1) High buprenorphine-related mortality is persistent in Finland.

Kriikku P, Häkkinen M, Ojanperä I.

Forensic Sci Int. 2018 Aug 17;291:76-82. doi: 10.1016/j.forsciint.2018.08.010. [Epub ahead of print]

Comments: This is an interesting topic. Finland seems to have a lot of buprenorphine injection, in the absence of much other injection opioid use. There is also high levels of alcohol and benzodiazepine use and that is the context of the deaths.

2) A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality.

Weiner SG, Price CN, Atalay AJ, Harry EM, Pabo EA, Patel R, Suzuki J, Anderson S, Ashley SW, Kachalia A.

Jt Comm J Qual Patient Saf. 2018 Aug 28. pii: S1553-7250(18)30088-6. doi: 10.1016/j.jcjq.2018.07.003. [Epub ahead of print]

Comments: Metrics of opioid prescribing declined with no change in overdose.

3) Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016-June 2017.

Mattson CL, O’Donnell J, Kariisa M, Seth P, Scholl L, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2018 Aug 31;67(34):945-951. doi: 10.15585/mmwr.mm6734a2.

Comments: This is an amazing piece that finallystarts to flesh out the basic epidemiology of overdose in the post-heroin world. Conducting enhanced surveillance of opioid overdose deaths in 11 cities, they identified 17.4% were from opioid analgesics only, 18.5% for both analgesics and illicit opioids, and 58.7% for illicit opioids only – rates varied substantially by region/state. 10% had been released from an institutional setting in the month before death (mostly hospital for prescription-only and mostly jail/prison for illicit-only, with a mix for combined deaths). There was evidence of injection in 49.2% of illicit-only deaths and 6.6% of prescription opioid-only deaths. Bystanders were present in 41.6% of prescription-only, 44.0% of illicit-only, and 45.0% of combined deaths. Naloxone was administered by 0.8%, 4.3%, and 4.4% of cases, respectively. As in prior studies, prescription-only were more likely to contain benzodiazepines whereas illicit-only deaths were more likely to have cocaine or methamphetamine, with combined deaths a blend of those two categories. Prescription-only deaths were evenly split between male and femaile, whereas other categories were nearly three-quarters male. These results are long-awaited and critical to beginning to understand fundamental elements of the evolving opioid crisis. Kudos to the CDC for this.

4) Addressing the Fentanyl Analog Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood.

Skov-Skov Bergh M, Bogen IL, Wilson SR, Øiestad ÅML.

Ther Drug Monit. 2018 Aug 27. doi: 10.1097/FTD.0000000000000564. [Epub ahead of print]

Comments: Method to look for both fentanyl/analogs and naloxone.

5) Opioid Analgesics in Georgia Medicaid: Trends in Potential Inappropriate Prescribing Practices by Demographic Characteristics, 2009-2014.

Jayawardhana J, Abraham AJ, Perri M.

J Manag Care Spec Pharm. 2018 Sep;24(9):886-894. doi: 10.18553/jmcp.2018.24.9.886.

Comments: Patients in “missing race” category are at high risk … ok that’s a strange outcome.

6) Opioid toxicity with underlying tumour lysis syndrome in a patient with CMML: a diagnostic and therapeutic challenge.

Vig S, Mishra S, Rustagi K, Bhan S.

BMJ Case Rep. 2018 Aug 27;2018. pii: bcr-2018-225646. doi: 10.1136/bcr-2018-225646.

Comments: Interesting case of opioid overdose induced by kidney failure caused by tumor lysis syndrome.

7) Identifying Missed Clinical Opportunities in Delivery of Overdose Prevention and Naloxone Prescription to Adolescents Using Opioids.

Wilson JD, Berk J, Adger H, Feldman L.

J Adolesc Health. 2018 Aug;63(2):245-248. doi: 10.1016/j.jadohealth.2018.05.011.

Comments: Pediatricians, opioids, and naloxone.

8) Government Patent Use to Address the Rising Cost of Naloxone: 28 U.S.C. § 1498 and Evzio.

Wang A, Kesselheim AS.

J Law Med Ethics. 2018 Jun;46(2):472-484. doi: 10.1177/1073110518782954.

Comments: Interesting approach to deal with out of control pharmaceutical pricing.

9) Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician’s Perspective.

Bone C, Eysenbach L, Bell K, Barry DT.

J Law Med Ethics. 2018 Jun;46(2):268-271. doi: 10.1177/1073110518782933.

Comments: Yes.

10) Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths – United States, 2007-2012.

Harduar Morano L, Steege AL, Luckhaupt SE.

MMWR Morb Mortal Wkly Rep. 2018 Aug 24;67(33):925-930. doi: 10.15585/mmwr.mm6733a3.

Comments: Construction, extraction, and healthcare industries – fascinating.

11) Using Publicly Available Data to Understand the Opioid Overdose Epidemic: Geospatial Distribution of Discarded Needles in Boston, Massachusetts.

Bearnot B, Pearson JF, Rodriguez JA.

Am J Public Health. 2018 Aug 23:e1-e3. doi: 10.2105/AJPH.2018.304583. [Epub ahead of print]

Comments: These analyses are interesting and need to be carefully done.

12) Supervised Injectable Opioid Treatment for the Management of Opioid Dependence.

Bell J, Belackova V, Lintzeris N.

Drugs. 2018 Aug 21. doi: 10.1007/s40265-018-0962-y. [Epub ahead of print] Review.

Comments: Interesting review of supervised opioid injection for treatment of opioid use disorder – another intervention that is often limited by politics.

13) Naloxone distribution and possession following a large-scale naloxone program.

Madah-Amiri D, Gjersing L, Clausen T.

Addiction. 2018 Aug 20. doi: 10.1111/add.14425. [Epub ahead of print]

Comments: The longer a naloxone program is around the more likely people are to carry naloxone. Actually an interesting conclusion – as time and intensity of programming may lead to a culture of overdose prevention in a given locality.

14) Comparison between buprenorphine provider availability and opioid deaths among US counties.

Jones CW, Christman Z, Smith CM, Safferman MR, Salzman M, Baston K, Haroz R.

J Subst Abuse Treat. 2018 Oct;93:19-25. doi: 10.1016/j.jsat.2018.07.008. Epub 2018 Jul 20.

Comments: Lots of variability in access that doesn’t always correspond to need.

15) A Randomized Usability Assessment of Simulated Naloxone Administration by Community Members.

Eggleston W, Sullivan RW, Pacelli L, Podolak C, Keenan M, Wojcik S.

Addiction. 2018 Aug 14. doi: 10.1111/add.14416. [Epub ahead of print]

Comments: Study showing the obvious: lay people not comfortable with needles can more easily administer the FDA-approved nasal spray than vial and syringe intramuscular. For people who inject drugs, the less costly vial and syringe allows for far broader reach of programming.

16) The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible.

Carroll JJ, Rich JD, Green TC.

J Addict Med. 2018 Aug 7. doi: 10.1097/ADM.0000000000000436. [Epub ahead of print]

Comments: The main reasons for use are managing withdrawal and opioid use disorder. 12% of those reporting diverted buprenorphine use reported that they had used it to get high.

17) Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy.

Harrison TK, Kornfeld H, Aggarwal AK, Lembke A.

Anesthesiol Clin. 2018 Sep;36(3):345-359. doi: 10.1016/j.anclin.2018.04.002. Epub 2018 Jul 11. Review.

Comments: There are some messed up guidelines out there that suggest stopping buprenorphine when admitted / heading to surgery – this is almost always a bad idea. People do much, much better with regard to pain when kept on buprenorphine.

18) Change and variability in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007.

Tempalski B, Cleland CM, Williams LD, Cooper HLF, Friedman SR.

Subst Abuse Treat Prev Policy. 2018 Aug 9;13(1):28. doi: 10.1186/s13011-018-0165-2.

Comments: Not enough.

19) On the front lines of the opioid epidemic: Rescue by naloxone.

Skolnick P.

Eur J Pharmacol. 2018 Sep 15;835:147-153. doi: 10.1016/j.ejphar.2018.08.004. Epub 2018 Aug 7.

Comments: Nasal naloxone works well at the higher concentrations.

20) Naloxone Administration Frequency During Emergency Medical Service Events – United States, 2012-2016.

Cash RE, Kinsman J, Crowe RP, Rivard MK, Faul M, Panchal AR.

MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):850-853. doi: 10.15585/mmwr.mm6731a2.

Comments: Exciting to see the work coming out of the expanded surveillance and research efforts.

21) Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study.

Larney S, Hickman M, Fiellin DA, Dobbins T, Nielsen S, Jones NR, Mattick RP, Ali R, Degenhardt L.

BMJ Open. 2018 Aug 5;8(8):e025204. doi: 10.1136/bmjopen-2018-025204.

Comments: Protocol for study exploring adverse outcomes during and after methadone and buprenorphine treatment.

22) The impact of medically supervised injection centres on drug-related harms: A meta-analysis.

May T, Bennett T, Holloway K.

Int J Drug Policy. 2018 Aug 2;59:98-107. doi: 10.1016/j.drugpo.2018.06.018. [Epub ahead of print] Review.

Comments: This paper is weird. They ask a slew of questions with often one or two observational papers for each question. Strange for a meta-analysis… Also, the paper the list as showing no decrease in overdose mortality is a dead link – appears it was a report posted but nothing ever published and not publicly available. The group that did the report also since published a paper showing a dramatic decrease in ambulance callouts for overdose with the facility.

23) Determining the effective dose of street-level heroin: A new way to consider fluctuations in heroinpurity, mass and potential contribution to overdose.

Stam NC, Gerostamoulos D, Gerstner-Stevens J, Scott N, Smith K, Drummer OH, Pilgrim JL.

Forensic Sci Int. 2018 Sep;290:219-226. doi: 10.1016/j.forsciint.2018.07.009. Epub 2018 Jul 19.

Comments: Heroin seized in Victoria had a median effective dose of heroin of 12.0mg; 8% had 1.5-2 doses and 6% had over a double dose. The “effective dose” approach has some logic.

24) Development and implementation of procedures for outpatient naloxone prescribing at a large academic medical center.

Zschoche JH, Nesbit S, Murtaza U, Sowell A, Waldfogel JM, Arwood N, Rush J, McNamara L, Swarthout M, Nesbit T, Ortmann M.

Am J Health Syst Pharm. 2018 Aug 3. pii: ajhp170759. doi: 10.2146/ajhp170759. [Epub ahead of print]

Comments: Pharmacy, nursing, and physician collaboration.

25) Rx for addiction and medication safety: An evaluation of teen education for opioid misuse prevention.

Patry E, Bratberg JP, Buchanan A, Paiva AL, Balestrieri S, Matson KL.

Res Social Adm Pharm. 2018 Jul 7. pii: S1551-7411(18)30287-0. doi: 10.1016/j.sapharm.2018.07.006. [Epub ahead of print]

Comments: Teaching students how to recognize overdose and administer naloxone.

26) Abuse of fentanyl: An emerging problem to face.

Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB.

Forensic Sci Int. 2018 Aug;289:207-214. doi: 10.1016/j.forsciint.2018.05.042. Epub 2018 Jun 2. Review.

Comments: Yes.

26 naloxone papers:

1) Naloxone prescriptions from the emergency department: An initiative in evolution.

Verdier M, Routsolias JC, Aks SE.

Am J Emerg Med. 2018 May 22. pii: S0735-6757(18)30422-4. doi: 10.1016/j.ajem.2018.05.044. [Epub ahead of print] No abstract available.

Comments: 18% got filled. More likely to get filled if sent with other Rx’s.

2) “Once I’d done it once it was like writing your name”: Lived experience of take-home naloxone administration by people who inject drugs.

McAuley A, Munro A, Taylor A.

Int J Drug Policy. 2018 May 23;58:46-54. doi: 10.1016/j.drugpo.2018.05.002. [Epub ahead of print]

Comments: Qualitative study with 8 PWID who have administered naloxone.

3) Characterizing peer roles in an overdose crisis: Preferences for peer workers in overdose response programs in emergency shelters.

Bardwell G, Kerr T, Boyd J, McNeil R.

Drug Alcohol Depend. 2018 Jun 26;190:6-8. doi: 10.1016/j.drugalcdep.2018.05.023. [Epub ahead of print]

Comments: Peers are hugely important in service provision.

4) Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report.

Ouyang S, Moore T.

Ment Health Clin. 2018 Mar 23;7(6):287-289. doi: 10.9740/mhc.2017.11.287. eCollection 2017 Nov.

Comments: There are hundreds to thousands of successful lay reversals in the US daily.

5) At-a-glance – Lessons learned from launching the Manitoba Take-Home Naloxone Program.

Bozat-Emre S, Marshall SG, Zhong C, Reimer J.

Health Promot Chronic Dis Prev Can. 2018 Jun;38(6):252-255. doi: 10.24095/hpcdp.38.6.06. English, French.

Comments: Standard programmatic data, noting that the program gives valuable information about street opioids.

6) Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review.

Behar E, Bagnulo R, Coffin PO.

Prev Med. 2018 Jun 15;114:79-87. doi: 10.1016/j.ypmed.2018.06.005. [Epub ahead of print] Review.

Comments: Systematic review of literature on naloxone prescribing from primary care.

7) Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone.

Kestler A, Giesler A, Buxton J, Meckling G, Lee M, Hunte G, Wilkins J, Marks D, Scheuermeyer F.

CJEM. 2018 May 23:1-9. doi: 10.1017/cem.2018.368. [Epub ahead of print]

Comments: Those refusing naloxone felt they weren’t at risk of overdose or that the ED wasn’t the place to get the prescription. Those accepting felt they could help others.

