clearly insufficient for the fentanyl crisis. The other devices – from 0.4mg IM to 4mg nasal – seem to mostly work pretty consistently. Another reason for difficult resuscitations in the fentanyl era is that fentanyl overdoses may result in rapid cessation of respiration. In contrast to a heroin overdose, whereby when the witness wakes up from a ‘nod’ their friend has slowly declining respirations but still has a pulse, in the event of a fentanyl overdose the victim may have already progressed to cardiac arrest – which requires advanced medical management.

10) Diagnosis of Heroin Overdose in an 8-Year-Old Boy: Reliable Contribution of Toxicological Investigations.

Soichot M, Julliand S, Filatriau J, Hurbain A, Bourgogne E, Mihoubi A, Gourlain H, Delhotal-Landes B.

J Anal Toxicol. 2017 Dec 28. doi: 10.1093/jat/bkx111. [Epub ahead of print]

Comment: Advanced toxicology identified findings consistent with heroin exposure.

11) Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large U.S. EMS System.

Grover JM, Alabdrabalnabi T, Patel MD, Bachman MW, Platts-Mills TF, Cabanas JG, Williams JG.

Prehosp Emerg Care. 2018 Jan 3:1-9. doi: 10.1080/10903127.2017.1387628. [Epub ahead of print]

Comment: Sensitivity of EMS naloxone administration for overdose was 57% and positive predictive value 60%. Unfortunately big data is failing us again – we need boots on the ground.

12) Prescription Opioid Dependence in Western New York: Using Data Analytics to Find an Answer to the Opioid Epidemic.

Sinha S, Burstein GR, Leonard KE, Murphy TF, Elkin PL.

Stud Health Technol Inform. 2017;245:594-598.

Comment: It’s a lot of work to glean good data from electronic medical records.

13) Increasing diversion of methadone in Vancouver, Canada, 2005-2015.

Reddon H, Ho J, DeBeck K, Milloy MJ, Liu Y, Dong H, Ahamad K, Wood E, Kerr T, Hayashi K.

J Subst Abuse Treat. 2018 Feb;85:10-16. doi: 10.1016/j.jsat.2017.11.010. Epub 2017 Nov 28.

Comment: The abstract seems to suggest that the increasing availability of diverted methadone is from agonist treatment, although couldn’t much of it be related to prescribing for pain, as is the case in the US?

14) Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency.

Wallace B, Barber K, Pauly BB.

Int J Drug Policy. 2017 Dec 28;53:83-89. doi: 10.1016/j.drugpo.2017.12.011. [Epub ahead of print]

Comment: Suggests that partial implementation of harm reduction strategies, without full engagement, carries risks.

15) Prescribing Opioid Replacement Therapy in U.S. Correctional Settings.

Farahmand P, Modesto-Lowe V, Chaplin MM.

J Am Acad Psychiatry Law. 2017 Dec;45(4):472-477.

Comment: A good idea, as the authors argue.

16) Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

Davidson PJ, Lopez AM, Kral AH.

Int J Drug Policy. 2017 Dec 23;53:37-44. doi: 10.1016/j.drugpo.2017.12.005. [Epub ahead of print]

Comment: The benefit of being underground is that you’re not constrained by political / institutional factors. There are coincident risks as well.

17) Intranasal and Intramuscular Naloxone for Opioid Overdose in the Pre-Hospital Setting: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet].

Peprah K, Frey N.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Mar 16.

Comment: Limited to absent data.

18) Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study.

Goldman-Hasbun J, DeBeck K, Buxton JA, Nosova E, Wood E, Kerr T.

Harm Reduct J. 2017 Dec 22;14(1):79. doi: 10.1186/s12954-017-0206-6.

Comment: People become more aware of naloxone the longer and more widespread its availability – the limited knowledge in this study is, I suspect, mostly related to the relatively late uptake of take-home naloxone in Canada.

19) Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities.

McCarty D, Priest KC, Korthuis PT.

Annu Rev Public Health. 2017 Dec 22. doi: 10.1146/annurev-publhealth-040617-013526. [Epub ahead of print]

Comment: Review of current strategies in prescribing opioids and managing OUD.

20) Managing opioid overdose in pregnancy with take-home naloxone.

Blandthorn J, Bowman E, Leung L, Bonomo Y, Dietze P.

Aust N Z J Obstet Gynaecol. 2017 Dec 22. doi: 10.1111/ajo.12761. [Epub ahead of print]

Comment: Mostly the same, but there are a couple of important additional pieces to remember. First, you always need to tilt / place visibly pregnant women in emergency situations on their left side – this takes pressure off of the blood supply to the fetus. Second, you should titrate the naloxone a bit more cautiously as precipitated withdrawal could be dangerous to the fetus; that being said, maternal respiratory arrest is clearly more hazardous.

21) Opioid, Overdose.

Schiller EY, Mechanic OJ.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-.
2017 Nov 28.

Comment: A basic description.

22) Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users.

Molist G, Brugal MT, Barrio G, Mesías B, Bosque-Prous M, Parés-Badell O, de la Fuente L; Spanish Working Group for the Study of Mortality among Drug Users.

Int J Drug Policy. 2017 Dec 18;53:8-16. doi: 10.1016/j.drugpo.2017.11.011. [Epub ahead of print]

Comment: Heroin and cocaine users have greatly elevated risk of mortality. Interestingly, and consistent with decades of research, death from overdose declined with age rather than rising.

23) Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

Dasgupta N, Beletsky L, Ciccarone D.

Am J Public Health. 2017 Dec 21:e1-e5. doi: 10.2105/AJPH.2017.304187. [Epub ahead of print]

Comment: This is one of my favorite papers in a long time. It is inspired, deeply moving, and beautifully crafted. There is so much more to this than reducing opioid prescribing, providing opioid use disorder treatment, handing out naloxone, etc. This issue involves economic and social abandonment, and so much more.

24) ED Treatment of Opioid Addiction: An Opportunity to Lead.

Martin A, Mitchell A.

Acad Emerg Med. 2017 Dec 21. doi: 10.1111/acem.13367. [Epub ahead of print]

Comment: Great!

25) Abuse-deterrent opioids: an update on current approaches and considerations.

Pergolizzi JV Jr, Raffa RB, Taylor R Jr, Vacalis S.

Curr Med Res Opin. 2017 Dec 21:1-42. doi: 10.1080/03007995.2017.1419171. [Epub ahead of print]

Comment: Industry-funded promotion of novel formulations of opioids.

26) Clinical Update: The Risk of Opioid Toxicity and Naloxone Use in Operational K9s.

Palmer LE, Gautier A.

J Spec Oper Med. 2017 Winter;17(4):86-92.

Comment: I can’t access this. Naloxone is effective in canines, as well as other animals to the best of my knowledge. Exposure risks, in contrast, are being greatly exaggerated in media of late.

27) Effects of naloxone distribution alone or in combination with addiction treatment with or without pre-exposure prophylaxis for HIV prevention in people who inject drugs: a cost-effectiveness modelling study.

Uyei J, Fiellin DA, Buchelli M, Rodriguez-Santana R, Braithwaite RS.

Lancet Public Health. 2017 Mar;2(3):e133-e140. doi: 10.1016/S2468-2667(17)30006-3. Epub 2017 Feb 10. Erratum in: Lancet Public Health. 2017 Apr;2(4):e165.

Comment: Added to naloxone distribution modeling with substance use disorder treatment referral and pre-exposure prophylaxis for HIV – an effort to merge management of syndemics as we see in practice, which can be really helpful for programmatic planning. The results appear reasonable, although I disagree with some of the model parameter estimates (e.g. overdose risk is modeled as 7.7% per year and constant – this leads to outcome estimates that are not reflected in epidemiologic data which suggests a declining overdose risk with age / some people overdose more than others).

28) A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

Maguire MA, Pavlakos RN, Mehta BH, Schmuhl KK, Beatty SJ.

Curr Pharm Teach Learn. 2018 Jan – Feb;10(1):72-77. doi: 10.1016/j.cptl.2017.09.007. Epub 2017 Oct 6.

Comment: That’s cool, and a great way to engage the profession longterm.

29) A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders.

Carpenter DM, Roberts CA, Westrick SC, Ferreri SP, Kennelty KA, Look KA, Abraham O, Wilson C.

Res Social Adm Pharm. 2017 Nov 21. pii: S1551-7411(17)30649-6. doi: 10.1016/j.sapharm.2017.11.011. [Epub ahead of print]

Comment: Talking with patients about naloxone requires a bit of subtlety.

30) A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013.

Marotta PL, McCullagh CA.

Eur J Epidemiol. 2017 Dec 12. doi: 10.1007/s10654-017-0342-z. [Epub ahead of print]

Comment: Implementation of methadone, buprenorphine, and those treatments for incarcerated populations were associate with less drug-related death.

31) Identifying gaps in the implementation of naloxone programs for laypersons in the United States.

Lambdin BH, Zibbell J, Wheeler E, Kral AH.

Int J Drug Policy. 2017 Dec 9;52:52-55. doi: 10.1016/j.drugpo.2017.11.017. [Epub ahead of print]

Comment: 8% of counties had naloxone programs, including only 13% of counties with the highest overdose rates.

32) Comparison of Two Naloxone Regimens in Addicted Methadone-Overdosed Patients, a Clinical Trial Study.

Khosravi N, Zamani N, Hassanian-Moghaddam H, Ostadi A, Rahimi M, Kabir A.

Curr Clin Pharmacol. 2017 Dec 11. doi: 10.2174/1574884713666171212112540. [Epub ahead of print]

Comment: Tintanelli is 0.1mg every 2-3 minutes. Goldfrank is escalating doses every 2-3 minutes. Goldfrank reverses faster but results in more complications due to rapid reversal.