8) Naloxone Use Among Emergency Department Patients with Opioid Overdose.

Marco CA, Trautman W, Cook A, Mann D, Rasp J, Perkins O, Ballester M.

J Emerg Med. 2018 May 16. pii: S0736-4679(18)30360-3. doi: 10.1016/j.jemermed.2018.04.022. [Epub ahead of print]

Comments: Ohio study of overdoses in the ED. Lots of repeated visits. Only 31% had home access to naloxone. Among those who had naloxone, 33% reported less opioid usage, 4% reported more, and 63% reported no change.

9) An overview of take-home naloxone programs in Australia.

Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, Lintzeris N, Oh G, Dicka J, Fry CL, Hayllar J, Lenton S.

Drug Alcohol Rev. 2018 May;37(4):440-449. doi: 10.1111/dar.12812.

Comments: Peer programs!

10) Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities.

Dietze PM, Stare M, Cogger S, Nambiar D, Olsen A, Burns L, Lenton S.

Drug Alcohol Rev. 2018 May;37(4):457-463. doi: 10.1111/dar.12644. Epub 2017 Dec 21.

Comments: Half of PWID were aware of take-home naloxone. Good start, ways to go.

11) Facilitators and Barriers to Naloxone Kit Use Among Opioid-Dependent Patients Enrolled in Medication Assisted Therapy Clinics in North Carolina.

Khatiwoda P, Proeschold-Bell RJ, Meade CS, Park LP, Proescholdbell S.

N C Med J. 2018 May-Jun;79(3):149-155. doi: 10.18043/ncm.79.3.149.

Comments: Smaller kits more likely to be carried.

12)Feasibility of Bystander Administration of Public-Access Naloxone for Opioid Overdose.

Goldberg SA, Dworkis DA, Liao VT, Eyre AJ, Albert J, Fawcett MM, Narovec CM, DiClemente J, Weiner SG.

Prehosp Emerg Care. 2018 May 3:1-7. doi: 10.1080/10903127.2018.1461284. [Epub ahead of print]

Comments: Public access naloxone stations is an idea that’s been batted about for decades without much in terms of implementation.

13)Pharmacokinetic properties of intranasal and injectable formulations of naloxone for community use: a systematic review.

Ryan SA, Dunne RB.

Pain Manag. 2018 Apr 23. doi: 10.2217/pmt-2017-0060. [Epub ahead of print]

Comments: Intranasal works well.

14) [Temporary approval for intranasal naloxone: Setting up in a French addiction center].

Barré T, Vorspan F, Fortias M, Veyrier M, Cavagna P, Azuar J, Nicolas L, Naccache F, Barreteau H, Bellivier F, Bloch V.

Therapie. 2018 Mar 29. pii: S0040-5957(18)30060-X. doi: 10.1016/j.therap.2018.03.003. [Epub ahead of print] French.

Comments: Pilot naloxone prescribing in France.

15) Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among HeroinUsers in the United Kingdom.

Langham S, Wright A, Kenworthy J, Grieve R, Dunlop WCN.

Value Health. 2018 Apr;21(4):407-415. doi: 10.1016/j.jval.2017.07.014. Epub 2018 Feb 4.

Comments: Remarkably similar outcomes as the 2012 naloxone model in the United States.

16) Distribution of take-home opioid antagonist kits during a synthetic opioid epidemic in British Columbia, Canada: a modelling study.

Irvine MA, Buxton JA, Otterstatter M, Balshaw R, Gustafson R, Tyndall M, Kendall P, Kerr T, Gilbert M, Coombs D.

Lancet Public Health. 2018 Apr 17. pii: S2468-2667(18)30044-6. doi: 10.1016/S2468-2667(18)30044-6. [Epub ahead of print]

Comments: Authors conclude that rapid expansion of naloxone access helped to reverse the increasing trend of opioid overdose deaths during the fentanyl crisis.

17) Prescribing naloxone for opioid overdose intervention.

Dunne RB.

Pain Manag. 2018 Apr 18. doi: 10.2217/pmt-2017-0065. [Epub ahead of print]

Comments: A review, although it is incorrect that screening for patients at risk of opioid overdose is required. The majority of US states allow for third party prescribing to those who might witness an opioid overdose. Moreover, the use of “overdose” when speaking to patients prescribed opioids can sabotage efforts to get naloxone to where the opioids are.

18) The feasibility of employing a home healthcare model for education and treatment of opioid overdoseusing a naloxone auto-injector in a private practice pain medicine clinic.

Dragovich A, Brason F, Beltran T, McCoart A, Plunkett AR.

Curr Med Res Opin. 2018 Apr 18:1-11. doi: 10.1080/03007995.2018.1466698. [Epub ahead of print]

Comments: Home health approach to training on overdose response.

19) Emergency physician resistance to a take-home naloxone program led by community harm reductionists.

Barbour K, McQuade M, Somasundaram S, Chakravarthy B.

Am J Emerg Med. 2018 Mar 17. pii: S0735-6757(18)30228-6. doi: 10.1016/j.ajem.2018.03.036. [Epub ahead of print] No abstract available.

Comments: A study of providing naloxone in an emergency department, in which the attending physician refused to prescribe naloxone to 37% of the patients who wanted it. Really unclear why someone would refuse to provide a naloxone prescription to a patient who wanted one. And few of the patients filled the prescription – again consistent with what we know about naloxone and any other preventive intervention like flu shots: it has to be free and convenient.

20) Pharmacokinetics and -dynamics of intramuscular and intranasal naloxone: an explorative study in healthy volunteers.

Skulberg AK, Tylleskar I, Nilsen T, Skarra S, Salvesen Ø, Sand T, Loftsson T, Dale O.

Eur J Clin Pharmacol. 2018 Mar 22. doi: 10.1007/s00228-018-2443-3. [Epub ahead of print]

Comments: Intranasal naloxone was 0.75 as bioavailable as intramuscular.

21) Implementation and evaluation of an opioid overdose education and naloxone distribution (OEND) program at a Veterans Affairs Medical Center.

Pauly JB, Vartan CM, Brooks AT.

Subst Abus. 2018 Mar 22:1-17. doi: 10.1080/08897077.2018.1449174. [Epub ahead of print]

Comments: 30% of veterans referred for naloxone completed education and most were at low risk for opioid overdose.

22) Naloxone reversal of clonidine toxicity: dose, dose, dose.

Seger DL, Loden JK.

Clin Toxicol (Phila). 2018 Mar 16:1-7. doi: 10.1080/15563650.2018.1450986. [Epub ahead of print]

Comments: 10mg of naloxone in pediatric patients worked very well. Fascinating.

23) Effects of naloxone distribution to likely bystanders: Results of an agent-based model.

Keane C, Egan JE, Hawk M.

Int J Drug Policy. 2018 Mar 7;55:61-69. doi: 10.1016/j.drugpo.2018.02.008. [Epub ahead of print]

Comments: I have a fair amount of experience with models (created several Markov and decision tree-based models) and, while I’ve never constructed an agent-based model, the absence of a table of parameters for this paper is highly concerning to me. I cannot evaluate if this paper has value.

24) Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities.

Zhang X, Marchand C, Sullivan B, Klass EM, Wagner KD.

Addict Behav. 2018 Mar 5. pii: S0306-4603(18)30109-6. doi: 10.1016/j.addbeh.2018.03.004. [Epub ahead of print]

Comments: EMTs can be trained to administer naloxone.

25) Naloxone formulation for overdose reversal preference among patients receiving opioids for pain management.

Dunn KE, Barrett FS, Bigelow GE.

Addict Behav. 2018 Mar 28. pii: S0306-4603(18)30131-X. doi: 10.1016/j.addbeh.2018.03.011. [Epub ahead of print]

Comments: They prefer non-injectable. No surprise there.

26) Utilizing risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) scores to prioritize offer of rescue naloxone in an outpatient veteran population: A telephone-based project.

Yates D, Frey T, Montgomery JC.

Subst Abus. 2018 Mar 26:1-12. doi: 10.1080/08897077.2018.1449171. [Epub ahead of print]

Comments: 63.4% of those contacted accepted the naloxone prescription.

Plus 6 papers on naloxone and Good Samaritan laws:

27) Naloxone laws facilitate the establishment of overdose education and naloxone distribution programs in the United States.

Lambdin BH, Davis CS, Wheeler E, Tueller S, Kral AH.

Drug Alcohol Depend. 2018 May 12. pii: S0376-8716(18)30238-2. doi: 10.1016/j.drugalcdep.2018.04.004. [Epub ahead of print]

Comments: As title says.

28) Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid.

Gertner AK, Domino ME, Davis CS.

Drug Alcohol Depend. 2018 Jun 22;190:37-41. doi: 10.1016/j.drugalcdep.2018.05.014. [Epub ahead of print]

Comments: Naloxone access laws are associated with increased outpatient prescriptions.

29) Opioid-overdose laws association with opioid use and overdose mortality.

McClellan C, Lambdin BH, Ali MM, Mutter R, Davis CS, Wheeler E, Pemberton M, Kral AH.

Addict Behav. 2018 Mar 19. pii: S0306-4603(18)30138-2. doi: 10.1016/j.addbeh.2018.03.014. [Epub ahead of print]

Comments: Laws supporting naloxone programming were associated with less opioid overdose mortality and no increase in non-medical opioid use.

30) Assessing the effectiveness of New York’s 911 Good Samaritan Law-Evidence from a natural experiment.

Nguyen H, Parker BR.

Int J Drug Policy. 2018 Jun 29;58:149-156. doi: 10.1016/j.drugpo.2018.05.013. [Epub ahead of print]

Comments: Interesting comparison between New York and New Jersey, although this could have been influenced by market forces as well.

31) Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties.

Watson DP, Ray B, Robison L, Huynh P, Sightes E, Walker S, Brucker K, Duwve J.

Harm Reduct J. 2018 Apr 6;15(1):18. doi: 10.1186/s12954-018-0226-x.

Comments: Knowing someone who overdosed predicts getting naloxone. If people know about Good Sam protections they are more likely to call emergency medical services after the overdose.

32) State naloxone access laws are associated with an increase in the number of naloxone prescriptions dispensed in retail pharmacies.

Xu J, Davis CS, Cruz M, Lurie P.

Drug Alcohol Depend. 2018 Aug 1;189:37-41. doi: 10.1016/j.drugalcdep.2018.04.020. Epub 2018 May 29.

Comments: See title.

And 6 papers on pharmacies and naloxone/opioids:

33) Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016.

Meyerson BE, Agley JD, Davis A, Jayawardene W, Hoss A, Shannon DJ, Ryder PT, Ritchie K, Gassman R.

Drug Alcohol Depend. 2018 Apr 26;188:187-192. doi: 10.1016/j.drugalcdep.2018.03.032. [Epub ahead of print]

Comments:  Bigger pharmacies and chains stocked naloxone more.

34) Reviewing state-mandated training requirements for naloxone-dispensing pharmacists.

Roberts AW, Carpenter DM, Smith A, Look KA.

Res Social Adm Pharm. 2018 Apr 5. pii: S1551-7411(17)30915-4. doi: 10.1016/j.sapharm.2018.04.002. [Epub ahead of print]

Comments: The state requirements are silly. Why do we always create barriers to providers taking care of people with substance use disorders and related issues?

35) Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice.

Gilmartin-Thomas JF, Bell JS, Liew D, Arnold CA, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson SJ, Giummarra MJ, Gowan J, Katz B, Lubman DI, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil J.

Res Social Adm Pharm. 2018 Mar 19. pii: S1551-7411(17)30669-1. doi: 10.1016/j.sapharm.2018.03.060. [Epub ahead of print]

Comments: How pharmacists can help.

36) Establishment of a pharmacist-led service for patients at high risk for opioid overdose.

Tewell R, Edgerton L, Kyle E.

Am J Health Syst Pharm. 2018 Mar 15;75(6):376-383. doi: 10.2146/ajhp170294.

Comments: Pharmacists are good at getting naloxone to people who may need it.

37) Naloxone for Opioid Overdose and the Role of the Pharmacist.

Toderika Y, Williams S.

Consult Pharm. 2018 Feb 1;33(2):98-104. doi: 10.4140/TCP.n.2018.98.

Comments: As above!

38) Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions.

Meyerson BE, Davis A, Agley JD, Shannon DJ, Lawrence CA, Ryder PT, Ritchie K, Gassman R.

Int J Drug Policy. 2018 Mar 17;56:46-53. doi: 10.1016/j.drugpo.2018.02.024. [Epub ahead of print]

Comments: Communities with high rates of opioid overdose death were less likely to have pharmacies that dispensed syringes to PWID.

9 papers on fentanyl:

39) Abuse of fentanyl: An emerging problem to face.

Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB.

Forensic Sci Int. 2018 Aug;289:207-214. doi: 10.1016/j.forsciint.2018.05.042. Epub 2018 Jun 2. Review.

Comments: Reviewing emerging presence of fentanyl in Poland.

40) Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD.

Park JN, Weir BW, Allen ST, Chaulk P, Sherman SG.

Harm Reduct J. 2018 Jul 5;15(1):34. doi: 10.1186/s12954-018-0240-z.

Comments: While this is an interesting effort, I’m not convinced that “perceived fentanyl presence” as a risk factor for overdose is particularly useful.

41) Fentanyl self-testing outside supervised injection settings to prevent opioid overdose: Do we know enough to promote it?

McGowan CR, Harris M, Platt L, Hope V, Rhodes T.

Int J Drug Policy. 2018 May 11;58:31-36. doi: 10.1016/j.drugpo.2018.04.017. [Epub ahead of print]

Comments: Not really, but we are desparate.

42)Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015.

Rowe C, Wheeler E, Stephen Jones T, Yeh C, Coffin PO.

J Urban Health. 2018 May 3. doi: 10.1007/s11524-018-0250-x. [Epub ahead of print]

Comments: Another role for naloxone distribution programs is as an early warning system of changes in the opioid market. In this case, a locality was alerted to fentanyl entering the supply by an increase in naloxone reversals, with no associated deaths. Of note, this clearly overlaps with the “naloxone” section above.

43) Characteristics of opioid-maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini-review.

Kimergård A, Dunne J, Bøgen A, Hindersson P, Breindahl T.

Drug Test Anal. 2018 Apr 19. doi: 10.1002/dta.2397. [Epub ahead of print]

Comments: Testing for fentanyl can be tricky in clinical practice.

44) Efficacious Vaccine against Heroin Contaminated with Fentanyl.

Hwang CS, Smith LC, Natori Y, Ellis B, Zhou B, Janda KD.

ACS Chem Neurosci. 2018 Mar 23. doi: 10.1021/acschemneuro.8b00079. [Epub ahead of print]

Comments: Interesting idea.

45) Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models.

Phalen P, Ray B, Watson DP, Huynh P, Greene MS.

Addict Behav. 2018 Mar 20. pii: S0306-4603(18)30121-7. doi: 10.1016/j.addbeh.2018.03.010. [Epub ahead of print]

Comments: Fentanyl deaths became predominant.

46) How Did We Get Here? Heroin and Fentanyl Trafficking Trends: A Law Enforcement Perspective.

Dismukes LC.

N C Med J. 2018 May-Jun;79(3):181-184. doi: 10.18043/ncm.79.3.181.

Comments: Describes a focus on the dark net.

47) Amount of naloxone used to reverse opioid overdoses outside of medical practice in a city with increasing illicitly manufactured fentanyl in illicit drug supply.

Bell A, Bennett AS, Jones TS, Doe-Simkins M, Williams LD.

Subst Abus. 2018 Mar 20:1-12. doi: 10.1080/08897077.2018.1449053. [Epub ahead of print]

Comments: There was no change in the dose or amount of lay-administered naloxone required to reverse overdoses in the community, regardless of a rapid increase in fentanyl-related overdoses.

13 papers on medications for opioid use disorder:

48) Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis.

Ma J, Bao YP, Wang RJ, Su MF, Liu MX, Li JQ, Degenhardt L, Farrell M, Blow FC, Ilgen M, Shi J, Lu L.

Mol Psychiatry. 2018 Jun 22. doi: 10.1038/s41380-018-0094-5. [Epub ahead of print]

Comments: Our medications for opioid use disorder – methadone, buprenorphine, and extended-release naltrexone – reduce mortality, particularly if used for over a year.

49) Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.

Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY.

Ann Intern Med. 2018 Jun 19. doi: 10.7326/M17-3107. [Epub ahead of print]

Comments: Another fascinating analysis out of a powerful dataset. After overdose, 11% enrolled in methadone for a median of 5 months, 17% buprenorphine for 4 months, and naltrexone for 1 month. Methadone and buprenorphine were associated with similar reductions in mortality (adjusted hazard ratio 0.47 and 0.41, respectively). Naltrexone was not associated with a mortality benefit, although the AHR was 1.44, suggesting a possible increase in mortality.

50) Developing an opioid use disorder treatment cascade: A review of quality measures.

Williams AR, Nunes EV, Bisaga A, Pincus HA, Johnson KA, Campbell AN, Remien RH, Crystal S, Friedmann PD, Levin FR, Olfson M.

J Subst Abuse Treat. 2018 Aug;91:57-68. doi: 10.1016/j.jsat.2018.06.001. Epub 2018 Jun 2. Erratum in: J Subst Abuse Treat. 2018 Sep;92:99.

Comments: There’s a lot of work going on now to determine the markers of successful care for patients with opioid use disorder. It’s an exciting time in which we are hopefully seeing a transformation in which substance use disorders are treated as chronic diseases, rather than somebody else’s problem.

51) Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016.

Socías ME, Wood E, Kerr T, Nolan S, Hayashi K, Nosova E, Montaner J, Milloy MJ.

Drug Alcohol Depend. 2018 Aug 1;189:90-95. doi: 10.1016/j.drugalcdep.2018.04.026. Epub 2018 May 29.

Comments: Generated 4 stages of OUD care: linkage to care, linkage to methadone/buprenorphine, retention on medications, and stability – and evaluated changes from 2006 to 2016. They found that all parameters improved, but retention on medications was lower than goal (about a third of patients).

52) Opioid Use Disorders: Perioperative Management of a Special Population.

Ward EN, Quaye AN, Wilens TE.

Anesth Analg. 2018 May 25. doi: 10.1213/ANE.0000000000003477. [Epub ahead of print]

Comments: Great topic. So much mismanagement, particularly of patients on buprenorphine as it is too often stopped leading to chaos in the hospital. The general rule is to continue buprenorphine!!! Use ancillary pain medications. Dose the bup 3-4 times a day. Use hydromorphone or fentanyl if necessary.

53) National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training.

Gust SW, McCormally J.

Curr Opin Psychiatry. 2018 Jul;31(4):287-293. doi: 10.1097/YCO.0000000000000426.

Comments: International research on OUD treatment and overdose prevention.

54) Stigma associated with medication treatment for young adults with opioid use disorder: a case series.

Hadland SE, Park TW, Bagley SM.

Addict Sci Clin Pract. 2018 May 7;13(1):15. doi: 10.1186/s13722-018-0116-2.

Comments: Case reports of patients being denied proper medical care. Grrr. If you had type 2 diabetes and were kicked off your insulin due to the ignorance of supposed “providers”, you’d make millions in court. Honestly, I can’t wait to see those cases emerge for people with opioid use disorder. Sadly, that is often the best way to change practice in the overly litigious United States.

55) Buprenorphine Therapy for Opioid Use Disorder.

Zoorob R, Kowalchuk A, Mejia de Grubb M.

Am Fam Physician. 2018 Mar 1;97(5):313-320.

Comments: A review of above.

56) Methadone maintenance treatment: A 15-year retrospective study in Split-Dalmatia County, Croatia.

Sutlovic D, Kljucevic Z, Sliskovic L, Susnjar H, Viskovic I, Definis-Gojanovic M.

Ther Drug Monit. 2018 Apr 11. doi: 10.1097/FTD.0000000000000519. [Epub ahead of print]

Comments: Programmatic data review.

57) Pharmacogenetics of Opioid Use Disorder Treatment.

Crist RC, Clarke TK, Berrettini WH.

CNS Drugs. 2018 Apr;32(4):305-320. doi: 10.1007/s40263-018-0513-9.

Comments: Metabolism, clearance, treatment outcomes for OUD meds.

58) Effectiveness of Tapering from Methadone or Buprenorphine Maintenance Treatment Compared to Traditional Maintenance Treatment for People with Opiate Addiction: Systematic Review [Internet].

Dalsbø TK, Steiro A, Strømme H, Reinar LM.

Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2017 Mar 2.

Comments: Insufficient data, although it’s clear from clinical practice that treatment should be provided as long as the patient will accept it, ideally at least a year.

59) The effect of Housing First on adherence to methadone maintenance treatment.

Parpouchi M, Moniruzzaman A, Rezansoff SN, Russolillo A, Somers JM.

Int J Drug Policy. 2018 Mar 30;56:73-80. doi: 10.1016/j.drugpo.2018.03.012. [Epub ahead of print]

Comments: No effect on adherence to OUD treatment with methadone.

60) Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment.

Havens JR, Walsh SL, Korthuis PT, Fiellin DA.

Curr HIV/AIDS Rep. 2018 Aug;15(4):315-323. doi: 10.1007/s11904-018-0402-3. Review.

Comments: 3% of primary care providers can provide buprenorphine. Can we please throw out the waiver requirement?

7 more emergency medical care papers (there’s overlap here, obviously):

61) Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment.

Stam NC, Pilgrim JL, Drummer OH, Smith K, Gerostamoulos D.

Clin Toxicol (Phila). 2018 Jun 6:1-7. doi: 10.1080/15563650.2018.1478093. [Epub ahead of print]

Comments: Not withstanding the remarkably offensive title, in effect describing people who use drugs as fish, the study shows no risk to releasing patients after initial paramedic treatment for opioid overdose.

62) Substance use and homelessness among emergency department patients.

Doran KM, Rahai N, McCormack RP, Milian J, Shelley D, Rotrosen J, Gelberg L.

Drug Alcohol Depend. 2018 May 22;188:328-333. doi: 10.1016/j.drugalcdep.2018.04.021. [Epub ahead of print]

Comments: Patients in emergency departments who are homeless have higher rates of problematic substance use.

63) Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.

Sanello A, Gausche-Hill M, Mulkerin W, Sporer KA, Brown JF, Koenig KL, Rudnick EM, Salvucci AA, Gilbert GH.

West J Emerg Med. 2018 May;19(3):527-541. doi: 10.5811/westjem.2018.1.36559. Epub 2018 Mar 8. Review.

Comments: Criteria for naloxone were – respiratory rate under 12, pinpoint pupils, presence of drug paraphernalia, and altered mental status. Interesting and may account for why we didn’t see as much naloxone given for prescription opioid overdose events during that era.

64) Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose.

Scheuermeyer FX, DeWitt C, Christenson J, Grunau B, Kestler A, Grafstein E, Buxton J, Barbic D, Milanovic S, Torkjari R, Sahota I, Innes G.

Ann Emerg Med. 2018 Mar 9. pii: S0196-0644(18)30082-9. doi: 10.1016/j.annemergmed.2018.01.054. [Epub ahead of print]

Comments: Brief observation is fine. Similar to the above “catch and release” paper.

65) Rate of patients at elevated risk of opioid overdose visiting the emergency department.

Pedigo JR, Seifert CF.

Am J Emerg Med. 2018 Mar 22. pii: S0735-6757(18)30247-X. doi: 10.1016/j.ajem.2018.03.055. [Epub ahead of print]

Comments: More opioid overdose ED visits.

66) A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States.

Klassen AB, Core SB, Lohse CM, Sztajnkrycer MD.

Prehosp Disaster Med. 2018 Apr;33(2):165-170. doi: 10.1017/S1049023X18000213. Epub 2018 Mar 13.

Comments: Overall police provide the initial care in 2% of cases and 13% of drug overdoses – in Norway (rates probably much higher in other countries like the U.S.).

67) Ambulance-attended opioid overdoses: an examination into overdose locations and the role of a safe injection facility.

Madah-Amiri D, Skulberg AK, Braarud AC, Dale O, Heyerdahl F, Lobmaier P, Clausen T.

Subst Abus. 2018 Jun 27:1-17. doi: 10.1080/08897077.2018.1485130. [Epub ahead of print]

Comments: Fascinating look at overdose ambulance calls – where they happen, if they are transported, overdose severity. Useful for a deeper understanding of the epidemiology of serious overdose.

7 surveillance-esque papers:

68) Standard Death Certificates Versus Enhanced Surveillance to Identify Heroin Overdose-Related Deaths.

Horon IL, Singal P, Fowler DR, Sharfstein JM.

Am J Public Health. 2018 Apr 19:e1-e5. doi: 10.2105/AJPH.2018.304385. [Epub ahead of print]

Comments: I love these type of projects. Basically re-litigating the cause of death from the medical examiner’s conclusion. This may sound bad, but the decision the medical examiner makes should be extremely conservative – based only upon what they are quite sure is true. By re-evaluating the data, we can identify a great many more probable heroin overdose events.

69) Accurate identification of opioid overdose deaths using coronial data.

Roxburgh A, Pilgrim JL, Hall WD, Burns L, Degenhardt L.

Forensic Sci Int. 2018 Mar 26;287:40-46. doi: 10.1016/j.forsciint.2018.03.032. [Epub ahead of print]

Comments: One quarter of “morphine” deaths were re-attributed to heroin on review of the clinical record. This passes my sniff test.

70) Mapping Drug Overdose Demographic and Socioeconomic Characteristics in the Community.

Rooney BL, Voter MT, Eberlein CM, Schossow AJ, Fischer CL.

WMJ. 2018 Mar;117(1):18-23.

Comments: Interesting chart review project of overdoses showing up in an emergency department in Wisconsin.

71) Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses – United States, July 2016-September 2017.

Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite-Powell A, Coletta MA.

MMWR Morb Mortal Wkly Rep. 2018 Mar 9;67(9):279-285. doi: 10.15585/mmwr.mm6709e1.

Comments: Up and up.

72) Prevalence of gabapentin in drug overdose postmortem toxicology testing results.

Slavova S, Miller A, Bunn TL, White JR, Kirschke D, Light T, Christy D, Thompson G, Winecker R.

Drug Alcohol Depend. 2018 May 1;186:80-85. doi: 10.1016/j.drugalcdep.2018.01.018. Epub 2018 Mar 10.

Comments: I remain doubtful that this represents a problem with gabapentin.

73) Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants – United States, 2015-2016.

Seth P, Scholl L, Rudd RA, Bacon S.

MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):349-358. doi: 10.15585/mmwr.mm6712a1.

Comments: We really need a major effort on surveillance.

74) Trends in Injector Deaths in Ireland, as Recorded by the National Drug-Related Deaths Index, 1998-2014.

Lynn TM, Lynn E, Keenan E, Lyons S.

J Stud Alcohol Drugs. 2018 Mar;79(2):286-292.

Comments: 90% of deaths were overdose (poisoning) deaths.

And lots (35) more!

75) Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids.

Young JC, Lund JL, Dasgupta N, Jonsson Funk M.

Pharmacoepidemiol Drug Saf. 2018 Jun 11. doi: 10.1002/pds.4572. [Epub ahead of print]

Comments: Wow. Honestly surprising results. One-third of patients started on >=90 morphine equivalent milligrams (MEMs) had no been receiving >=60 MEMs for 7 of the prior 14 days.

76) Prescription opioid use among individuals with serious mental illness.

Spivak S, Cullen B, Eaton W, Nugent K, Spivak A, Fenton A, Rodriguez K, Mojtabai R.

Psychiatry Res. 2018 May 31;267:85-87. doi: 10.1016/j.psychres.2018.05.075. [Epub ahead of print]

Comments: The intersection of mental illness, opioid use, and benzodiazepine use is fascinating and potentially quite complex. This study found that 12.9% of patients at two urban psychiatry clinics were prescribed opioids, and that being prescribed opioids was associated with having used heroin and using benzos; using benzos was associated with suicidal ideation. This doesn’t account for chicken or egg, but is interesting nonetheless.

77) Medical, psychosocial, and treatment predictors of opioid overdose among high risk opioid users.

Schiavon S, Hodgin K, Sellers A, Word M, Galbraith JW, Dantzler J, Cropsey KL.

Addict Behav. 2018 May 30. pii: S0306-4603(18)30575-6. doi: 10.1016/j.addbeh.2018.05.029. [Epub ahead of print]

Comments: Some unusual associations with overdose: HCV infection, witnessing an overdose, or more buprenorphine treatment episodes.

78) Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine.

Lorvick J, Browne EN, Lambdin BH, Comfort M.

Addict Behav. 2018 Oct;85:94-99. doi: 10.1016/j.addbeh.2018.05.013. Epub 2018 May 24.

Comments: Polydrug use is associated with lots of health problems and risk behaviors.

79) Not just heroin: Extensive polysubstance use among US high school seniors who currently use heroin.

Palamar JJ, Le A, Mateu-Gelabert P.

Drug Alcohol Depend. 2018 Jul 1;188:377-384. doi: 10.1016/j.drugalcdep.2018.05.001. Epub 2018 Jun 4.

Comments: Interesting analysis. Alcohol use is less likely as heroin use increases, but benzodiazepine use is.

80) Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base.

Ranapurwala SI, Naumann RB, Austin AE, Dasgupta N, Marshall SW.

Pharmacoepidemiol Drug Saf. 2018 Jun 3. doi: 10.1002/pds.4564. [Epub ahead of print] Review.

Comments: Concerns with studies used to justify the CDC opioid prescribing guidelines.

81) Quantity fluctuations of illicitly used opioids and overdose risk.

Rowe C, Wheeler E, Vittinghoff E, Santos GM, Behar E, Coffin PO.

Int J Drug Policy. 2018 May 25;58:64-70. doi: 10.1016/j.drugpo.2018.05.004. [Epub ahead of print]

Comments: An interesting analysis of data from a randomized trial of overdose prevention, finding that variations in the amount of opioids used over time was associated with subsequent overdose.

82) Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review.

Fink DS, Schleimer JP, Sarvet A, Grover KK, Delcher C, Castillo-Carniglia A, Kim JH, Rivera-Aguirre AE, Henry SG, Martins SS, Cerdá M.

Ann Intern Med. 2018 May 8. doi: 10.7326/M17-3074. [Epub ahead of print]

Comments: First, can we please call these what they are: Controlled Substance Monitoring Programs (CSMPs)? Please? Second, as the review concludes data are insufficient.

83) Risk factors for opioid overdose among hospitalized patients.

Vu Q, Beselman A, Monolakis J, Wang A, Rastegar D.

J Clin Pharm Ther. 2018 May 23. doi: 10.1111/jcpt.12701. [Epub ahead of print]

Comments: For patients in the hospital, risk of overdose was associated with older age, being in the ICU, getting other depressants, and impaired kidneys.

84) Trends in non-medical prescription opioids and heroin co-use among adults, 2003-2014.

Mital S, Windle M, Cooper HLF, Crawford ND.

Addict Behav. 2018 May 16. pii: S0306-4603(18)30468-4. doi: 10.1016/j.addbeh.2018.05.005. [Epub ahead of print]

Comments: Pulling trends from the National Survey on Drug Use and Health is tough work. Authors found increasing co-use of these opioids.

85) Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency.

Mars SG, Ondocsin J, Ciccarone D.

Harm Reduct J. 2018 May 16;15(1):26. doi: 10.1186/s12954-018-0232-z.

Comments: Such important work! Not just tester shots. Also “slow shots”, trying the drug through other routes of administration first, watching someone else use first, etc.

86) Post-stroke Intranasal (+)-Naloxone Delivery Reduces Microglial Activation and Improves Behavioral Recovery from Ischemic Injury.

Anttila JE, Albert K, Wires ES, Mätlik K, Loram LC, Watkins LR, Rice KC, Wang Y, Harvey BK, Airavaara M.

eNeuro. 2018 Apr 18;5(2). pii: ENEURO.0395-17.2018. doi: 10.1523/ENEURO.0395-17.2018. eCollection 2018 Mar-Apr.

Comments: I’m so intrigued by this. Clinically, I have sometimes seen a slight reaction to naloxone when given for a non-opioid arrest event – have always wondered what was going on.

87) Young adults’ opioid use trajectories: From nonmedical prescription opioid use to heroin, druginjection, drug treatment and overdose.

Guarino H, Mateu-Gelabert P, Teubl J, Goodbody E.

Addict Behav. 2018 May 1. pii: S0306-4603(18)30362-9. doi: 10.1016/j.addbeh.2018.04.017. [Epub ahead of print]

Comments: Use started with Rx opioids, 83% transitioned to heroin and 64% to heroin injection, generally within 4 years of initial nonmedical use. First overdose occurred on average <1 year after starting heroin.

88) Harm Reduction Strategies for the Opiod [sic] Crisis.

Castillo T.

N C Med J. 2018 May-Jun;79(3):192-194. doi: 10.18043/ncm.79.3.192.

Comments: What’s happening in North Carolina.

89) Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan, Kyrgyzstan, and Ukraine.

Rozanova J, Morozova O, Azbel L, Bachireddy C, Izenberg JM, Kiriazova T, Dvoryak S, Altice FL.

J Urban Health. 2018 May 4. doi: 10.1007/s11524-018-0256-4. [Epub ahead of print]

Comments: Prisoners did not prioritize getting on methadone for opioid use disorder prior to release. Presumably this is related to both access and competing priorities.

90) Physician Prescribing of Opioids to Patients at Increased Risk of Overdose From Benzodiazepine Use in the United States.

Ladapo JA, Larochelle MR, Chen A, Villalon MM, Vassar S, Huang DYC, Mafi JN.

JAMA Psychiatry. 2018 Apr 12. doi: 10.1001/jamapsychiatry.2018.0544. [Epub ahead of print]

Comments: Although new opioid prescriptions have been declining, including among patients taking benzodiazepines, getting started on opioids is still more likely for patients already using benzodiazepines compared to those not using benzos. Authors conclude that other factors appear to be contributing to overdose, rather than prescribing practices.

91)Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula.

Ratycz MC, Papadimos TJ, Vanderbilt AA.

Med Educ Online. 2018 Dec;23(1):1466574. doi: 10.1080/10872981.2018.1466574.

Comments: Yes, please! All medical students should get buprenorphine waivered in order to complete pre-clinical training.

92)The long-term impact of post traumatic stress disorder on recovery from heroin dependence.

Mills KL, Marel C, Darke S, Ross J, Slade T, Teesson M.

J Subst Abuse Treat. 2018 Jun;89:60-66. doi: 10.1016/j.jsat.2018.04.001. Epub 2018 Apr 4.

Comments: Patients with PTSD and opioid use disorder did just as well as those without PTSD with regard to recovery, but had higher rates of major depression, attempted suicide, trauma, and poor occupational function.

93)Re-racialization of Addiction and the Redistribution of Blame in the White Opioid Epidemic.

Mendoza S, Rivera AS, Hansen HB.

Med Anthropol Q. 2018 Apr 27. doi: 10.1111/maq.12449. [Epub ahead of print]

Comments: Such complicated issues. Overall, the narrative of white opioid users opened an opportunity for us to treat ALL people with substance use disorders with respect.

94)The U.S. opioid epidemic: One disease, diverging tales.

McBain R, Rose AJ, LaRochelle MR.

Prev Med. 2018 Apr 20. pii: S0091-7435(18)30134-8. doi: 10.1016/j.ypmed.2018.04.023. [Epub ahead of print] No abstract available.

Comments: Interesting discussion of opioid health outcomes in older versus younger adults.

95) Survey Assessing Medical Student and Physician Knowledge and Attitudes Regarding the Opioid Crisis.

Chouinard S, Prasad A, Brown R.

WMJ. 2018 Mar;117(1):34-37.

Comments: A lot of education is needed.

96) Delayed Cerebral Edema Leading to Cerebral Hernia in a Patient With Heroin Overdose.

Amjad W, Qureshi WT, Farooq AU.

Am J Ther. 2018 Apr 11. doi: 10.1097/MJT.0000000000000761. [Epub ahead of print] No abstract available.

Comments: I have no way to access.

97) Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City.

Hunter K, Park JN, Allen ST, Chaulk P, Frost T, Weir BW, Sherman SG.

Int J Drug Policy. 2018 Apr 13;57:25-31. doi: 10.1016/j.drugpo.2018.03.026. [Epub ahead of print]

Comments: Injecting in public spaces was associated with overdose, arrest, and receptive syringe sharing.

98) Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results.

Simmons J, Rajan S, Goldsamt LA, Elliott L.

Subst Use Misuse. 2018 Apr 11:1-6. doi: 10.1080/10826084.2018.1451891. [Epub ahead of print]

Comments: Online training in naloxone is certainly sufficient.

99) America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis.

Ostling PS, Davidson KS, Anyama BO, Helander EM, Wyche MQ, Kaye AD.

Curr Pain Headache Rep. 2018 Apr 4;22(5):32. doi: 10.1007/s11916-018-0685-5. Review.

Comments: Review of issues related to opioid crisis.

100) Blocking interleukin-4 enhances efficacy of vaccines for treatment of opioid abuse and prevention of opioid overdose.

Laudenbach M, Baruffaldi F, Robinson C, Carter P, Seelig D, Baehr C, Pravetoni M.

Sci Rep. 2018 Apr 3;8(1):5508. doi: 10.1038/s41598-018-23777-6.

Comments: Given the diversity of opioids, I remain skeptical that a vaccine specific to an individual opioid would be particularly beneficial.

101) Fatal and non-fatal overdose among opiate users in South Wales: A qualitative study of peer responses.

Holloway K, Hills R, May T.

Int J Drug Policy. 2018 Mar 29;56:56-63. doi: 10.1016/j.drugpo.2018.03.007. [Epub ahead of print]

Comments: Hm. These results seem a bit odd and may be specific to South Wales. Overdose isn’t that hard to identify…

102) An electronic intervention to improve safety for pain patients co-prescribed chronic opioids and benzodiazepines.

Zaman T, Rife TL, Batki SL, Pennington DL.

Subst Abus. 2018 Mar 29:1-8. doi: 10.1080/08897077.2018.1455163. [Epub ahead of print]

Comments: The VA has done some remarkable work, always with attention to the needs of its patients.

103) Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists.

Peglow SL, Binswanger IA.

Med Clin North Am. 2018 Jul;102(4):621-634. doi: 10.1016/j.mcna.2018.02.005. Review.

Comments: Review of overdose prevention plans.

104) Opioid use and harms associated with a sustained-release tapentadol formulation: a postmarketing study protocol.

Peacock A, Larance B, Farrell M, Cairns R, Buckley N, Degenhardt L.

BMJ Open. 2018 Mar 23;8(3):e020006. doi: 10.1136/bmjopen-2017-020006.

Comments: Methods for a postmarketing study that has not yet been conducted.

105) The President’s Commission on Combating Drug Addiction and the Opioid Crisis: Origins and Recommendations.

Madras BK.

Clin Pharmacol Ther. 2018 Mar 23. doi: 10.1002/cpt.1050. [Epub ahead of print]

Comments: As title says.

106) Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA.

Poowanawittayakom N, Dutta A, Stock S, Touray S, Ellison RT 3rd, Levitz SM.

Emerg Infect Dis. 2018 Apr;24(4). doi: 10.3201/eid2404.171807.

Comments: As title says. Hopefully an inspiration for infectious disease providers to engage in addiction medicine.

107) Beyond the walls: Risk factors for overdose mortality following release from the Philadelphia Department of Prisons.

Pizzicato LN, Drake R, Domer-Shank R, Johnson CC, Viner KM.

Drug Alcohol Depend. 2018 Aug 1;189:108-115. doi: 10.1016/j.drugalcdep.2018.04.034. Epub 2018 Jun 5.

Comments: In Pennsylvania, former inmates released from state prison. 3% died and one-third were due to overdose. Whites were at higher risk than Blacks and Latinos and serious mental illness predicted overdose death.

108) Criminal justice continuum for opioid users at risk of overdose.

Brinkley-Rubinstein L, Zaller N, Martino S, Cloud DH, McCauley E, Heise A, Seal D.

Addict Behav. 2018 Feb 24. pii: S0306-4603(18)30089-3. doi: 10.1016/j.addbeh.2018.02.024. [Epub ahead of print]

Comments: Criminal justice settings need to take substance use disorders seriously, providing services that can greatly improve health and post-release survival.