33) Back to the core: A network approach to bolster harm reduction among persons who inject drugs.

Bouchard M, Hashimi S, Tsai K, Lampkin H, Jozaghi E.

Int J Drug Policy. 2017 Dec 8;51:95-104. doi: 10.1016/j.drugpo.2017.10.006. [Epub ahead of print]

Comment: Network interventions make a lot of sense, and are really challenging to design / test.

34) An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study.

Katzman JG, Takeda MY, Bhatt SR, Moya Balasch M, Greenberg N, Yonas H.

J Addict Med. 2017 Dec 7. doi: 10.1097/ADM.0000000000000374. [Epub ahead of print]

Comment: Given naloxone to patients on agonist maintenance treatment leads to reversals in their immediate social networks.

35) Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon.

Ghaddar A, Abbas Z, Haddad R.

Harm Reduct J. 2017 Dec 8;14(1):78. doi: 10.1186/s12954-017-0204-8.

Comment: Treating opioid use disorder with proven medications works in Lebanon as well.

36) Rethinking Naloxone: Overdose drug is only one part of the cycle of narcotic abuse.

Richmond NJ.

JEMS. 2017 Feb;42(2):63. No abstract available.

Comment: Can’t access and no abstract.

37) Housing and overdose: an opportunity for the scale-up of overdose prevention interventions?

Bardwell G, Collins AB, McNeil R, Boyd J.

Harm Reduct J. 2017 Dec 6;14(1):77. doi: 10.1186/s12954-017-0203-9.

Comment: Important target for overdose prevention.

38) Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine.

Krawczyk N, Picher CE, Feder KA, Saloner B.

Health Aff (Millwood). 2017 Dec;36(12):2046-2053. doi: 10.1377/hlthaff.2017.0890.

Comment: Why aren’t we using the proven treatments for opioid use disorder? This is like not providing anti-hyperglycemic agents for a diabetic individual.

39) Opiate use disorders and overdose: Medical students’ experiences, satisfaction with learning, and attitudes toward community naloxone provision.

Tobin H, Klimas J, Barry T, Egan M, Bury G.

Addict Behav. 2017 Nov 22. pii: S0306-4603(17)30436-7. doi: 10.1016/j.addbeh.2017.11.028. [Epub ahead of print]

Comment: There is always a need for more education on this topic.

40) Factors associated with naloxone administration in an opioid dependent sample.

Kenney SR, Anderson BJ, Bailey GL, Stein MD.

J Subst Abuse Treat. 2018 Jan;84:17-20. doi: 10.1016/j.jsat.2017.10.008. Epub 2017 Oct 18.

Comment: Interesting analysis of people entering opioid detox. Only heroin users (i.e. no prescription opioid users) had administered naloxone and few African Americans had done so.

41) Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse.

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.

Comment: Vaccines have long been a goal of some for substance use disorders. There remain many challenges.

42) Case 37-2017. A 36-Year-Old Man with Unintentional Opioid Overdose.

Raja AS, Miller ES, Flores EJ, Wakeman SE, Eng G.

N Engl J Med. 2017 Nov 30;377(22):2181-2188. doi: 10.1056/NEJMcpc1710563. Comment: Exciting to see the NEJM taking a deep dive into a patient with an opioid use disorder!

43) Elderly Man in Respiratory Arrest.

Mackle T, Rhine D.

Ann Emerg Med. 2017 Oct;70(4):599-604. doi: 10.1016/j.annemergmed.2017.04.035. No abstract available.

Comment: Gastric perforation due to resuscitation. Complications of well-intentioned medical interventions … suck.

44) Detection of Carfentanil by LC-MS-MS and Reports of Associated Fatalities in the USA.

Shanks KG, Behonick GS.

J Anal Toxicol. 2017 Jul 1;41(6):466-472. doi: 10.1093/jat/bkx042.

Comment: Go low.

45) Naloxone Access and Use for Suspected Opioid Overdoses.

Ann Emerg Med. 2017 Jul;70(1):112-113. doi: 10.1016/j.annemergmed.2017.03.031. No abstract available.

Comment:  The American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the American College of Medical Toxicology (ACMT) affirm naloxone access for all emergency responders and lay persons by prescription, as well as the ability for pharmacists to furnish without prescription.

46) Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine.

Dempsey SK, Poklis JL, Sweat K, Cumpston K, Wolf CE.

J Anal Toxicol. 2017 Jul 1;41(6):547-550. doi: 10.1093/jat/bkx034.

Comment: A tricyclic antidepressant approved in Europe (not in the US) overdose that responded to naloxone … authors presume that this was managing the tricyclic overdose although one might wonder if there was an undetected synthetic opioid on board.

Consumption spaces

47) Changes in public order after the opening of an overdose monitoring facility for people who inject drugs.

León C, Cardoso LJP, Johnston S, Mackin S, Bock B, Gaeta JM.

Int J Drug Policy. 2017 Dec 30;53:90-95. doi: 10.1016/j.drugpo.2017.12.009. [Epub ahead of print]

Comment: There were fewer people on the streets oversedated.

48) Perceptions about supervised injection facilities among people who inject drugs in Philadelphia.

Harris RE, Richardson J, Frasso R, Anderson ED.

Int J Drug Policy. 2017 Dec 10;52:56-61. doi: 10.1016/j.drugpo.2017.11.005. [Epub ahead of print]

Comment: Again, people who use drugs support a safe consumption space.

OxyContin reformulation

49) The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study.

Larance B, Dobbins T, Peacock A, Ali R, Bruno R, Lintzeris N, Farrell M, Degenhardt L.

Lancet Psychiatry. 2018 Jan 10. pii: S2215-0366(18)30003-8. doi: 10.1016/S2215-0366(18)30003-8. [Epub ahead of print]

Comment: “This formulation of controlled-release oxycodone reduced tampering with pharmaceutical opioids among people who inject drugs, but did not affect population-level opioid use or harm.”

50) The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons.

Jauncey M, Livingston M, Salmon AM, Dietze P.

Int J Drug Policy. 2017 Dec 18;53:17-22. doi: 10.1016/j.drugpo.2017.11.025. [Epub ahead of print]

Comment: More on the unintended consequence of OxyContin reformulation.

Fentanyl papers

51) The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016.

Creppage KE, Yohannan J, Williams K, Buchanich JM, Songer TJ, Wisniewski SR, Fabio A.

Public Health Rep. 2018 Jan 1:33354917753119. doi: 10.1177/0033354917753119. [Epub ahead of print]

Comment: Per title.

52) Newly Emerging Drugs of Abuse and Their Detection Methods: An ACLPS Critical Review.

Liu L, Wheeler SE, Venkataramanan R, Rymer JA, Pizon AF, Lynch MJ, Tamama K.

Am J Clin Pathol. 2018 Jan 29;149(2):105-116. doi: 10.1093/ajcp/aqx138.

Comment: New standard for untargeted drug identification.

53) Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study.

Hayashi K, Milloy MJ, Lysyshyn M, DeBeck K, Nosova E, Wood E, Kerr T.

Drug Alcohol Depend. 2017 Dec 5;183:1-6. doi: 10.1016/j.drugalcdep.2017.10.020. [Epub ahead of print]

Comment: Lots of fentanyl exposure.

54) Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD.

Mars SG, Ondocsin J, Ciccarone D.

J Psychoactive Drugs. 2017 Dec 6:1-10. doi: 10.1080/02791072.2017.1394508. [Epub ahead of print]

Comment: Critical ethnography.

55) Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin.

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. Review.

Comment: Way more complicated than just pain meds.

56) Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn.

Shoff EN, Zaney ME, Kahl JH, Hime GW, Boland DM.

J Anal Toxicol. 2017 Jul 1;41(6):484-492. doi: 10.1093/jat/bkx041.

Comment: Another paper on identifying fentanyl analogs.

57) Fatalities Involving Carfentanil and Furanyl Fentanyl: Two Case Reports.

Swanson DM, Hair LS, Strauch Rivers SR, Smyth BC, Brogan SC, Ventoso AD, Vaccaro SL, Pearson JM.

J Anal Toxicol. 2017 Jul 1;41(6):498-502. doi: 10.1093/jat/bkx037.

Comment: And another!

1) Clinical Presentation and the Outcome of Therapy in a Cohort of Patients with Methadone Toxicity in Iran.

Eizadi-Mood N, Yaraghi A, Sharifian Z, Feizi A, Hedaiaty M, Sabzghabaee AM.

Mater Sociomed. 2015 Aug;27(4):276-9. doi: 10.5455/msm.2015.27.276-279.

Comments: Some interesting data on methadone toxicity in Iran. Length of stay was 33 hours (median). 90.3% survived. There were several complications. GCS on admission predicted survival. Useful data for economic modeling …

2) Overdose prevention for prisoners in New York: a novel program and collaboration.

Zucker H, Annucci AJ, Stancliff S, Catania H.

Harm Reduct J. 2015 Nov 5;12(1):51. doi: 10.1186/s12954-015-0084-8.

PMID: 26541987 Free Article

Comments: Early report describing the establishment of a prison naloxone program in NY. Some of the most important work happening in this area…

3) Response to “Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review”.

Winstanley EL, Clark A, Wilder CM.

J Addict Med. 2015 Dec;9(6):503-4. doi: 10.1097/ADM.0000000000000160. No abstract available.

Comments: Can’t access. Meh.

4) Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review: Re: Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014 May-June;8(3): 153-163.

Orkin AM, Bingham K, Buick JE, Klaiman M, Leece P, Kouyoumdjian F.

J Addict Med. 2015 Dec;9(6):502-3. doi: 10.1097/ADM.0000000000000161. No abstract available.

Comments: Also can’t access.

5) Implementation of an inpatient opioid overdose prevention program.

Clark A, Winstanley EL, Martsolf DS, Rosen M.