109) “Taking away the chaos”: a health needs assessment for people who inject drugs in public places in Glasgow, Scotland.

Tweed EJ, Rodgers M, Priyadarshi S, Crighton E.

BMC Public Health. 2018 Jul 4;18(1):829. doi: 10.1186/s12889-018-5718-9.

Comments: Support for safer consumptions spaces in Scotland.

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) Using Group Visits to Provide Overdose Education and Distribute Naloxone to High-Risk Primary Care Patients.

Bair MJ.

Pain Med. 2017 Nov 1. doi: 10.1093/pm/pnx279. [Epub ahead of print] No abstract available.

Comment: Described in the title, this is a commentary on a quasi-experimental study in Veterans’ Administration clinics.

2) Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative.

Spelman JF, Peglow S, Schwartz AR, Burgo-Black L, McNamara K, Becker WC.

Pain Med. 2017 Oct 16. doi: 10.1093/pm/pnx243. [Epub ahead of print]

Comment: The paper discussed in the above commentary.

3) Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France.

Roux P, Rojas Castro D, Ndiaye K, Briand Madrid L, Laporte V, Mora M, Maradan G, Morel S, Spire B, Carrieri P.

Subst Abuse Treat Prev Policy. 2017 Nov 2;12(1):46. doi: 10.1186/s13011-017-0131-4.

Comment: If oral therapy did not work, some people would accept supervised IV buprenorphine treatment.

4) Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 – 10 States, July-December 2016.

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1197-1202. doi: 10.15585/mmwr.mm6643e1.

Comment: >10% of deaths involved fentanyl and analogues.

5) Trends in Hospitalization for Opioid Overdose among Rural Compared to Urban Residents of the United States, 2007-2014.

Mosher H, Zhou Y, Thurman AL, Sarrazin MV, Ohl ME.

J Hosp Med. 2017 Nov;12(11):925-929. doi: 10.12788/jhm.2793.

Comment: Can’t access full article, but this seems to compare overdose hospitalizations between urban and rural sites and urban and rural residents.

6) Is systematic training in opioid overdose prevention effective?

Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT; REDAN Group.

PLoS One. 2017 Oct 31;12(10):e0186833. doi: 10.1371/journal.pone.0186833. eCollection 2017.

Comment: Yes. Improved knowledge and a possible slight decline in regional fatal overdoses.

7) Heroin Contaminated with Fentanyl Dramatically Enhances Brain Hypoxia and Induces Brain Hypothermia.

Solis E Jr, Cameron-Burr KT, Kiyatkin EA.

eNeuro. 2017 Oct 30;4(5). pii: ENEURO.0323-17.2017. doi: 10.1523/ENEURO.0323-17.2017. eCollection 2017 Sep-Oct.

Comment: As the title says.

8) A Survey of Prescribers’ Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program.

Peckham AM, Niculete ME, Steinberg H, Boggs DL.

J Public Health Manag Pract. 2017 Oct 27. doi: 10.1097/PHH.0000000000000668. [Epub ahead of print]

Comment: Providers still need individualized training for this.

9) Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review.

Lewis CR, Vo HT, Fishman M.

Subst Abuse Rehabil. 2017 Oct 11;8:79-95. doi: 10.2147/SAR.S101700. eCollection 2017. Review.

Comment: Progress has been made but we have a long way to go.

10) Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial.

Coffin PO, Santos GM, Matheson T, Behar E, Rowe C, Rubin T, Silvis J, Vittinghoff E.

PLoS One. 2017 Oct 19;12(10):e0183354. doi: 10.1371/journal.pone.0183354. eCollection 2017.

Comment: Talking about overdose regularly can reduce overdose events…

11) Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas – United States.

Mack KA, Jones CM, Ballesteros MF.

MMWR Surveill Summ. 2017 Oct 20;66(19):1-12. doi: 10.15585/mmwr.ss6619a1.

Comment: Not as simple as we’ve been told.

12) The US Opioid Crisis: Current Federal and State Legal Issues.

Soelberg CD, Brown RE Jr, Du Vivier D, Meyer JE, Ramachandran BK.

Anesth Analg. 2017 Nov;125(5):1675-1681. doi: 10.1213/ANE.0000000000002403. Review.

Comment: Legal and policy approaches.

13) Increasing availability of illicit and prescription opioids among people who inject drugs in a Canadian setting, 2010-2014.

Ho J, DeBeck K, Milloy MJ, Dong H, Wood E, Kerr T, Hayashi K.

Am J Drug Alcohol Abuse. 2017 Oct 19:1-10. doi: 10.1080/00952990.2017.1376678. [Epub ahead of print]

Comment: As title says, and in some contrast to the U.S. experience in which prescription opioid availability began to decline after 2010.

14) Imaging Sex Differences in Regional Brain Metabolism during Acute Opioid Withdrawal.

Santoro GC, Carrion J, Dewey SL.

J Alcohol Drug Depend. 2017 Apr;5(2). pii: 262. doi: 10.4172/2329-6488.1000262. Epub 2017 Apr 6.

Comment: Differences between men and women may help to explain different responsiveness to opioid use disorder treatment.

15) Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”.

Salama A, Levin Y, Jha P, Alweis R.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):222-226. doi: 10.1080/20009666.2017.1351290. eCollection 2017 Oct.

Comment: Yikes.

16) Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU.

Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, Jean E.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):202-207. doi: 10.1080/20009666.2017.1356189. eCollection 2017 Oct.

Comment: This was a study of ICU admissions for acute drug poisoning in a single facility in NYC over 6 months from late 2015 to early 2016. The 65 patients accounted for 19% of all ICU admissions during the period; 8 signed out AMA while in the ICU and 5 patients died. The most common drugs positive on serumor urine testing were alcohol (35%), opioids (33%), cocaine (24%), methadone (22%), benzodiazepines (18%), and marijuana (16%). Among the 35% with negative screens, causes of the admission including tylenol, ethylene gycol, isopropyl alcohol, bleach, NSAIDS, and antidepressants. Mean cost of ICU care was $16k.

I don’t see a report on length of stay or on disposition (i.e. did they go home, to skilled nursing, were they vegetative, etc.).

17) Naloxone Counseling for Harm Reduction and Patient Engagement.

Han JK, Hill LG, Koenig ME, Das N.

Fam Med. 2017 Oct;49(9):730-733.

Comment: Family health providers providing naloxone kits.

18) National trends and outcomes of cardiac arrest in opioid overdose.

Sakhuja A, Sztajnkrycer M, Vallabhajosyula S, Cheungpasitporn W, Patch R 3rd, Jentzer J.

Resuscitation. 2017 Oct 14;121:84-89. doi: 10.1016/j.resuscitation.2017.10.010. [Epub ahead of print]

Comment: Interesting. Mortality in the hospital for drug poisoning 1.5%: heroin overdose 4.4% (61.8% if arrived in cardiac arrest), prescription opioid overdose 2.3% (58.3% for cardiac arrest), non-opioid 1.2% (54.7% for cardiac arrest). Authors report increasing rate of cardiac arrest presentations for heroin overdose from 2000-2013, and most presentations are for prescription opioids. Trying to tease this apart is a bit tricky. Does this mean heroin overdoses are getting more dangerous? If the data went to 2015 or 2016 the answer would likely be yes, due to fentanyl, but earlier years didn’t see much of that so I don’t think this is explained by fentanyl. Were more heroin overdoses being managed in the field, either by lay persons or paramedics with more lenient transport policies, and thus not presenting to the hospital unless they had serious complications?

19) Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature.

Butler DC, Shanks K, Behonick GS, Smith D, Presnell SE, Tormos LM.

J Anal Toxicol. 2017 Sep 28:1-6. doi: 10.1093/jat/bkx083. [Epub ahead of print]

Comment: Hard to detect.

20) Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists.

Knipper E, Banta-Green CJ, Jimenez N.

Paediatr Anaesth. 2017 Nov;27(11):1070-1076. doi: 10.1111/pan.13225. Review.

Comment: Discussion of disordered opioid use by pediatric patients.

21) Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses.

Larance B, Degenhardt L, Peacock A, Gisev N, Mattick R, Colledge S, Campbell G.

Drug Alcohol Rev. 2017 Oct 12. doi: 10.1111/dar.12617. [Epub ahead of print]

Comment: Not much harm yet and interest in developing policies and practices to prevent them.

22) Basic and Advanced EMS Providers Are Equally Effective in Naloxone Administration for Opioid Overdose in Northern New England.

Gulec N, Lahey J, Suozzi JC, Sholl M, MacLean CD, Wolfson DL.

Prehosp Emerg Care. 2017 Oct 12:1-7. doi: 10.1080/10903127.2017.1371262. [Epub ahead of print]

Comment: It’s a remarkably safe and straightforward drug.

23) Use of on-site detoxification services co-located with a supervised injection facility.

Gaddis A, Kennedy MC, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T.

J Subst Abuse Treat. 2017 Nov;82:1-6. doi: 10.1016/j.jsat.2017.08.003. Epub 2017 Aug 8.

Comment: Insite has a detox service. 11% of Insite attendees utilized it in a 2 year period. A recent overdose roughly doubled the chances that a participant would access the service (adjusted odds ratio 1.90).

24) Acute eosinophilic pneumonia secondary to heroin inhalation.

Eyüpoğlu D, Ortaç Ersoy E, Rollas K, Topeli A.

Tuberk Toraks. 2017 Jun;65(2):154-156. doi: 10.5578/tt.10438.

Comment: Treated with steroids.

25) Patterns of substance use and mortality risk in a cohort of “hard-to-reach” polysubstance users.

Gjersing L, Bretteville-Jensen AL.

Addiction. 2017 Oct 7. doi: 10.1111/add.14053. [Epub ahead of print]

Comment: 6% reported an overdose in the preceding 30 days. Crude mortality was 2.52/100py, 57% of which was due to overdose. A past-four week overdose quadrupled the risk of death and agonist treatment halved mortality. Using a latent class analysis among those not in agonist treatment, polysubstance injectors and somewhat frequent injectors were the most likely to die.

26) Combatting the opioid epidemic: Baltimore’s experience and lessons learned.

Wen LS, Warren KE.

J Public Health (Oxf). 2017 Jul 19:1-5. doi: 10.1093/pubmed/fdx093. [Epub ahead of print]

Comment: Summary of actions in Baltimore

27) Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers.

Dahlem CHG, King L, Anderson G, Marr A, Waddell JE, Scalera M.

Public Health Nurs. 2017 Oct 6. doi: 10.1111/phn.12365. [Epub ahead of print]

Comment: Description of naloxone use by law enforcement.

28) Opioid crisis at the Jersey Shore-special report.

Dudley LS, Konomos D, Robbins V, Qiu L, Bauter R, Merlin MA.

J Public Health (Oxf). 2017 Aug 31:1-6. doi: 10.1093/pubmed/fdx106. [Epub ahead of print]

Comment: Jersey Shore overdoses seen by advanced EMS. 312 cases. 212 got first naloxone by lay person, police, or other BLS provider. Of those 5.2% died. Of those who got first naloxone dose by paramedics, 19.3% died.

29) A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose.

Griswold MK, Chai PR, Krotulski AJ, Friscia M, Chapman BP, Varma N, Boyer EW, Logan BK, Babu KM.

J Med Toxicol. 2017 Oct 2. doi: 10.1007/s13181-017-0632-6. [Epub ahead of print]

Comment: Oral fluid testing.

30) The Opioid Epidemic: Crisis and Solutions.

Skolnick P.

Annu Rev Pharmacol Toxicol. 2017 Oct 2. doi: 10.1146/annurev-pharmtox-010617-052534. [Epub ahead of print]

Comment: Discussion of need for alternative pharmacotherapies for pain.

31) Take-home naloxone provision cuts opioid overdose deaths.

Thompson J.

Practitioner. 2016 Nov;260(1798):7. No abstract available.

Comment: Letter. Can’t access.

32) Fentanyl and the Evolving Opioid Epidemic: What Strategies Should Policy Makers Consider?

Barry CL.

Psychiatr Serv. 2017 Oct 2:appips201700235. doi: 10.1176/appi.ps.201700235. [Epub ahead of print]

Comment: Several harm reduction approaches discussed.

33) Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015.

Eigner G, Henriksen B, Huynh P, Murphy D, Brubaker C, Sanders J, McMahan D.

Health Serv Res Manag Epidemiol. 2017 Sep 8;4:2333392817727424. doi: 10.1177/2333392817727424. eCollection 2017 Jan-Dec.

Comment: Opioid deaths in Allen County, Indiana.

34) Heroin-Related Compartment Syndrome: An Increasing Problem for Acute Care Surgeons.

Benns M, Miller K, Harbrecht B, Bozeman M, Nash N.

Am Surg. 2017 Sep 1;83(9):962-965.

Comment: Unable to access, but I assume this is in Kentucky. Heroin is now the second most common etiology for compartment syndrome. Compartment syndrome is basically when there is so much swelling in a part of the body that blood can no longer flow to that region.

35) Concurrent Use of Opioids and Benzodiazepines: Evaluation of Prescription Drug Monitoring by a United States Laboratory.

McClure FL, Niles JK, Kaufman HW, Gudin J.

J Addict Med. 2017 Sep 28. doi: 10.1097/ADM.0000000000000354. [Epub ahead of print]

Comment: Among people who were prescribed either an opioid or a benzodiazepine and who were urine tox tested, 25% had the other drug class – half of those cases were not prescribed the other class of drugs. 19% of specimens testing positive for prescribed opioids also had non-prescribed benzodiazepines and 15% of specimens testing positive for prescribed benzodiazepines also had non-prescribed opioids. These data are a bit confusing as many are presented as specimen data rather than patient data; clearly a person who is tested frequently is more likely to have non-prescribed use and results would be similar within-person.

36) The Curious (Dis)Connection between the Opioid Epidemic and Crime.

Szalavitz M, Rigg KK.

Subst Use Misuse. 2017 Sep 27:1-5. doi: 10.1080/10826084.2017.1376685. [Epub ahead of print]

Comment: “That trend—towards viewing addiction as a medical, rather than a moral problem—has also been given a tremendous boost by the media focus on opioid addiction as a white problem.”

37) Community use of naloxone for opioid overdose.

Jauncey ME, Nielsen S.

Aust Prescr. 2017 Aug;40(4):137-140. doi: 10.18773/austprescr.2017.043. Epub 2017 Aug 1. Review. No abstract available.

Comment: Pharmacy review.

38) Modifiable risk factors for external cause mortality after release from prison: a nested case-control study.

Spittal MJ, Forsyth S, Borschmann R, Young JT, Kinner SA.

Epidemiol Psychiatr Sci. 2017 Sep 25:1-10. doi: 10.1017/S2045796017000506. [Epub ahead of print]

Comment: Use of opioids in the community more than doubles the risk of death on prison release.

39) Methods for delivering the UK’s multi-centre prison-based naloxone-on-release pilot randomised trial (N-ALIVE): Europe’s largest prison-based randomised controlled trial.

Meade AM, Bird SM, Strang J, Pepple T, Nichols LL, Mascarenhas M, Choo L, Parmar MKB.

Drug Alcohol Rev. 2017 Sep 21. doi: 10.1111/dar.12592. [Epub ahead of print]

Comment: Feasibility of RCT in prison.

40) Opioid Overdose Outbreak – West Virginia, August 2016.

Massey J, Kilkenny M, Batdorf S, Sanders SK, Ellison D, Halpin J, Gladden RM, Bixler D, Haddy L, Gupta R.

MMWR Morb Mortal Wkly Rep. 2017 Sep 22;66(37):975-980. doi: 10.15585/mmwr.mm6637a3.

Comment: 20 overdoses in 2 days in a town in West Virginia, lots of fentanyl products.

41) A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder.

Chang DC, Klimas J, Wood E, Fairbairn N.

J Addict Med. 2017 Sep 19. doi: 10.1097/ADM.0000000000000359. [Epub ahead of print]

Comment: Are we still surprised by this? Detox is extremely dangerous.

42) Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments.

Lacroix L, Thurgur L, Orkin AM, Perry JJ, Stiell IG.

CJEM. 2017 Sep 18:1-7. doi: 10.1017/cem.2017.390. [Epub ahead of print]

Comment: 86% of ED docs were willing to prescribe naloxone. That’s substantial.

43) Advances in the delivery of buprenorphine for opioid dependence.

Rosenthal RN, Goradia VV.

Drug Des Devel Ther. 2017 Aug 28;11:2493-2505. doi: 10.2147/DDDT.S72543. eCollection 2017. Review.

Comment: Patches, injections, and implants, oh my.

44) Deaths from Opioid Overdosing: Implications of Coroners’ Inquest Reports 2008-2012 and Annual Rise in Opioid Prescription Rates: A Population-Based Cohort Study.

Shipton EE, Shipton AJ, Williman JA, Shipton EA.

Pain Ther. 2017 Sep 8. doi: 10.1007/s40122-017-0080-7. [Epub ahead of print]

Comment: A 33% increase in opioid death from 2001 to 2012 in New Zealand.

45) Treating Acute Pain in the Opiate-Dependent Patient.

Dever C.

J Trauma Nurs. 2017 Sep/Oct;24(5):292-299. doi: 10.1097/JTN.0000000000000309.

Comment: Per title, can’t access.

46) Mobile Technology to Increase HIV/HCV Testing and Overdose Prevention/Response among People Who Inject Drugs.

Aronson ID, Bennett A, Marsch LA, Bania TC.

Front Public Health. 2017 Aug 23;5:217. doi: 10.3389/fpubh.2017.00217. eCollection 2017.

Comment: Combining HIV, HCV, and overdose into a tablet.

47) Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis.

Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ.

Drug Alcohol Depend. 2017 Aug 10;180:33-38. doi: 10.1016/j.drugalcdep.2017.07.016. [Epub ahead of print]

Comment: Public injecting was associated with detectable HIV viral load, incarceration, and daily injection. Overdose was more likely in bivariate but not adjusted analyses.

48) Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region – United States, 2006-2015.

O’Donnell JK, Gladden RM, Seth P.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):897-903. doi: 10.15585/mmwr.mm6634a2.

Comment: Mortality increased throughout the nation, least in the West and most in the Northeast

49) Overdose Deaths Related to Fentanyl and Its Analogs – Ohio, January-February 2017.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore IE, Harshbarger KE, Antonides HM, Carlson RR.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):904-908. doi: 10.15585/mmwr.mm6634a3.

Comment: Fentanyl and related products overtaking

50) Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid.

Frazier W, Cochran G, Lo-Ciganic WH, Gellad WF, Gordon AJ, Chang CH, Donohue JM.

JAMA. 2017 Aug 22;318(8):750-752. doi: 10.1001/jama.2017.7818. No abstract available.

Comment: Slight increase in pharmacotherapy for opioid use disorder after overdose event

51) Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015.

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

Public Health Rep. 2017 Sep/Oct;132(5):563-569. doi: 10.1177/0033354917717230. Epub 2017 Jul 27.

Comment: 22% of people who inject drugs had take-home naloxone.

108 articles in four months. The fentanyl ones are all at the end in a special section, as are the injection facility ones. The rest you will have to parse through. Okay, that’s it – I feel myself turning into a pumpkin.

1) A mapping review of take-home naloxone for people released from correctional settings.

Horton M, McDonald R, Green TC, Nielsen S, Strang J, Degenhardt L, Larney S.

Int J Drug Policy. 2017 May 30;46:7-16. doi: 10.1016/j.drugpo.2017.05.015. [Epub ahead of print]

Comment: Naloxone pre-release is totally doable, but outcome studies have run into some challenges.

2) Buprenorphine implants in medical treatment of opioid addiction.

Chavoustie S, Frost M, Snyder O, Owen J, Darwish M, Dammerman R, Sanjurjo V.

Expert Rev Clin Pharmacol. 2017 Jun 2. doi: 10.1080/17512433.2017.1336434. [Epub ahead of print]

Comment: Looking forward to this. It should overcome a lot of the misinformed resistance.

3) The societal cost of heroin use disorder in the United States.

Jiang R, Lee I, Lee TA, Pickard AS.

PLoS One. 2017 May 30;12(5):e0177323. doi: 10.1371/journal.pone.0177323. eCollection 2017.

Comment: I haven’t read this in depth, but find it a bit disturbing. It always seems a bit off in economic models when you “charge” people for incarcerating them.

4) DNA Methylation Profiling of Human Prefrontal Cortex Neurons in Heroin Users Shows Significant Difference between Genomic Contexts of Hyper- and Hypomethylation and a Younger Epigenetic Age.

Kozlenkov A, Jaffe AE, Timashpolsky A, Apontes P, Rudchenko S, Barbu M, Byne W, Hurd YL, Horvath S, Dracheva S.

Genes (Basel). 2017 May 30;8(6). pii: E152. doi: 10.3390/genes8060152.

Comment: Possible heroin-associated changes in the prefrontal cortex.

5) Overdose Education and Naloxone Distribution for Veterans with Opioid Use Disorder: Results from a Pilot Initiative.

Chang G, Davids M, Kershaw A.

J Addict Dis. 2017 May 26:0. doi: 10.1080/10550887.2017.1333331. [Epub ahead of print]

Comment: 89% of outpatient and 63% of inpatient veterans accepted take-home naloxone.

6) A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program.

Piper BJ, Desrosiers CE, Fisher HC, McCall KL, Nichols SD.

Pharmacotherapy. 2017 May 19. doi: 10.1002/phar.1952. [Epub ahead of print]

Comment: A registry of drug arrests including type of drug.

7) Frequency and severity of non-fatal opioid overdoses among clients attending the Sydney Medically Supervised Injecting Centre.

Roxburgh A, Darke S, Salmon AM, Dobbins T, Jauncey M.

Drug Alcohol Depend. 2017 May 17;176:126-132. doi: 10.1016/j.drugalcdep.2017.02.027. [Epub ahead of print]

Comment: Great data. 12.7 overdose events per 1,000 heroin injections; 4.1 oxycodone overdoses per 1,000 injections. Another confirmation that injecting prescribed opioids is safer than heroin / street drugs, and thus possibly explaining at least part of the increase in overdose death while we pull back on opioid prescribing.

8) Use of naloxone nasal spray 4 mg in the community setting: a survey of use by community organizations.

Avetian GK, Fiuty P, Mazzella S, Koppa D, Heye V, Hebbar P.

Curr Med Res Opin. 2017 May 23:1-9. doi: 10.1080/03007995.2017.1334637. [Epub ahead of print]

Comment: Some good initial field data on the 4mg nasal spray. We were worried about precipitated withdrawal, but the results seem to be pretty similar to the other doses. 98.8% survived and 2 of the 3 deaths were thought to be already dead when naloxone was administered (there was no further info for the third case). 14% had withdrawal, 10% had retching/vomiting type symptoms, and 9% were angry. Interestingly, given the “high” dose and exposure of this product, a second dose was used 33% of the time, with >=3 doses in 2.4% of cases. As we know, it is difficult to wait for naloxone to start to work, and many of the second doses are administered in a panic rather than due to lack of effect of the first dose.

9) Rapid widespread distribution of intranasal naloxone for overdose prevention.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2017 Apr 1;173:17-23. doi: 10.1016/j.drugalcdep.2016.12.013. Epub 2017 Jan 28.

Comment: Government-supported program gets the product out fast.

10) Increases in prescription opioid injection abuse among treatment admissions in the United States, 2004-2013.

Jones CM, Christensen A, Gladden RM.

Drug Alcohol Depend. 2017 May 16;176:89-95. doi: 10.1016/j.drugalcdep.2017.03.011. [Epub ahead of print]

Comment: When you look at the years in Figure 1, once again the biggest change centers around 2010, a key year in all of the opioid trend graphs.

11) Update on Barriers to Pharmacotherapy for Opioid Use Disorders.

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

Curr Psychiatry Rep. 2017 Jun;19(6):35. doi: 10.1007/s11920-017-0783-9. Review.

Comment: Financial, regulatory, geographic, attitudinal, and logistic.

12) Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver.

Boyd S, Murray D; SNAP, MacPherson D.

Harm Reduct J. 2017 May 18;14(1):27. doi: 10.1186/s12954-017-0152-3.

Comment: Some powerful activism in Vancouver.

13) Safety profile of injectable hydromorphone and diacetylmorphine for long-term severe opioid use disorder.

Oviedo-Joekes E, Brissette S, MacDonald S, Guh D, Marchand K, Jutha S, Harrison S, Janmohamed A, Zhang DZ, Anis AH, Krausz M, Marsh DC, Schechter MT.

Drug Alcohol Depend. 2017 May 10;176:55-62. doi: 10.1016/j.drugalcdep.2017.02.021. [Epub ahead of print]

Comment: Generally, in a chronic disease that requires ongoing management and can be extremely morbid, we accept with open arms any treatment that has at least some benefit.

14) 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. Review.

Comment: We need to study non-fatal overdose more.

15) Comparison of a New Intranasal Naloxone Formulation to Intramuscular Naloxone: Results from Hypothesis-generating Small Clinical Studies.

Gufford BT, Ainslie GR, White JR Jr, Layton ME, Padowski JM, Pollack GM, Paine MF.

Clin Transl Sci. 2017 May 15. doi: 10.1111/cts.12473. [Epub ahead of print]

Comment: Interesting data comparing the products; overall 2mg IN and 2mg IM naloxone were pretty similar.

16) Risk to heroin users of polydrug use of pregabalin or gabapentin.

Lyndon A, Audrey S, Wells C, Burnell ES, Ingle S, Hill R, Hickman M, Henderson G.

Addiction. 2017 May 10. doi: 10.1111/add.13843. [Epub ahead of print]

Comment: Interesting. Initially I suspected that the association of increased prescribing of gabapentins and increased opioid overdose mortality was a nature of the growing population of opioid dependent persons, but the authors present some interview data and animal data suggesting that these agents lessen the tolerance to the respiratory depressive effects of opioids. Is this yet another combination we should try to avoid clinically? We are running out of options.

17) Medical providers’ knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings.

Winograd RP, Davis CS, Niculete M, Oliva E, Martielli RP.

Subst Abus. 2017 Apr-Jun;38(2):135-140. doi: 10.1080/08897077.2017.1303424.

Comment: I find it so weird that a physician would say that prescribing naloxone would increase opioid use. I doubt any would say the same about prescribing or recommending insulin, glucagon, epinephrine pens, or fire extinguishers.

18) Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing.

Faul M, Lurie P, Kinsman JM, Dailey MW, Crabaugh C, Sasser SM.

Prehosp Emerg Care. 2017 May 8:1-8. doi: 10.1080/10903127.2017.1315203. [Epub ahead of print]

Comment: Pretty good analysis.

19) Beliefs about the consequences of using benzodiazepines among persons with opioid use disorder.

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

J Subst Abuse Treat. 2017 Jun;77:67-71. doi: 10.1016/j.jsat.2017.03.002. Epub 2017 Mar 9.

Comment: Benzo users generally know that they are risky.

20) Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis.

Jordan AE, Blackburn NA, Des Jarlais DC, Hagan H.