Addict Behav. 2015 Oct 8;53:141-145. doi: 10.1016/j.addbeh.2015.10.006. [Epub ahead of print] No abstract available.

Comments: Authors report on development of an electronic book on overdose prevention for use in addiction treatment settings.

6) Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods.

Ashrafioun L, Gamble S, Herrmann M, Baciewicz G.

Subst Abus. 2015 Oct 29:0. [Epub ahead of print]

Comments: Those trained in intranasal naloxone were more confident than those trained in injectable. That is odd, as studies suggest that injectable is easier than intranasal.

7) Methadone related deaths compared to all prescription related deaths.

Lev R, Petro S, Lee A, Lee O, Lucas J, Castillo EM, Egnatios J, Vilke GM.

Forensic Sci Int. 2015 Oct 22;257:347-352. doi: 10.1016/j.forsciint.2015.09.021. [Epub ahead of print]

Comments: The lack of data from methadone maintenance programs makes it quite challenging to interpret some of the methadone-related mortality data.

8) Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users.

McAuley A, Aucott L, Matheson C.

Int J Drug Policy. 2015 Oct 1. pii: S0955-3959(15)00306-0. doi: 10.1016/j.drugpo.2015.09.011. [Epub ahead of print]

Comments: 9% of kits were likely to be used for overdose rescue. That looks like a rather low number, but it’s over a 3-month period. I suspect the annual rate is closer to 20% +/- 5%.

9) Legal changes to increase access to naloxone for opioid overdose reversal in the United States.

Davis CS, Carr D.

Drug Alcohol Depend. 2015 Oct 22. pii: S0376-8716(15)01695-6. doi: 10.1016/j.drugalcdep.2015.10.013. [Epub ahead of print]

Comments: Great paper, title says it all.

10) Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J.

PLoS One. 2015 Oct 23;10(10):e0140995. doi: 10.1371/journal.pone.0140995. eCollection 2015.

Comments: I like this study. The physiology of “overdose” is totally fascinating and nowhere near as simple as it seems.

11) Hair testing in postmortem diagnosis of substance abuse: An unusual case of slow-release oral morphine abuse in an adolescent.

Baillif-Couniou V, Kintz P, Sastre C, Pok PP, Chèze M, Pépin G, Leonetti G, Pelissier-Alicot AL.

J Forensic Leg Med. 2015 Sep 4;36:172-176. doi: 10.1016/j.jflm.2015.08.014. [Epub ahead of print]

Comments: Morphine overdose in an adolescent in France. It’s news there because they don’t see people dying of prescription opioids like in the U.S.

12) Effects of acute and repeated administration of oxycodone and naloxone-precipitated withdrawal on Intracranial Self-Stimulation (ICSS) in rats.

Wiebelhaus JM, Walentiny DM, Beardsley PM.

J Pharmacol Exp Ther. 2015 Oct 21. pii: jpet.115.228940. [Epub ahead of print]

Comments: Oxycodone works like other opioids.

13) Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting.

Tucker D, Hayashi K, Milloy MJ, Nolan S, Dong H, Kerr T, Wood E.

Addict Behav. 2015 Oct 9;52:103-107. doi: 10.1016/j.addbeh.2015.10.002. [Epub ahead of print]

Comments: Benzo use is associated with lots of risk factors for negative health outcomes, including blood-borne virus transmission, among drug users.

14) Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid overdose-an important opportunity for saving lives.

Dailey M.

Addiction. 2015 Nov;110(11):1775-6. doi: 10.1111/add.13093. No abstract available.

Comments: Nice commentary, pointing out the opportunities for intervention among those who contact the medical system with an overdose.

15) Flumazenil, naloxone and the ‘coma cocktail’.

Sivilotti ML.

Br J Clin Pharmacol. 2015 Aug 7. doi: 10.1111/bcp.12731. [Epub ahead of print] Review.

Comments: Fascinating differences between benzo and opioid-induced respiratory depression. Benzos cause apnea usually because the upper airway is blocked or collapses – so respiratory support is the need – and the antidote can lead to seizures. Opioids are different and naloxone much safer.

16) Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies.

Cheatle MD, Webster LR.

Pain Med. 2015 Oct;16 Suppl 1:S22-6. doi: 10.1111/pme.12910. Review.

Comments: Opioids might be dangerous with sleep disorders.

17) More than just someone to inject drugs with: Injecting within primary injection partnerships.

Morris MD, Bates A, Andrew E, Hahn J, Page K, Maher L.

Drug Alcohol Depend. 2015 Nov 1;156:275-81. doi: 10.1016/j.drugalcdep.2015.09.025. Epub 2015 Sep 30.

Comments: Injection partnerships can have divergent benefits and risks.

18) A True Antidote.

Berlin J.

Tex Med. 2015 Oct 1;111(10):41-7.

Comments: Naloxone in Texas!

19) The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs.

Lake S, Hayashi K, Buxton J, Milloy MJ, Dong H, Wood E, Montaner J, Kerr T.

Drug Alcohol Depend. 2015 Nov 1;156:297-303. doi: 10.1016/j.drugalcdep.2015.09.026. Epub 2015 Sep 30.

Comments: Interesting analysis – injecting prescription opioids didn’t by itself increase overdose risk. Injecting of both prescription opioids and heroin did, however. So there is probably some protection offered by the known doses and constituents in prescription opioids.

20) Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature.

Martins SS, Sampson L, Cerdá M, Galea S.

Am J Public Health. 2015 Nov;105(11):e29-49. doi: 10.2105/AJPH.2015.302843.

Comments: Nice summary of global data looking at some basic overdose results. Mean/median rate of witnessed overdose in a drug user’s lifetime = 73/70%. Lifetime prevalence of experienced overdose was mean of 45.4% and median of 47%. Population-based overdose mortality rates varied from 0.4-46.6 / 100,000 person years (note, this is population based).

21) An Overdose Antidote Goes Mainstream.

Humphreys K.

Health Aff (Millwood). 2015 Oct 1;34(10):1624-7. doi: 10.1377/hlthaff.2015.0934.

Comments: Review of naloxone based on summer 2015 FDA meeting.

22) Is immunotherapy an opportunity for effective treatment of drug addiction?

Zalewska-Kaszubska J.

Vaccine. 2015 Oct 2. pii: S0264-410X(15)01369-9. doi: 10.1016/j.vaccine.2015.09.079. [Epub ahead of print] Review.

Comments: Really interesting idea – use antibodies against drugs, like cocaine, to manage overdose on those drugs. Excellent.

23) Involvement of Opioid Receptors in the Lipid Rescue of Bupivacaine-Induced Cardiotoxicity.

Partownavid P, Sharma S, Li J, Umar S, Rahman S, Eghbali M.

Anesth Analg. 2015 Aug;121(2):340-7. doi: 10.1213/ANE.0000000000000788.

Comments: Opioid receptors are required for rescuing people from the cardiac toxicity of bupivacaine overdose.

24) New drugs of abuse.

Rech MA, Donahey E, Cappiello Dziedzic JM, Oh L, Greenhalgh E.

Pharmacotherapy. 2015 Feb;35(2):189-97. doi: 10.1002/phar.1522. Epub 2014 Dec 4. Review.

Comments: Desomorphine. Blech.

25) What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose.

Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM.

Drug Alcohol Depend. 2014 Dec 1;145:34-47. doi: 10.1016/j.drugalcdep.2014.10.001. Epub 2014 Oct 14. Review.

Comments: Not much.

26) Access to harm reduction and HIV-related treatment services inside Indian prisons: experiences of formerly incarcerated injecting drug users.

Chakrapani V, Kamei R, Kipgen H, Kh JK.

Int J Prison Health. 2013;9(2):82-91. doi: 10.1108/17449201311326952.

Comments: Access is … no there.

27) Low Expression of D2R and Wntless Correlates With High Motivation for Heroin.

Tacelosky DM, Alexander DN, Morse M, Hajnal A, Berg A, Levenson R, Grigson PS.

Behav Neurosci. 2015 Oct 26. [Epub ahead of print]

Comments: Holding drug exposure constant, reducing dopamine D2 receptors or that other thing (Wntless) results in more opioid craving.

28) The misuse and abuse of prescription medications: part 1 current trends.

Allread V, Paul S.

MD Advis. 2014 Fall;7(4):12-20. Review.

Comments: Can’t access. Review for New Jersey and rest of US regarding prescription opioids and heroin use.

1) Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies.

Hawk KF, Vaca FE, D’Onofrio G.

Yale J Biol Med. 2015 Sep 3;88(3):235-245. eCollection 2015 Sep. Review.

Comment: Can’t access full article. Appears to be a review of harm reduction strategies for opioid overdose prevention.

2) Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update.

Brady KT, McCauley JL, Back SE.

Am J Psychiatry. 2015 Sep 4:appiajp201515020262. [Epub ahead of print]

Comment: Appropriately draws attention to the problem now faced in the United States: we are cutting back on opioid prescribing to try to limit further opioid dependence, but effectively abandoning many of the people who are already dependent.

3) Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

DeVido J, Connery H, Hill KP.

J Opioid Manag. 2015 Jul-Aug;11(4):363-6. doi: 10.5055/jom.2015.0285.

Comment: Two case reports of sleep-disordered breathing among buprenorphine patients suggesting that buprenorphine may contribute to sleep apnea.

4) Buprenorphine infrequently found in fatal overdose in New York City.

Paone D, Tuazon E, Stajic M, Sampson B, Allen B, Mantha S, Kunins H.

Drug Alcohol Depend. 2015 Aug 15. pii: S0376-8716(15)01598-7. doi: 10.1016/j.drugalcdep.2015.08.007. [Epub ahead of print]

Comment: Actually, none of the decedents tested positive for buprenorphine – very few (2) were found to have positive toxicology for norbuprenorphine, a metabolite demonstrating recent – but not recent enough to be causal – consumption of buprenorphine. This is not surprising since it’s tough to overdose on buprenorphine. Nice work.

5) Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication.

Hassanian-Moghaddam H, Soltaninejad K, Shadnia S, Kabir A, Movahed M, Mirafzal A.

Basic Clin Pharmacol Toxicol. 2015 Aug 24. doi: 10.1111/bcpt.12476. [Epub ahead of print]

Comment: Lower consciousness/respirations once in the emergency room were associated with increased likelihood of being intubated and/or dying from methadone overdose. This is interesting in the context of previous papers included on this blog that demonstrate lower likelihood of such outcomes when naloxone is administered in the field. Is it time to think of naloxone as an automated electronic defibrillator?

6) The characteristics of a cohort who tamper with prescribed and diverted opioid medications.

Larance B, Lintzeris N, Bruno R, Peacock A, Cama E, Ali R, Kihas I, Hordern A, White N, Degenhardt L.

J Subst Abuse Treat. 2015 Jun 24. pii: S0740-5472(15)00137-3. doi: 10.1016/j.jsat.2015.06.001. [Epub ahead of print]

Comment: This is a complex population. Although risk outcomes appear closer to those of someone who uses heroin than those of someone prescribed opioids, the clinical characteristics overlap substantially with the latter group.

7) Capsule Commentary on Binswanger et al., Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.

Jackson JL.

J Gen Intern Med. 2015 Aug 19. [Epub ahead of print] No abstract available.

Comment: Summarizes the Bingswanger paper and that’s about it.

8) Factors associated with illicit methadone injecting in a Canadian setting.

Tucker D, Milloy MJ, Hayashi K, Nguyen P, Kerr T, Wood E.

Am J Addict. 2015 Sep;24(6):532-7. doi: 10.1111/ajad.12257. Epub 2015 Aug 18.

Comment: Really high-risk people inject methadone.

9) Gender differences in mortality among treated opioid dependent patients.

Evans E, Kelleghan A, Li L, Min J, Huang D, Urada D, Hser YI, Nosyk B.

Drug Alcohol Depend. 2015 Jul 17. pii: S0376-8716(15)00381-6. doi: 10.1016/j.drugalcdep.2015.07.010. [Epub ahead of print]

Comment: Some findings from a longitudinal study that I find hard to interpret and potentially specious.

10) Clinical and Forensic Diagnosis of Very Recent Heroin Intake by 6-acetylmorphine Immunoassay Test and LC-MS/MS Analysis in Urine and Blood.

Borriello R, Carfora A, Cassandro P, Petrella R.

Ann Clin Lab Sci. 2015 Jul;45(4):414-8.

Comment: The 6-MAM assay is pretty good.

11) Intravenous Heroin-Associated Delayed Spongiform Leukoencephalopathy: Case Report and Reviews of the Literature.

Pirompanich P, Chankrachang S.

J Med Assoc Thai. 2015 Jul;98(7):703-8.

Comment: We’ve reviewed heroin-associated spongiform leukoencephalopathy before on this blog. This is another case identified in a heroin injector – instead of smoker – and review of the literature. Interestingly, this case was identified after an overdose.

12) Intermittent versus Persistent Wolff-Parkinson-White Syndrome in Children: Electrophysiologic Properties and Clinical Outcomes.

Kiger ME, McCanta AC, Tong S, Schaffer M, Runciman M, Collins KK.

Pacing Clin Electrophysiol. 2015 Aug 8. doi: 10.1111/pace.12732. [Epub ahead of print]

Comment: There are some questions about the role of cardiac disease on overdose risk – this is pretty clearly the case for cocaine but not well understood for opioids. This report on WPW patients (WPW is an electrical conduction disease of the heart that affects repolarization of cardiac tissue and can result in potentially fatal arrhythmias in otherwise healthy people) refers briefly to a WPW patient who had to be resuscitated after methadone overdose. No further details unfortunately.

13) Orienting patients to greater opioid safety: models of community pharmacy-basednaloxone.

Green TC, Dauria EF, Bratberg J, Davis CS, Walley AY.

Harm Reduct J. 2015 Aug 6;12:25. doi: 10.1186/s12954-015-0058-x.

Comment: Two models of pharmacy provision of naloxone. Exciting work in New England.

14) Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers.

LaBelle CT, Han SC, Bergeron A, Samet JH.

J Subst Abuse Treat. 2015 Jun 26. pii: S0740-5472(15)00146-4. doi: 10.1016/j.jsat.2015.06.010. [Epub ahead of print]

Comment: Describes an effort to expand buprenorphine treatment availability in Massachusetts.

15) Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011.

Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S.

Arch Iran Med. 2014 Aug;17(8):534-8. doi: 014178/AIM.003.

Comment: Interesting that pesticides match opioids as the two leading causes of poisoning death.

16) DOH issues emergency regulations on expanding use of Narcan to prevent opioidoverdose deaths.

R I Med J (2013). 2014 Apr;97(4):49. No abstract available.

Comment: We should exercise caution in our use of the term “Narcan” in the future as the brand was purchased by the manufacturers of a nasal device that is likely to be approved in the near future. Promoting one brand over another is poor form in public health and academic venues.

1. Opioid OverdosePrevention Programs Providing Naloxoneto Laypersons – United States, 2014.

Wheeler E, Jones TS, Gilbert MK, Davidson PJ.

MMWR Morb Mortal Wkly Rep. 2015 Jun 19;64(23):631-5.

Comment: The long-awaited sequel to 2010’s blockbuster naloxone MMWR report! 152,283 laypersons trained and 26,463 overdose reversals reported to naloxone programs through 2014.

2. Heroin-related overdose: The unexplored influences of markets, marketing and source-types in the United States.

Mars SG, Fessel JN, Bourgois P, Montero F, Karandinos G, Ciccarone D.

Soc Sci Med. 2015 Jun 30;140:44-53. doi: 10.1016/j.socscimed.2015.06.032. [Epub ahead of print]

Comment: Interesting use of qualitative data exploring the role of heroin markets on overdose risk, suggesting that factors such as open-air versus behind-closed-door markets can affect risk.

3. Risk factors for concurrent use of benzodiazepines and opioids among individuals under community corrections supervision.

Cropsey KL, Stevens EN, Valera P, Brendan Clark C, Bulls HW, Nair P, Lane PS.

Drug Alcohol Depend. 2015 Jul 10. pii: S0376-8716(15)00352-X. doi: 10.1016/j.drugalcdep.2015.06.038. [Epub ahead of print]

Comment: There’s a movement toward not prescribing opioids with benzodiazepines at all. This makes some sense from an overdose prevention perspective, however the impact of such a policy is unknown. Those who require both opioids and benzodiazepines generally have far more complex and substantial mental health challenges. Just removing one or the other of the agents may results in worsening mental health or even increased rates of self-harm. Or not. Nobody knows.

4. Drugquality assessment practices and communication of drugalerts among people who use drugs.

Soukup-Baljak Y, Greer AM, Amlani A, Sampson O, Buxton JA.

Int J Drug Policy. 2015 Jul 2. pii: S0955-3959(15)00200-5. doi: 10.1016/j.drugpo.2015.06.006. [Epub ahead of print]

Comment: This is interesting, particularly in an era of frequent high-potency batches of heroin or even pure fentanyl derivatives. Subjects recommend using words like “dangerous” or “lethal” instead of “potent” which can be misconstrued as desirable. They also emphasized timeliness. As one of the first studies to really look at this issue, this paper is well worth the read.

5. Opioid OverdoseDeaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities.

Visconti AJ, Santos GM, Lemos NP, Burke C, Coffin PO.

J Urban Health. 2015 Jun 16. [Epub ahead of print]

Comment: Epidemiology of opioid overdose mortality in San Francisco – the first since Pete Davidson’s seminal geocoding paper in 2003 that led SF to refocus overdose prevention efforts to the hardest hit neighborhoods. This paper documents that heroin overdose is now remarkably rare in San Francisco, although for me it raises more questions than it answers.

6. Ethanol Reversal of Tolerance to the Respiratory Depressant Effects of Morphine.

Hill R, Lyndon A, Withey S, Roberts J, Kershaw Y, MacLachlan J, Lingford-Hughes A, Kelly E, Bailey C, Hickman M, Henderson G.

Neuropsychopharmacology. 2015 Jul 14. doi: 10.1038/npp.2015.201. [Epub ahead of print]

Comment: Okay, this is a very cool mouse study. They gave morphine to mice until they developed tolerance. The tolerance to respiratory depression effects of morphine were reversed by ethanol. Methadone and buprenorphine seemed to protect mice from this reversal of tolerance effect. Very cool. This is why I do these reviews.

7. OverdoseEducation and Naloxonefor Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.

Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM.

J Gen Intern Med. 2015 Jun 9. [Epub ahead of print]

Comment: Interesting initial look at prescriber concerns regarding prescribing naloxone from primary care practices. Issues are knowledge about lay use, uncertainty about who to prescribe to, logistical barriers, fears about offending patients, fears about risky use, and discomfort with their own opioid prescribing practices.

8. Methadoneoverdosecausing acute cerebellitis and multi-organ damage.

Rando J, Szari S, Kumar G, Lingadevaru H.

Am J Emerg Med. 2015 Jun 18. pii: S0735-6757(15)00509-4. doi: 10.1016/j.ajem.2015.06.032. [Epub ahead of print] No abstract available.

Comment: A very sad case in which a 14 year old boy accessed his mother’s methadone (apparently prescribed for pain) and had severe disease of the cerebellum as a result. When we speak of opioid overdose, we are generally talking about respiratory depression, but there are some complications that can be unique to particular opioids.

9. Vital Signs: Demographic and Substance Use Trends Among HeroinUsers – United States, 2002-2013.

Jones CM, Logan J, Gladden RM, Bohm MK.

MMWR Morb Mortal Wkly Rep. 2015 Jul 10;64(26):719-25.

Comment: Just after 2010 there was a big uptick in heroin use and overdose mortality. Again, this suggests that the increases in heroin use and sequelae were not simply the inevitable consequence of increased opioid dependence, but resulted from – or were substantially contributed to by – restrictions on prescription opioids. It is essential to recognize this in order to minimize the harms of the new/emerging paradigm of opioid prescribing.

10. High uptake of naloxone-based overdoseprevention training among previously incarcerated syringe-exchange program participants.

Barocas JA, Baker L, Hull SJ, Stokes S, Westergaard RP.

Drug Alcohol Depend. 2015 Jun 24. pii: S0376-8716(15)00322-1. doi: 10.1016/j.drugalcdep.2015.06.023. [Epub ahead of print]

Comment: People who have been incarcerated are more likely to access naloxone programs. This is consistent with the aims of naloxone programming.

11. Messaging to Increase Public Support for NaloxoneDistribution Policies in the United States: Results from a Randomized Survey Experiment.

Bachhuber MA, McGinty EE, Kennedy-Hendricks A, Niederdeppe J, Barry CL.

PLoS One. 2015 Jul 1;10(7):e0130050. doi: 10.1371/journal.pone.0130050. eCollection 2015.

Comment: Useful study testing different approaches to providing information about naloxone programming. The finding that adding sympathetic narratives to factual information roughly doubles support for the programs is consistent with recent experience in which personal exposure to the tragedy of opioid overdose has led many people in positions of power to advocate for naloxone programming.

12. Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdoseamong psychologically distressed people who inject drugs?

Betts KS, McIlwraith F, Dietze P, Whittaker E, Burns L, Cogger S, Alati R.

Drug Alcohol Depend. 2015 Jun 22. pii: S0376-8716(15)00319-1. doi: 10.1016/j.drugalcdep.2015.06.020. [Epub ahead of print]

Comment: This is fascinating. Polysubstance use research is an underdeveloped (and surprisingly challenging) avenue of research. The finding that those with less psychological distress are protected by a combination of agonist maintenance and prescription drug use is of particular interest…

13. Duration of opioid receptor blockade determines biotherapeutic response.

McLaughlin PJ, Zagon IS.

Biochem Pharmacol. 2015 Jun 25. pii: S0006-2952(15)00332-9. doi: 10.1016/j.bcp.2015.06.016. [Epub ahead of print]

Comment: This isn’t really about overdose or even substance use, but it’s about naloxone and naltrexone – opioid blockers – and it’s intriguing. There are some other potential therapeutic roles for opioid blockade, related to complications of diabetes, autoimmune disorders, and cancer.

14. Chiral analysis of methorphan in opiate-overdoserelated deaths by using capillary electrophoresis.

Bertaso A, Musile G, Gottardo R, Seri C, Tagliaro F.

J Chromatogr B Analyt Technol Biomed Life Sci. 2015 Jul 19;1000:130-135. doi: 10.1016/j.jchromb.2015.07.024.

Comment: Methorphan, a codeine analog and related to dextromethorphan, is being added to heroin sometimes. This paper describes how to test for it.

15. Naloxone-does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose.

Neale J, Strang J.

Addiction. 2015 Jun 27. doi: 10.1111/add.13027. [Epub ahead of print]

Comment: Medical professionals are generally cautious in administering naloxone these days because we know it makes patients miserable. Low doses and, if in a monitored setting, only using it when oxygen saturation begins to decline helps to minimize the untoward effects. In this study naloxone had a bad rap but respondents often didn’t know that it had been administered because it was done cautiously.

16. Technology: Barriers to misuse.

Dolgin E.

Nature. 2015 Jun 25;522(7557):S60-1. doi: 10.1038/522S60a. No abstract available.

Comment: There’s a serious problem with the term “abuse-deterrent formulations.” These are formulations of opioids that are more difficult to inject – or in some cases insufflate. They should really be referred to as “injection-deterrent formulations.” They don’t prevent somebody from developing an opioid habit. This article instead reads more like a press release for “abuse-deterrent formulations.”

17. Incidence and predictors of non-fatal drug overdoseafter release from prison among people who inject drugs in Queensland, Australia.

Winter RJ, Stoové M, Degenhardt L, Hellard ME, Spelman T, Jenkinson R, McCarthy DR, Kinner SA.

Drug Alcohol Depend. 2015 Aug 1;153:43-9. doi: 10.1016/j.drugalcdep.2015.06.011. Epub 2015 Jun 16.

Comment: People overdose after they leave prison.

18. The Supply of Physicians Waivered to Prescribe Buprenorphinefor Opioid Use Disorders in the United States: A State-Level Analysis.

Knudsen HK.

J Stud Alcohol Drugs. 2015 Jul;76(4):644-54.

Comment: The average U.S. state has 8 physicians per 100,000 residents able to prescribe buprenorphine for opioid dependence. This rate is even worse in many states, from a low of 1.9 in Nebraska to a high of 27.9 in Vermont. Appalachia – probably the region with the most urgent need – has a rate of 3 to 11 / 100,000 residents. We really need to do something about this waiver situation.

19. Druguse patterns predict risk of non-fatal overdoseamong street-involved youth in a Canadian setting.

Mitra G, Wood E, Nguyen P, Kerr T, DeBeck K.

Drug Alcohol Depend. 2015 Aug 1;153:135-9. doi: 10.1016/j.drugalcdep.2015.05.035. Epub 2015 May 28.

Comment: This is a sample of street-involved youth – 17.1% injected heroin. Any opioid use was associated with overdose, but interestingly prescription opioid use was a stronger predictor than heroin. That’s surprising. The relatively low overall rate of overdose – 7.67/100,000 person years is not surprising given the distribution of substance use.

20. The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of HeroinUse, and the Federal Response.

Kanouse AB, Compton P.

J Pain Palliat Care Pharmacother. 2015 Jun;29(2):102-14. doi: 10.3109/15360288.2015.1037521.

Comment: This leaves some holes in the story, such as the role of reduced access to prescription opioids has had in rising heroin use. Another issue is the suggestion in the text that police getting naloxone has led to 10,000 lay reversals. These were lay person – aka drug user – reversals. It’s frustrating to see this misinformation being spread in the literature.

21. Association between non-fatal opioid overdoseand encounters with healthcare and criminal justice systems: Identifying opportunities for intervention.

Wagner KD, Liu L, Davidson PJ, Cuevas-Mota J, Armenta RF, Garfein RS.

Drug Alcohol Depend. 2015 Aug 1;153:215-20. doi: 10.1016/j.drugalcdep.2015.05.026. Epub 2015 May 27.

Comment: Criminal justice and hospital-related opportunities for naloxone distribution.

22. Harm Reduction: Front Line Public Health.

Stancliff S, Phillips BW, Maghsoudi N, Joseph H.

J Addict Dis. 2015 Jun 16:0. [Epub ahead of print]

Comment: Excellent harm reduction review.

23. Intranasal naloxoneadministration by police first responders is associated with decreased opioid overdosedeaths.

Rando J, Broering D, Olson JE, Marco C, Evans SB.

Am J Emerg Med. 2015 May 29. pii: S0735-6757(15)00443-X. doi: 10.1016/j.ajem.2015.05.022. [Epub ahead of print]

Comment: Naloxone should be in the hands of first responders. Even more important, however, is that naloxone is in the hands of people who use drugs – who are much more likely to be present at the time of an overdose. If the data from this paper are scientific evidence that naloxone given to first responders is associated with reduced mortality, then we had much stronger evidence for giving it to drug users in the late 20^th century. Neither of those statements is true.

24. Heroinuse, HIV-risk, and criminal behavior in Baltimore: Findings from Clinical Research.

Schwartz RP, Kelly SM, Gryczynski J, Mitchell SG, O’Grady KE, Jaffe JH.

J Addict Dis. 2015 Jun 16:0. [Epub ahead of print]

Comment: Interesting data and experience out of Baltimore with harm reduction interventions.

25. Engaging Law Enforcement in OverdoseReversal Initiatives: Authorization and Liability for NaloxoneAdministration.

Davis CS, Carr D, Southwell JK, Beletsky L.

Am J Public Health. 2015 Aug;105(8):1530-7. doi: 10.2105/AJPH.2015.302638. Epub 2015 Jun 11.

Comment: Review of police and naloxone administration.

26. Prehospital NaloxoneAdministration as a Public Health Surveillance Tool: A Retrospective Validation Study.

Lindstrom HA, Clemency BM, Snyder R, Consiglio JD, May PR, Moscati RM.

Prehosp Disaster Med. 2015 Jun 10:1-5. [Epub ahead of print]

Comment: Interesting paper. Pre-hospital naloxone administrations are more likely for heroin overdose than prescription opioid overdose.

27. Accidental methadoneintoxication masquerading as asthma exacerbation with respiratory arrest in a six-year-old boy.

Swenson O.

Del Med J. 2015 May;87(5):147-9.

Comment: Keep your eyes out for pinpoint pupils.

28. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery.

Lubana SS, Genin DI, Singh N, De La Cruz A.

Am J Case Rep. 2015 Jun 8;16:353-6. doi: 10.12659/AJCR.893880.

Comment: Survival after cardiac arrest in opioid overdose is thought to be quite uncommon.

29. Economic impact of a novel naloxoneautoinjector on third-party payers.

Weiss RC, Bazalo GR, Thomson H, Edwards E.

Manag Care. 2015 Feb;24(2):41-8.