J Subst Abuse Treat. 2017 Jun;77:31-37. doi: 10.1016/j.jsat.2017.03.007. Epub 2017 Mar 12.

Comment: Increased through the 2000s.

21) Treatment of opioid overdose: a brief review of naloxone pharmacology and delivery.

Hendley TM, Hersh EV, Moore PA, Stahl B, Saraghi M.

Gen Dent. 2017 May-Jun;65(3):18-21. No abstract available.

Comment: Can’t access.

22) Drug users’ experiences of witnessing overdoses: what do they know and what do they need to know?

Best D, Man LH, Gossop M, Noble A, Strang J.

Drug Alcohol Rev. 2000 Dec;19(4):407-412. doi: 10.1080/713659420.

Comment: Drug users are interested in overdose prevention…

23) Correction: Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal.

Ann Intern Med. 2017 May 2;166(9):687. doi: 10.7326/M17-0652. No abstract available.

Comment: This is a small correction in one of the appendix tables from the Coffin cost-effectiveness paper. There was an error in Appendix Table 3, where the total number of overdose events was overcounted. The correction is in the online table only:

24) Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine.

Pricolo A, Nielsen S.

Drug Alcohol Rev. 2017 Apr 27. doi: 10.1111/dar.12547. [Epub ahead of print]

Comment: Overcomes the standing order barrier that the U.S. has.

25) Supervised dosing with a long-acting opioid medication in the management of opioid dependence.

Saulle R, Vecchi S, Gowing L.

Cochrane Database Syst Rev. 2017 Apr 27;4:CD011983. doi: 10.1002/14651858.CD011983.pub2. Review.

Comment: Not much data comparing supervised to unsupervised dosing.

26) Pharmacokinetics after a single dose of naloxone administered as a nasal spray in healthy volunteers.

Vanky E, Hellmundt L, Bondesson U, Eksborg S, Lundeberg S.

Acta Anaesthesiol Scand. 2017 Jul;61(6):636-640. doi: 10.1111/aas.12898. Epub 2017 Apr 25.

Comment: Using a 0.4mg/mL formulation intranasally (which nobody uses), uptake was fast and concentration highly variable.

27) Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

Wiessing L, Ferri M, Běláčková V, Carrieri P, Friedman SR, Folch C, Dolan K, Galvin B, Vickerman P, Lazarus JV, Mravčík V, Kretzschmar M, Sypsa V, Sarasa-Renedo A, Uusküla A, Paraskevis D, Mendão L, Rossi D, van Gelder N, Mitcheson L, Paoli L, Gomez CD, Milhet M, Dascalu N, Knight J, Hay G, Kalamara E, Simon R; EUBEST working group, Comiskey C, Rossi C, Griffiths P.

Harm Reduct J. 2017 Apr 22;14(1):19. doi: 10.1186/s12954-017-0141-6.

Comment: Really cool set of best practice indicators.

28) Pharmacokinetics of concentrated naloxone nasal spray over first 30 minutes post-dosing: analysis of suitability for opioid overdose reversal.

Mundin G, McDonald R, Smith K, Harris S, Strang J.

Addiction. 2017 Apr 21. doi: 10.1111/add.13849. [Epub ahead of print]

Comment: Concentrated nasal naloxone pk data.

29) Expanding access to naloxone for family members: The Massachusetts experience.

Bagley SM, Forman LS, Ruiz S, Cranston K, Walley AY.

Drug Alcohol Rev. 2017 Apr 20. doi: 10.1111/dar.12551. [Epub ahead of print]

Comment: Good experience.

30) Peripartum Anesthetic Management of the Opioid-tolerant or Buprenorphine/Suboxone-dependent Patient.

Pan A, Zakowski M.

Clin Obstet Gynecol. 2017 Jun;60(2):447-458. doi: 10.1097/GRF.0000000000000288.

Comment: As above.

31) Assessing causality in drug policy analyses: How useful are the Bradford Hill criteria in analysing take-home naloxone programs?

Olsen A, McDonald D, Lenton S, Dietze PM.

Drug Alcohol Rev. 2017 Apr 18. doi: 10.1111/dar.12523. [Epub ahead of print]

Comment: There’s more than Bradford Hill criteria supporting naloxone. Very little we do in medicine has RCT data.

32) Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations.

Nadpara PA, Joyce AR, Murrelle EL, Carroll NW, Carroll NV, Barnard M, Zedler BK.

Pain Med. 2017 Apr 13. doi: 10.1093/pm/pnx038. [Epub ahead of print]

Comment: Risk factors were similar in the two populations, including substance use disorder, depression, other mental health disorders, organ dysfunction, higher doses, fentanyl/morphine/methadone, and other psychoactive medications.

33) Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015.

Stopka TJ, Donahue A, Hutcheson M, Green TC.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S34-S44. doi: 10.1016/j.japh.2016.12.077. Epub 2017 Feb 8.

Comment: 45% of surveyed pharmacies stocked naloxone.

34) Underestimated impact of novel psychoactive substances: laboratory confirmation of recreational drug toxicity in Oslo, Norway.

Vallersnes OM, Persett PS, Øiestad EL, Karinen R, Heyerdahl F, Hovda KE.

Clin Toxicol (Phila). 2017 Apr 13:1-9. doi: 10.1080/15563650.2017.1312002. [Epub ahead of print]

Comment: There are drug fads, but there are core drugs that dominate the scene and tend to stick around.

35) Naloxone Administration for Opioid Overdose Reversal in the Prehospital Setting: Implications for Pharmacists.

Weaver L, Palombi L, Bastianelli KM.

J Pharm Pract. 2017 Jan 1:897190017702304. doi: 10.1177/0897190017702304. [Epub ahead of print]

Comment: Information on naloxone formulations for pharmacists.

36) Scotland’s national naloxone program: The prison experience.

Horsburgh K, McAuley A.

Drug Alcohol Rev. 2017 Apr 10. doi: 10.1111/dar.12542. [Epub ahead of print]

Comment: Implementation challenges.

37) How Would You Manage Opioid Use in These Three Patients?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Alford DP, Cohen ML, Reynolds EE.

Ann Intern Med. 2017 Apr 4;166(7):506-513. doi: 10.7326/M17-0287.

Comment: Case review for clinicians.

38) Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice.

Wakeman SE, Kanter GP, Donelan K.

J Addict Med. 2017 Apr 3. doi: 10.1097/ADM.0000000000000314. [Epub ahead of print]

Comment: Not so long ago, a physician was on their own in treating diabetes.
They had a ton of medications, so the situation was better than for most substance use disorders. But they didn’t have nutritionists and other services to round off care and ensure patients were well taken care of; it was tough and often dissatisfying. Now they have more wraparound services. Do it for substance use disorders and you get a similar improvement in satisfaction all around.

39) Proceedings from Bridging Health Disparities to Address the Opioid Epidemic: A Symposium at the Warren Alpert Medical School of Brown University.

Dumenco L, Monteiro K, Mello M, Collins S, Operario D, Scanlan K, Dollase R, George P.

R I Med J (2013). 2017 Apr 3;100(4):16-18.

Comment: Addressing the Rhode Island crisis.

40) When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.

Rech MA, Barbas B, Chaney W, Greenhalgh E, Turck C.

Ann Emerg Med. 2017 Mar 25. pii: S0196-0644(17)30194-4. doi: 10.1016/j.annemergmed.2017.02.015.

Comment: Naloxone, fentanyl, and midazolam are often used intranasal in emergency settings.

41) Buprenorphine physician supply: Relationship with state-level prescription opioid mortality.

Knudsen HK, Havens JR, Lofwall MR, Studts JL, Walsh SL.

Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S55-S64. doi: 10.1016/j.drugalcdep.2016.08.642.

Comment: these ecologic studies are hard to interpret.

42) Randomized controlled trial of a computerized opioid overdose education intervention.

Dunn KE, Yepez-Laubach C, Nuzzo PA, Fingerhood M, Kelly A, Berman S, Bigelow GE.

Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S39-S47. doi: 10.1016/j.drugalcdep.2016.12.003.

Comment: Interesting data from an online training

43) Development of a targeted naloxone coprescribing program in a primary care practice.

Wilson CG, Rodriguez F, Carrington AC, Fagan EB.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S130-S134. doi: 10.1016/j.japh.2016.12.076. Epub 2017 Feb 9.

Comment: Chart review identified a large number of patients eligible for naloxone and only about 3% had the medication on their med list.

44) Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies – United States, 2007-2014.

Faul M, Bohm M, Alexander C.

MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):320-323. doi: 10.15585/mmwr.mm6612a2.

Comment: As we shifted away from methadone for pain, there were fewer methadone deaths. I’m think deck chairs, Titanic …

45) Use of Intranasal Naloxone by Basic Life Support Providers.

Weiner SG, Mitchell PM, Temin ES, Langlois BK, Dyer KS.

Prehosp Emerg Care. 2017 May-Jun;21(3):322-326. doi: 10.1080/10903127.2017.1282562. Epub 2017 Feb 6.

Comment: BLS naloxone is a good thing.

46) Knowledge of Opioid Overdose and Attitudes to Supply of Take-Home Naloxone Among People with Chronic Noncancer Pain Prescribed Opioids.

Nielsen S, Peacock A, Lintzeris N, Bruno R, Larance B, Degenhardt L.

Pain Med. 2017 Mar 13. doi: 10.1093/pm/pnx021. [Epub ahead of print]

Comment: 14% had experienced overdose symptoms They liked the idea of naloxone but didn’t know much about overdose.

47) Physician Dispensing of Oxycodone and Other Commonly Used Opioids, 2000-2015, United States.

Mack KA, Jones CM, McClure RJ.

Pain Med. 2017 Mar 15. doi: 10.1093/pm/pnx007. [Epub ahead of print]

Comment: Radical shifts in direct dispensing of opioids, particularly in Florida. Wow.

48) Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico.

Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL.

Drug Alcohol Rev. 2017 Mar 24. doi: 10.1111/dar.12524. [Epub ahead of print]

Comment: Polydrug use (and polyroute) and HIV & overdose risk.

49) Revisiting the ‘paradigm shift’ in opioid use: Developments and implications 10 years later.

Fischer B, Rehm J.

Drug Alcohol Rev. 2017 Mar 23. doi: 10.1111/dar.12539. [Epub ahead of print]

Comment: This is an interesting one. The authors describe the situation well. The interesting part, however, is that they write “little did we know” how bad it was going to get. Well … the piece they refer to was written by them in 2009 (Thinking the unthinkable: could the increasing misuse of prescription opioids among street drug users offer benefits for public health? Public Health. 2009). In that same issue, I wrote a companion piece in which I disagreed with their thesis that overprescribing opioids could be a good thing and emphasized the need to respond to the overdose epidemic (Balancing the costs and benefits of opioid analgesics in the United States. Public Health. 2009). My point is that, certainly by 2009, we did know.

50) No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone.

Jones JD, Campbell A, Metz VE, Comer SD.

Addict Behav. 2017 Mar 9;71:104-106. doi: 10.1016/j.addbeh.2017.03.008. [Epub ahead of print]

Comment: The best study to-date demonstrating the lack of risk compensation associated with naloxone provision.

51) Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern.

Al-Tayyib A, Koester S, Langegger S, Raville L.

Subst Use Misuse. 2017 Mar 21:1-8. doi: 10.1080/10826084.2016.1271432. [Epub ahead of print]

Comment: Methamphetamine has largely replaced cocaine as the stimulant injected alongside heroin in much of the U.S. There are suggestions that the apparent role of cocaine in contributing to heroin overdose may also apply to methamphetamine.

52) Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study.

Abrahamsson T, Berge J, Öjehagen A, Håkansson A.

Drug Alcohol Depend. 2017 Feb 28;174:58-64. doi: 10.1016/j.drugalcdep.2017.01.013. [Epub ahead of print]

Comment: Sedating drugs are associated with mortality in methadone patients. It’s important to ask, however, the mechanism of this. Those in need of these medications may simply be at higher risk of death. In the absence of randomized trial data, it is hard to rule out such a confounder – see paper #16 however, which gets pretty close.

53) The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy.

Faulkner-Gurstein R.

Soc Sci Med. 2017 Mar 9;180:20-27. doi: 10.1016/j.socscimed.2017.03.013. [Epub ahead of print]

Comment: The utilization of the context of drug use as an opportunity for intervention.

54) Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings.

Brinkley-Rubinstein L, Cloud DH, Davis C, Zaller N, Delany-Brumsey A, Pope L, Martino S, Bouvier B, Rich J.

Int J Prison Health. 2017 Mar 13;13(1):25-31. doi: 10.1108/IJPH-08-2016-0039.

Comment: Yup.

55) Body pushing, prescription drugs and hospital admission.

Byard RW, Kenneally M.

Forensic Sci Med Pathol. 2017 Mar 15. doi: 10.1007/s12024-017-9855-8. [Epub ahead of print]

Comment: Authors suggest that the patient intended to overdose and get admitted to a secure psychiatric facility, with pills stored in the rectum for use while in the facility, but died by accident.

56) Medicalizing the Opioid Epidemic in the U.S. in the Era of Health Care Reform.

Smith DE.

J Psychoactive Drugs. 2017 Mar 15:1-7. doi: 10.1080/02791072.2017.1295334. [Epub ahead of print]

Comment: Challenges.

57) Naloxone for Outpatients at Risk of Opioid Overdose #328.

Chwistek M, Wolf M.

J Palliat Med. 2017 Mar 15. doi: 10.1089/jpm.2017.0087. [Epub ahead of print] No abstract available.

Comment: A summary of co-prescribing for palliative care providers.