Comment: This model attempts to estimate the cost to payers of the naloxone autoinjector, accounting for anticipated savings. There are some serious issues with this model that are quite disappointing. As a minor example, authors used “80%” as the likelihood naloxone would be administered. This assumption was based on a qualitative paper estimating the likelihood that naloxone would be administered if a heroin user was carrying it. In this paper it was used as the likelihood that the autoinjector would be used in an overdose if it had been prescribed. For a model such as this, that’s a quite different parameter.

30. A comparison of liver disease mortality with HIV and overdosemortality among Georgia prisoners and releasees: a 2-decade cohort study of prisoners incarcerated in 1991.

Spaulding AC, Sharma A, Messina LC, Zlotorzynska M, Miller L, Binswanger IA.

Am J Public Health. 2015 May;105(5):e51-7. doi: 10.2105/AJPH.2014.302546. Epub 2015 Mar 19.

Comment: Another paper from the analysis of mortality among prisoners in the state of Georgia (not the country). Overdose was only a minor contributor, in contrast to many other prison releasee studies.

31. Overdosereversal.

Spencer S.

Am J Nurs. 2015 Jan;115(1):13. doi: 10.1097/01.NAJ.0000459609.86788.ac. No abstract available.

Comment: Letter I’m unable to access.

32. Safety studies of post-surgical buprenorphinetherapy for mice.

Traul KA, Romero JB, Brayton C, DeTolla L, Forbes-McBean N, Halquist MS, Karnes HT, Sarabia-Estrada R, Tomlinson MJ, Tyler BM, Ye X, Zadnik P, Guarnieri M.

Lab Anim. 2015 Apr;49(2):100-10. doi: 10.1177/0023677214554216. Epub 2014 Oct 10.

Comment: Mice can handle remarkably high doses of buprenorphine without adverse effects.

33. An overview of the patterns of prescription opioid use, costs and related harms in Australia.

Blanch B, Pearson SA, Haber PS.

Br J Clin Pharmacol. 2014 Nov;78(5):1159-66. doi: 10.1111/bcp.12446. Review.

Comment: Review of opioid use and death rates in Australia, illustrating something that looks like a very mild version of what’s happened in the U.S.

34. Gender differences in mortality and risk factors in a 13-year cohort study of street-recruited injecting drugusers.

Gjersing L, Bretteville-Jensen AL.

BMC Public Health. 2014 May 10;14:440. doi: 10.1186/1471-2458-14-440.

Comment: Study in Norway of mortality among injectors recruited in 1997 and followed for 13 years, comparing men to women. Overdose was the leading cause of death. Men had a higher mortality rate but women had higher early mortality.

1) Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic.

Dahlem CH, Horstman MJ, Williams BC.

J Am Assoc Nurse Pract. 2015 Mar 26. doi: 10.1002/2327-6924.12249. [Epub ahead of print]

Comments: Naloxone programs have been providing kits to settings where homeless people receive services for many years. This is a description of a program at a homeless health clinic.

2) Quantification of morphine, morphine 6-glucuronide, buprenorphine, and the enantiomers of methadone by enantioselective mass spectrometric chromatography in whole blood.

Christoffersen DJ, Brasch-Andersen C, Thomsen JL, Worm-Leonhard M, Damkier P, Brøsen K.

Forensic Sci Med Pathol. 2015 Jun;11(2):193-201. doi: 10.1007/s12024-015-9673-9. Epub 2015 Mar 24.

Comments: It’s been awhile since we had a forensics paper here. I think this is a novel method of identifying enantiomers.

3) A Comparison of Liver Disease Mortality With HIV and Overdose Mortality Among Georgia Prisoners and Releasees: A 2-Decade Cohort Study of Prisoners Incarcerated in 1991.

Spaulding AC, Sharma A, Messina LC, Zlotorzynska M, Miller L, Binswanger IA.

Am J Public Health. 2015 May;105(5):e51-7. doi: 10.2105/AJPH.2014.302546. Epub 2015 Mar 19.

Comments: Stunningly low rate of drug overdose mortality in this cohort of prisoners in Georgia. This is one of the first times I’ve seen a paper on opioid overdose find radically different results in a different setting. I can’t access for details.

4) A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming Into Clinical Practice.

Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA.

Subst Abus. 2015 Mar 16:1-14. [Epub ahead of print]

Comments: A review toward the end of using community distribution data to build clinical care naloxone prescription.

5) Long-term course of opioid addiction.

Hser YI, Evans E, Grella C, Ling W, Anglin D.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):76-89. doi: 10.1097/HRP.0000000000000052.

Comments: This is a systematic review of long-term studies of opioid users. Among many fascinating data reported, the length of time not using a drug of choice increases the likelihood of continuing to not use that drug. This seems obvious to many, but I don’t believe it’s been documented before. Good read for anyone looking to understand some of the longitudinal outcome data.

6) Medication-assisted treatment of opioid use disorder: review of the evidence and future directions.

Connery HS.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):63-75. doi: 10.1097/HRP.0000000000000075.

Comments: Nice review of treatment options for opioids. Strong evidence for methadone and buprenorphine. Weak evidence of naltrexone therapies – with oral increasing mortality and early but favorable evidence for injectable naltrexone.

7) The impact of chronic pain on opioid addiction treatment: a systematic review protocol.

Dennis BB, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z.

Syst Rev. 2015 Apr 16;4(1):49. doi: 10.1186/s13643-015-0042-2.

Comments: A paper describing a planned paper. Hmm.

8) Acute fatal posthypoxic leukoencephalopathy following benzodiazepine overdose: a case report and review of the literature.

Aljarallah S, Al-Hussain F.

BMC Neurol. 2015 Apr 30;15(1):69. doi: 10.1186/s12883-015-0320-6.

Comments: Usually we see this after opioid overdose. Interesting.

9) Functional mu opioid receptor polymorphism (OPRM1 A¹¹⁸ G) associated with heroinuse outcomes in Caucasian males: A pilot study.

Woodcock EA, Lundahl LH, Burmeister M, Greenwald MK.

Am J Addict. 2015 Apr 24. doi: 10.1111/ajad.12187. [Epub ahead of print]

Comments: The 118G allele was once associated with better responsiveness to naltrexone for alcohol dependence. Interesting now to see it associated with more troubling heroin use patterns. Can’t access full article for details.

10) Comparative Usability Study of a Novel Auto-Injector and an Intranasal System for Naloxone Delivery.

Edwards ET, Edwards ES, Davis E, Mulcare M, Wiklund M, Kelley G.

Pain Ther. 2015 Apr 25. [Epub ahead of print]

Comments: The naloxone autoinjector is easier to use than the jerry-rigged intranasal device.

11) Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in US Rural Communities.

Faul M, Dailey MW, Sugerman DE, Sasser SM, Levy B, Paulozzi LJ.

Am J Public Health. 2015 Apr 23:e1-e7. [Epub ahead of print]

Comments: Basic life support-trained EMTs generally don’t administer naloxone – and they deal with most overdoses in rural areas.

12) HIV prevention and treatment strategies can help address the overdose crisis.

Walley AY.

Prev Med. 2015 Apr 18. pii: S0091-7435(15)00109-7. doi: 10.1016/j.ypmed.2015.04.004. [Epub ahead of print]

Comments: Yup.

13) Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene.

Larochelle MR, Zhang F, Ross-Degnan D, Wharam JF.

JAMA Intern Med. 2015 Apr 20. doi: 10.1001/jamainternmed.2015.0914. [Epub ahead of print]

Comments: Being that I’m not a pharmaceutical company, my interest is in the welfare of people regardless of what they are putting into their bodies. Oxycodone, morphine, methadone, hydromorphone, oxymorphone, or heroin. The clear uptick in heroin use and heroin (as well as overall opioid) overdose mortality began when we started using injection-deterrent formulations (the formulations only address injection – not other potentially problematic use patterns).

14) Paramedic supplied “take home” naloxone: a randomised feasibility study.

Moore C, Lloyd G, Oretti R, Russell I, Snooks H.

Emerg Med J. 2015 May;32(5):421-2. doi: 10.1136/emermed-2015-204877.3.

Comments: Great idea. I believe the naloxone program in Inverness, Scotland, first inspired this idea by following up with overdose patients in the month after a paramedic reversal.

15) Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio.

Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, Starr S.

Subst Abuse Treat Prev Policy. 2015 Mar 28;10(1):13. doi: 10.1186/s13011-015-0009-2.

Comments: Unfortunately there are multiple barriers. Physician availability, reimbursement, etc.

16) Prescription opioid abuse: Problems and responses.

Compton WM, Boyle M, Wargo E.

Prev Med. 2015 Apr 11. pii: S0091-7435(15)00103-6. doi: 10.1016/j.ypmed.2015.04.003. [Epub ahead of print]

Comments: Review of prescription opioid use problems and responses, including agonist treatment and naloxone.

17) Reducing the harm of opioid overdose with the safe use of naloxone : a pharmacologic review.

Kim HK, Nelson LS.

Expert Opin Drug Saf. 2015 Apr 12:1-10. [Epub ahead of print]

Comments: Naloxone is safe. Don’t use massive doses or people go into severe withdrawal. Lay programs generally use 0.4mg intramuscular. The intranasal 2mg dose has some variability, but is probably equivalent to 0.3-0.4mg intramuscular for many people.

18) Lessons learned from the expansion of naloxone access in Massachusetts and North Carolina.

Davis CS, Walley AY, Bridger CM.

J Law Med Ethics. 2015 Mar;43 Suppl 1:19-22. doi: 10.1111/jlme.12208.

Comments: Laws aren’t enough. Providers need education and the formulations are problematic.

19) Naloxone’s basic benefit. Why the overdose-reversal drug is worth expanding beyond just ALS providers.

Furlano E.

EMS World. 2014 Oct;43(10):28-30, 32-4. No abstract available.

Comments: Basic life support-trained providers should have naloxone.

20) Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program.

Rowe C, Santos GM, Vittinghoff E, Wheeler E, Davidson P, Coffin PO.

Addiction. 2015 Apr 27. doi: 10.1111/add.12961. [Epub ahead of print]

Comments: Among recipients of take-home naloxone, those most likely to report using it to reverse an overdose are active drug users themselves. This emphasizes the top priority of getting naloxone into the hands of drug users.

21) Causes of death in a cohort treated for opioid dependence between 1985 and 2005.

Degenhardt L, Larney S, Randall D, Burns L, Hall W.

Addiction. 2014 Jan;109(1):90-9. doi: 10.1111/add.12337. Epub 2013 Oct 9.

Comments: Another stellar longitudinal paper. Overdose is of course the driver of mortality, but major organ disease-related mortality becomes a close competitor after age 45. Suicide is common, accounting for 10-15% of mortality. Another must read.

26) Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users.

Espelt A, Barrio G, Álamo-Junquera D, Bravo MJ, Sarasa-Renedo A, Vallejo F, Molist G, Brugal MT.

Eur Addict Res. 2015 May 28;21(6):300-306. [Epub ahead of print]

Comments: Authors of this study from Madrid and Barcelona come to a similar conclusion as some older papers on heroin overdose – that approximately 4% are fatal. Of note, these are young heroin users, which implies events that are more likely to be witnessed. Mortality is likely higher among older users, who are more likely to be socially isolated, leading to an overall estimated mortality of approximately 10%.

27) Dynamic model of nonmedical opioid use trajectories and potential policy interventions.

Wakeland W, Nielsen A, Geissert P.

Am J Drug Alcohol Abuse. 2015 May 18:1-11. [Epub ahead of print]

Comments: I can’t access. I believe this was also presented as a poster at CPDD this year.

28) Fentanyls: Are we missing the signs? Highly potent and on the rise in Europe.

Mounteney J, Giraudon I, Denissov G, Griffiths P.

Int J Drug Policy. 2015 Apr 17. pii: S0955-3959(15)00097-3. doi: 10.1016/j.drugpo.2015.04.003. [Epub ahead of print]

Comments: Ugh. Fentanyl is scary because it is dosed in micrograms – which is really hard to do safely, especially in an illicit market.

29) Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012.

Meiman J, Tomasallo C, Paulozzi L.

Drug Alcohol Depend. 2015 Jul 1;152:177-184. doi: 10.1016/j.drugalcdep.2015.04.002. Epub 2015 Apr 18.

Comments: Most states/localities saw a stark inflection point in heroin overdose events after 2010; that inflection seems less pronounced in this study.

30) Overdose prevention in injecting opioid users: the role of substance abuse treatment and training programs.

Sarasa-Renedo A, Espelt A, Folch C, Vecino C, Majó X, Castellano Y, Casabona J, Brugal MT; Redan Study Group.

Gac Sanit. 2014 Mar-Apr;28(2):146-54. doi: 10.1016/j.gaceta.2013.10.012. Epub 2014 Jan 10.

Comments: Study out of Barcelona looking at predictors of less overdose prevention knowledge.

31) Griffith Edwards, the Addiction Research Unit and research on the criminal justice system.

Farrell M, Marsden J, Strang J.

Addiction. 2015 Jul;110 Suppl 2:54-8. doi: 10.1111/add.12910.

Comments: Review of Griffith Edwards’s work in the 1960s and 1970s addressing the transition from correctional to community settings. Important prelude to what’s been done over the past 20 years and what we hope will be achieved in the years to come.

32) Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths.

Strang J.

Addiction. 2015 Jul;110 Suppl 2:27-35. doi: 10.1111/add.12904.

Comments: Let’s move on to implementation science?

33) Reversal of overdose on fentanyl being illicitly sold as heroin with naloxone nasal spray: A case report.

Fareed A, Buchanan-Cummings AM, Crampton K, Grant A, Drexler K.

Am J Addict. 2015 Jun 3. doi: 10.1111/ajad.12230. [Epub ahead of print]

Comments: Report out of the Veterans’ Administration, which is admirably taking on overdose prevention.

34) Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial.

Rich JD, McKenzie M, Larney S, Wong JB, Tran L, Clarke J, Noska A, Reddy M, Zaller N.

Lancet. 2015 May 28. pii: S0140-6736(14)62338-2. doi: 10.1016/S0140-6736(14)62338-2. [Epub ahead of print]

Comments: With respect to the excellent investigators, are we really living in a world where this kind of study is either needed or permitted? “Usual care” as forced withdrawal of a life-saving medication is … leaving me speechless.

35) The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales.

Marteau D, McDonald R, Patel K.

BMJ Open. 2015 May 29;5(5):e007629. doi: 10.1136/bmjopen-2015-007629.

Comments: Buprenorphine is six times safer than methadone with regard to risk of drug overdose death. This is, of course, observational, and does not take into account differing characteristics of opioid dependent persons that may drive them to one treatment or another. Methadone is an invaluable tool for a large proportion of individuals in need.

36) Distribution of naloxone for overdose prevention to chronic pain patients.

Coe MA, Walsh SL.

Prev Med. 2015 May 27. pii: S0091-7435(15)00175-9. doi: 10.1016/j.ypmed.2015.05.016. [Epub ahead of print]

Comments: Commentary on the concept of co-prescribing naloxone to pain patients on opioids.

37) Responding to illicit drug use in family practice.

Robertson JR, Robertson AR.

Curr Opin Psychiatry. 2015 Jul;28(4):286-91. doi: 10.1097/YCO.0000000000000174.

Comments: Review of substance use issues affecting family practice providers.

38) Reducing opioid analgesic deaths in america: what health providers can do.

Agarin T, Trescot AM, Agarin A, Lesanics D, Decastro C.

Pain Physician. 2015 May-Jun;18(3):E307-22.

Comments: Nobody knows yet.

39) Opioid education and nasal naloxone rescue kits in the emergency department.

Dwyer K, Walley AY, Langlois BK, Mitchell PM, Nelson KP, Cromwell J, Bernstein E.

West J Emerg Med. 2015 May;16(3):381-284. doi: 10.5811/westjem.2015.2.24909. Epub 2015 Apr 1.

Comments: Nice initial observational study of naloxone from emergency departments. Low response rate.

40) Buprenorphine treatment for narcotic addiction: not without risks.

Sansone RA, Sansone LA.

Innov Clin Neurosci. 2015 Mar-Apr;12(3-4):32-6.

Comments: Buprenorphine is hard to overdose on in the absence of sedatives such as benzodiazepines. There is diversion, but largely to individuals already dependent on opioids who are seeking to stave off withdrawal or often self-detox. It’s about time we moved on to more sophisticated diversion research, which differentiated the type of prescription drug diversion most people have engaged in – like sharing your leftover amoxicillin or hydrocortisone cream – and more dangerous forms.

41) Coherent long-term treatment approaches-superior in the treatment of opioid dependence.

Clausen T.

Addiction. 2015 Jun;110(6):1006-7. doi: 10.1111/add.12922. No abstract available.

Comments: Nice commentary on the role and importance of agonist medications in treating opioid use disorder.

42) Economic impact of a novel naloxone autoinjector on third-party payers.

Weiss RC, Bazalo GR, Thomson H, Edwards E.

Manag Care. 2015 Feb;24(2):41-8.

Comments: I can no longer claim to have the only mathematical model of opioid overdose! This is a model from the payer perspective. Funded and co-authored by the manufacturers of the naloxone autoinjector.

43) Take home naloxone for Ireland.

Bury G.

Ir Med J. 2015 Mar;108(3):70. No abstract available.

Comments: can’t access.

44) [The message from heroin overdoses].

Pap Á, Hegedűs K.

Orv Hetil. 2015 Mar 1;156(9):352-7. doi: 10.1556/OH.2015.30091. Review. Hungarian.

Comments: Review of overdose / prevention in Hungary.

45) Out-of-hospital mortality among patients receiving methadone for noncancer pain.

Ray WA, Chung CP, Murray KT, Cooper WO, Hall K, Stein CM.

JAMA Intern Med. 2015 Mar;175(3):420-7. doi: 10.1001/jamainternmed.2014.6294.

Comments: More on the potential hazards of methadone when used for chronic noncancer pain. I remain mixed on these data. There is a mechanistic argument that methadone is more risky, but at the same time it is generally prescribed to lower income patients with less optimal insurance that doesn’t cover the more expensive long-acting opioid formulations. It’s hard to convincingly disentangle the risks of the population from the risks of the drug.

46) Increased densities of nitric oxide synthase expressing neurons in the temporal cortex and the hypothalamic paraventricular nucleus of polytoxicomanic heroinoverdose victims: possible implications for heroin neurotoxicity.

Bernstein HG, Trübner K, Krebs P, Dobrowolny H, Bielau H, Steiner J, Bogerts B.

Acta Histochem. 2014 Jan;116(1):182-90. doi: 10.1016/j.acthis.2013.07.006. Epub 2013 Aug 13.

Comments: Interesting. Not sure what to make of this one.

1) Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study.

Doe-Simkins M, Quinn E, Xuan Z, Sorensen-Alawad A, Hackman H, Ozonoff A, Walley AY.

BMC Public Health. 2014 Apr 1;14(1):297. [Epub ahead of print]

Comments: Sometimes naloxone is used by bystanders who have not been formally educated (or “trained”) in administering naloxone. This innovative analysis suggests that the untrained witness does a good job in lay naloxone administration.

2) Easy-to-use overdose antidote earns fast-track approval.

Kuehn BM.

JAMA. 2014 Apr 23-30;311(16):1600. doi: 10.1001/jama.2014.4483. No abstract available.

Comments: The naloxone auto-injector – Evzio – has been approved and is expected to be available this summer.

3) Research gaps on methadone harms and comparative harms: findings from a review of the evidence for an american pain society and college on problems of drug dependence clinical practice guideline.

Weimer MB, Chou R.

J Pain. 2014 Apr;15(4):366-76. doi: 10.1016/j.jpain.2014.01.496.

Comments: Basic summary is that it’s not entirely clear why there was such a surge in methadone-related deaths in the early part of the 2000s. It’s important to remember that the surge came after a surge in oxycontin-related deaths, when many payers shifted their preferred agent from oxycontin to methadone. Mortality data seems to follow the trend of the most prescribed agent.

4) Paramedic-supplied ‘Take Home’ Naloxone: protocol for cluster randomised feasibility study.

Moore C, Lloyd G, Oretti R, Russell I, Snooks H.

BMJ Open. 2014 Mar 20;4(3):e004712. doi: 10.1136/bmjopen-2013-004712.

Comments: Outstanding, innovative design to reach those at very high risk of future overdose events. I anxiously await results.

5) Intranasal naloxone for treatment of opioid overdose.

Med Lett Drugs Ther. 2014 Mar 17;56(1438):21-4. No abstract available.

Comments: Can’t access.

6) Long-term opioids and naloxone administration in a district general hospital.

Facey C, Brooks D.

BMJ Support Palliat Care. 2014 Mar;4 Suppl 1:A103. doi: 10.1136/bmjspcare-2014-000654.297.

Comments: All I see is an abstract here that suggests naloxone is being over-administered to patients on long-acting opioids in the inpatient setting. This is hard to assess without more details, including the context of the facility, but I am somewhat skeptical of the authors stark conclusions. The authors state that the only reason to administer naloxone is respiratory depression. There are flaws with this – providers often don’t document respiratory rate or use default parameters and don’t actually measure the rate; oxygenation is often a far better parameter; and there are other reasons to administer naloxone in a monitored setting, such as hypotension which is often caused by opioids and may be somewhat improved with naloxone.

7) Management of opioid addiction with buprenorphine: French history and current management.

Poloméni P, Schwan R.

Int J Gen Med. 2014 Mar 3;7:143-8. doi: 10.2147/IJGM.S53170. eCollection 2014.

Comments: A history and update on opioid use disorder management in France, including summary of the remarkable impact of buprenorphine on overdose mortality in that country.

8) Methadone overdose and cardiac arrhythmia potential: findings from a review of the evidence for an american pain society and college on problems of drug dependence clinical practice guideline.

Chou R, Weimer MB, Dana T.

J Pain. 2014 Apr;15(4):338-65. doi: 10.1016/j.jpain.2014.01.495.

Comments: Methadone has a long history of potential issues with the QT phase of the cardiac cycle (we’ve discussed this before on this blog so I won’t include a nifty cardiac cycle picture again here). One question with the surge in methadone deaths was if it was related to the lengthening of the QT interval. The basic summary is that there’s no data to support that at this time.

9) Methadone safety: a clinical practice guideline from the american pain society and college on problems of drug dependence, in collaboration with the heart rhythm society.

Chou R, Cruciani RA, Fiellin DA, Compton P, Farrar JT, Haigney MC, Inturrisi C, Knight JR, Otis-Green S, Marcus SM, Mehta D, Meyer MC, Portenoy R, Savage S, Strain E, Walsh S, Zeltzer L.

J Pain. 2014 Apr;15(4):321-37. doi: 10.1016/j.jpain.2014.01.494.

Comments: No recommendations were based on high-quality data.

10) Methadone Overdose and Withdrawal in a Tetraplegic Patient: A Case Report.

Connelly P, Wu H.

PM R. 2014 Mar 2. pii: S1934-1482(14)00098-7. doi: 10.1016/j.pmrj.2014.02.012. [Epub ahead of print] No abstract available.

Comments: Methadone is metabolized by enzymes in the liver that are also affected by other common drugs. In this case ciprofloxacin and phenytoin messed up the metabolism and caused overdose, then withdrawal. This is also a reminder that overdose isn’t always evidence of a substance use disorder – it is a risk of ‘risky medications’ not necessarily ‘risky patients.’

11) High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in OverdoseDeaths.

Baumblatt JA, Wiedeman C, Dunn JR, Schaffner W, Paulozzi LJ, Jones TF.

JAMA Intern Med. 2014 Mar 3. doi: 10.1001/jamainternmed.2013.12711. [Epub ahead of print]

Comments: Risk factors for death were high dose opioid prescription and using multiple providers – 55% of deaths had one of these risk factors. What’s interesting, however, is the other 45%, who did not have any of these risk factors.

12) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2014 Jan 7;186(1):17. doi: 10.1503/cmaj.109-4663. Epub 2013 Nov 25. No abstract available.

Comments: A news article in the journal regarding naloxone programs.

13) Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.

Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, Di Capua P, Chou R.

Ann Intern Med. 2014 Jan 7;160(1):38-47. doi: 10.7326/0003-4819-160-1-201401070-00732. Review.

Comments: There are lots of guidelines for reducing risk with opioid prescribing but no data.

14) Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010.

Jones CM.

Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi: 10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12.

Comments: Opioid use precedes heroin use, heroin use is going up.

15) “SALOME gave my dignity back”: the role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada.

Jozaghi E.

Int J Qual Stud Health Well-being. 2014 Mar 13;9:23698. doi: 10.3402/qhw.v9.23698. eCollection 2014.

Comments: Personal level experience in heroin treatment programs.

16) ‘Lingering’ opiate deaths? Concentration of opiates in medulla and femoral blood.

Naso-Kaspar CK, Herndon GW, Wyman JF, Felo JA, Lavins ES, Gilson TP.

J Anal Toxicol. 2013 Oct;37(8):507-11. doi: 10.1093/jat/bkt061. Epub 2013 Jul 18.

Comments: Analysis of opiate levels from femoral and cerebral sources suggesting opiates linger in the brain – authors suggest this may explain low blood opioid levels in overdose deaths but I’m not sure that’s a reasonable conclusion.

17) Is opioid substitution treatment beneficial if injecting behaviour continues?

Gjersing L, Bretteville-Jensen AL.

Drug Alcohol Depend. 2013 Nov 1;133(1):121-6. doi:

Comments: Yes.

18) Medication-Assisted Therapies – Tackling the Opioid-Overdose Epidemic.

Volkow ND, Frieden TR, Hyde PS, Cha SS.

N Engl J Med. 2014 Apr 23. [Epub ahead of print]

Comments: A discussion of methadone, buprenorphine and naltrexone as responses to the opioid overdose epidemic.

19) Poisonings requiring admission to the pediatric intensive care unit: A 5-year review.

Even KM, Armsby CC, Bateman ST.

Clin Toxicol (Phila). 2014 Apr 17. [Epub ahead of print]

Comments: An increasing proportion of pediatric poisonings involve opioids.

20) Opioid-related mortality and filled prescriptions for buprenorphine and methadone.

Wikner BN, Ohman I, Seldén T, Druid H, Brandt L, Kieler H.

Drug Alcohol Rev. 2014 Apr 16. doi: 10.1111/dar.12143. [Epub ahead of print]

Comments: Rarely does methadone or buprenorphine prescribed for maintenance result in death. I can’t access the full article so cannot assess quality.

21) Unexpected variation of the codeine/morphine ratio following fatal heroin overdose.

Gambaro V, Argo A, Cippitelli M, Dell’acqua L, Farè F, Froldi R, Guerrini K, Roda G, Rusconi C, Procaccianti P.

J Anal Toxicol. 2014 Jun;38(5):289-94. doi: 10.1093/jat/bku016. Epub 2014 Apr 11.

Comments: Codeine may accumulate in brain tissue more than morphine (heroin’s major metabolites are codeine, morphine, and 6-monoacetylmorphine).

22) Suboxone versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Nov 14.

Comments: They are similar.

23) [No opiates against cannabis hyperemesis syndrome].

Bonnet U, Stratmann U, Isbruch K.

Dtsch Med Wochenschr. 2014 Feb;139(8):375-7. doi: 10.1055/s-0033-1360065. Epub 2014 Feb 11. German.

Comments: An odd case report.

24) Analyzing methadone-related deaths.

Newman RG.

J Addict Med. 2014 Jan-Feb;8(1):73. doi: 10.1097/ADM.0000000000000014. No abstract available.

Comments: A letter responding to “Methadone-related overdose deaths in rural Virginia: 1997 to 2003” – I can’t access.

2) Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment.
Green TC, Black R, Grimes Serrano JM, Budman SH, Butler SF.
PLoS One. 2011;6(11):e27244. Epub 2011 Nov 2.
Comment: This one takes a while to read through, but is intensely interesting. I highly recommend taking a close look at the article, the figures and tables, and even (!) digging through the entire text. Keep in mind this is a sample seeking substance abuse treatment – this is not an analysis of the general population of people who use prescription opioid.

3) HIV infection and risk of overdose: a systematic review and meta-analysis.
Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD.
AIDS. 2011 Nov 22.
Comment: In many areas of the world, overdose is the most common cause of death among those at risk for (or infected with) HIV. This study found that HIV-seropositivity was associated with a 74% increased risk overdose death (I can’t access the article to provide more detail about this).
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The next two are directed at those prescribing opioids …

4) Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 2: special populations.
Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A.
Can Fam Physician. 2011 Nov;57(11):1269-76.
Comment: Title is really self-explanatory – recommendations for managing opioids in adolescents.

5) Management of chronic noncancer pain in depressed patients.
Barkin RL, Barkin SJ, Irving GA, Gordon A.
Postgrad Med. 2011 Sep;123(5):143-54. Review.
Comments: Another review for physicians of how to not rely so much on opioids for chronic pain.