58) Primary care management of opioid use disorders: Abstinence, methadone, or buprenorphine-naloxone?

Srivastava A, Kahan M, Nader M.

Can Fam Physician. 2017 Mar;63(3):200-205. Review.

Comment: Agonist treatment is more effective.

59) Pharmacy-based statewide naloxone distribution: A novel “top-down, bottom-up” approach.

Morton KJ, Harrand B, Floyd CC, Schaefer C, Acosta J, Logan BC, Clark K.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S99-S106.e5. doi: 10.1016/j.japh.2017.01.017.

Comment: Great program they describe, but not clear if the claims for naloxone were related to direct provision from pharmacy or an increase in prescriptions from physicians and mid-level providers. Also the increase in provision was co-incident with the availability of the new nasal naloxone that made provision easier.

60) Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program.

Oliva EM, Christopher ML, Wells D, Bounthavong M, Harvey M, Himstreet J, Emmendorfer T, Valentino M, Franchi M, Goodman F, Trafton JA; Veterans Health Administration Opioid Overdose Education and Naloxone Distribution National Support and Development Workgroup..

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S168-S179.e4. doi: 10.1016/j.japh.2017.01.022.

Comment: 39,000 VA patients got naloxone by the end of 2016. Seriously impressive work by those who coordinated the project and the many VA providers.

61) Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone.

Duvivier H, Gustafson S, Greutman M, Jangchup T, Harden AK, Reinhard A, Warshany K.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S135-S140. doi: 10.1016/j.japh.2017.01.005.

Comment: More on pharmacists and opioid safety/naloxone.

62) Overdose Education and Naloxone Distribution Program Attendees: Who Attends, What Do They Know, and How Do They Feel?

Heavey SC, Burstein G, Moore C, Homish GG.

J Public Health Manag Pract. 2017 Mar 1. doi: 10.1097/PHH.0000000000000538. [Epub ahead of print]

Comment: Can only access abstract, but looks like they did surveys and follow ups for trainees in a naloxone program in Erie County NY. They found that a lot of trainees were family rather than drug users themselves.

63) Drug Overdose Deaths in the United States, 1999-2015.

Hedegaard H, Warner M, Minino AM.

NCHS Data Brief. 2017 Feb;(273):1-8.

Comment: Deaths from stimulants and all classes of opioids, with the exception of methadone, have been increasing since 2010.

64) Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision.

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

Br J Gen Pract. 2017 Apr;67(657):e267-e273. doi: 10.3399/bjgp17X689857. Epub 2017 Feb 28.

Comment: In Ireland, 75% of general practitioners had patients who used illicit opioids, 25% provided methadone treatment, and two-thirds supported increased access to naloxone.

65) Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD.

Addict Sci Clin Pract. 2017 Feb 28;12(1):7. doi: 10.1186/s13722-017-0072-2.

Comment: Home inductions with buprenorphine lead to similar outcomes as in-clinic efforts. This is a big deal as in-clinic inductions are a barrier to broadening the base of providers willing to address the – largely iatrogenic – opioid epidemic.

66) Mortality trends among heroin users treated between 1975 and 2013 in Northern Italy: Results of a longitudinal study.

Pavarin RM, Fioritti A, Sanchini S.

J Subst Abuse Treat. 2017 Feb 23. pii: S0740-5472(16)30376-2. doi: 10.1016/j.jsat.2017.02.009. [Epub ahead of print]

Comment: HIV, overdose, and liver disease. The age range in which heroin users die at the most increased rate relative to the general population is 25-34 years.

67) Implementing an overdose education and naloxone distribution program in a health system.

Devries J, Rafie S, Polston G.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S154-S160. doi: 10.1016/j.japh.2017.01.002. Epub 2017 Feb 21.

Comment: UC San Diego, implemented electronic health record alert, saw an increase from 4.5 to 46 naloxone prescriptions per month.

68) Overdose Risk in Young Children of Women Prescribed Opioids.

Finkelstein Y, Macdonald EM, Gonzalez A, Sivilotti ML, Mamdani MM, Juurlink DN; Canadian DrugSafety And Effectiveness Research Network (CDSERN)..

Pediatrics. 2017 Mar;139(3). pii: e20162887. doi: 10.1542/peds.2016-2887. Epub 2017 Feb 20.

Comment: If you have opioids in the house, you should have naloxone there too.

69) [Misuse and dependence on prescription opioids: Prevention, identification and treatment].

Rolland B, Bouhassira D, Authier N, Auriacombe M, Martinez V, Polomeni P, Brousse G, Schwan R, Lack P, Bachellier J, Rostaing S, Bendimerad P, Vergne-Salle P, Dematteis M, Perrot S.

Rev Med Interne. 2017 Feb 14. pii: S0248-8663(17)30021-8. doi: 10.1016/j.revmed.2016.12.024. [Epub ahead of print] French.

Comment: Just as complicated in French as in English.

70) Implementing take-home naloxone in an urban community pharmacy.

Akers JL, Hansen RN, Oftebro RD.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S161-S167. doi: 10.1016/j.japh.2017.01.006. Epub 2017 Feb 13.

Comment: Process outcomes.

71) Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12.

Hsu DJ, McCarthy EP, Stevens JP, Mukamal KJ.

Addiction. 2017 Feb 13. doi: 10.1111/add.13795. [Epub ahead of print]

Comment: Rising.

72) Strategies and policies to address the opioid epidemic: A case study of Ohio.

Penm J, MacKinnon NJ, Boone JM, Ciaccia A, McNamee C, Winstanley EL.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S148-S153. doi: 10.1016/j.japh.2017.01.001. Epub 2017 Feb 8.

Comment: Challenges.

73) A nationwide pharmacy chain responds to the opioid epidemic.

Shafer E, Bergeron N, Smith-Ray R, Robson C, O’Koren R.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S123-S129. doi: 10.1016/j.japh.2016.12.075. Epub 2017 Feb 3.

Comment: Drug disposal, naloxone, patient education.

74) Epidemiology of naloxone use for opioid overdose in a tertiary care medical center.

Rudd-Barnard G, Pangarkar S, Moaleji N, Glassman P.

J Pain. 2016 Apr;17(4S):S11. doi: 10.1016/j.jpain.2016.01.044. Epub 2016 Mar 24. No abstract available.

Comment: Some largely inpatient data on naloxone use.

75) Development and delivery of a pharmacist training program to increase naloxone access in Kentucky.

Palmer E, Hart S, Freeman PR.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S118-S122. doi: 10.1016/j.japh.2016.12.071. Epub 2017 Feb 1.

Comment: Increased number of pharmacists that have gotten certified to dispense naloxone under a physician protocol.

76) Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England.

Marsden J, Stillwell G, Jones H, Cooper A, Eastwood B, Farrell M, Lowden T, Maddalena N, Metcalfe C, Shaw J, Hickman M.

Addiction. 2017 Feb 4. doi: 10.1111/add.13779. [Epub ahead of print]

Comment: Wow! Prison agonist treatment was associated with 75% reduction in all-cause death and 85% reduction in drug overdose death in the first month out of prison.

77) An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills.

Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, Dollase R, George P.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S113-S117. doi: 10.1016/j.japh.2016.12.069. Epub 2017 Jan 31.

Comment: I’ve always felt that health professionals respond better to any disease where they learn interventions to treat it.

78) Do heroin overdose patients require observation after receiving naloxone?

Willman MW, Liss DB, Schwarz ES, Mullins ME.

Clin Toxicol (Phila). 2017 Feb;55(2):81-87. doi: 10.1080/15563650.2016.1253846. Epub 2016 Nov 16. Review.

Comment: No.

79) The authors reply regarding “Do heroin overdose patients require observation after receiving naloxone?”

Willman MW, Liss DB, Schwarz ES, Mullins ME.

Clin Toxicol (Phila). 2017 Apr;55(4):309-310. doi: 10.1080/15563650.2017.1284337. Epub 2017 Feb 3. No abstract available.

Comment: Authors defend their conclusion that people who respond to naloxone given for presumed heroin overdose can safely refuse transport if there is no sign of returning opioid toxicity after an hour.

80) The Opioid Epidemic: What Does it Mean for Nurses?

Leahy LG.

J Psychosoc Nurs Ment Health Serv. 2017 Jan 1;55(1):18-23. doi: 10.3928/02793695-20170119-03.\

Comment: Medications to treat opioid use disorder.

81) A case of massive methadone overdose presented with refractory hypoglycemia.

Li AT, Chu FK.

Clin Toxicol (Phila). 2017 Mar;55(3):233. doi: 10.1080/15563650.2016.1277236. Epub 2017 Jan 24. No abstract available.

Comment: Fascinating. I love these case reports.

82) Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity.

Isbister GK, Heppell SP, Page CB, Ryan NM.

Clin Toxicol (Phila). 2017 Mar;55(3):187-192. doi: 10.1080/15563650.2016.1277234. Epub 2017 Jan 20.

Comment: Again, case reports are fascinating.

83) Prescription drug abuse – A timely update.

Monheit B, Pietrzak D, Hocking S.

Aust Fam Physician. 2016 Dec;45(12):862-866.

Comment: Review for Australian physicians.

84) Process evaluation of the Prevent Overdose in Toronto (POINT) program.

Leece P, Gassanov M, Hopkins S, Marshall C, Millson P, Shahin R.

Can J Public Health. 2016 Oct 20;107(3):e224-e230. doi: 10.17269/cjph.107.5480.

Comment: Process outcomes.

85) Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

Rowe C, Vittinghoff E, Santos GM, Behar E, Turner C, Coffin PO.

Acad Emerg Med. 2017 Apr;24(4):475-483. doi: 10.1111/acem.13121. Epub 2017 Mar 17.

Comment: ICD codes for opioid poisoning only identified 25% of opioid overdose events identified by clinical chart review, and naloxone administration didn’t help to refine that. Such a bummer that DAWN isn’t around anymore, because we just can’t get good enough substance use-related data from coding / big data – we need manual reviews.

86) Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.

Toce MS, Burns MM, O’Donnell KA.

Clin Toxicol (Phila). 2017 Jan;55(1):12-17. doi: 10.1080/15563650.2016.1244337. Epub 2016 Oct 19.

Comment: Most develop signs of toxicity within 8 hours of exposure.

87) President’s message: Food and Drug Administration approved naloxone and continued use of improvised nasal naloxone: What is a treatment advocate and educator to do?

Morrone WR.

J Addict Dis. 2016 Oct-Dec;35(4):339-345. No abstract available.

Comment: Can’t access.

88) Caring for patients with opioid use disorder in the hospital.

Donroe JH, Holt SR, Tetrault JM.

CMAJ. 2016 Dec 6;188(17-18):1232-1239. Epub 2016 Sep 19. Review. No abstract available.

Comment: We have treatments! Use them.

89) Five minutes with . . . Steve Rolles, drug policy analyst.

Gulland A.

BMJ. 2016 Sep 14;354:i4930. doi: 10.1136/bmj.i4930. No abstract available.

Comment: Focus on public health.

90) Combating Opioid Overdose With Public Access to Naloxone.

Mitchell KD, Higgins LJ.

J Addict Nurs. 2016 Jul-Sep;27(3):160-79. doi: 10.1097/JAN.0000000000000132. Review.

Comment: Can’t access.

91) A case of U-47700 overdose with laboratory confirmation and metabolite identification.

Jones MJ, Hernandez BS, Janis GC, Stellpflug SJ.

Clin Toxicol (Phila). 2017 Jan;55(1):55-59. doi: 10.1080/15563650.2016.1209767. Epub 2016 Aug 23. Erratum in: Clin Toxicol (Phila). 2017 Jan;55(1):76.

Comment: Responded to naloxone in the field.

92) Will Adding Methadone to Controlled Substance Monitoring Programs Help Psychiatrists Prevent Prescription Drug Overdoses?

DiPrinzio D, Sethi R.

Prim Care Companion CNS Disord. 2016 Apr 7;18(2). doi: 10.4088/PCC.15l01871. eCollection 2016. No abstract available.

Comment: Authors argue that methadone used in opioid use disorder treatment should show up in prescription drug monitoring programs. As an individual clinician, that would be helpful for me. However, the stigma around opioid use disorder treatment is still massive.

93) The pharma-fever that almost got away.

Zhang XC, Siket M, Binder W.

R I Med J (2013). 2016 Jul 1;99(7):29-31. No abstract available.

Comment: Can’t access.

94) Opioid Use Disorders.

Sharma B, Bruner A, Barnett G, Fishman M.

Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87. doi: 10.1016/j.chc.2016.03.002. Epub 2016 Apr 9. Review.

Comment: A review.

95) Weighing the Risks and Benefits of Chronic Opioid Therapy.

Lembke A, Humphreys K, Newmark J.

Am Fam Physician. 2016 Jun 15;93(12):982-90.

Comment: Again, this is so complicated.

96) 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;22(5):249-58. doi: 10.1159/000446429. Epub 2016 Jun 1.

Comment: This is difficult to tease out, as liberal methadone can reach the highest risk persons, who would also have a higher risk of death.

Fentanyl:

97) Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Moore PQ, Weber J, Cina S, Aks S.

Am J Emerg Med. 2017 May 8. pii: S0735-6757(17)30367-4. doi: 10.1016/j.ajem.2017.05.003. [Epub ahead of print]

Comment: Other studies have found these data to have real limitations, but in general they should pick up on large trends. The other issue is that lay naloxone responders may not call EMS after a successful reversal, so a community with excellent naloxone coverage may not experience EMS upticks in the context of a small outbreak.

98) Characteristics of Fentanyl Overdose – Massachusetts, 2014-2016.

Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, Ruiz S, Babakhanlou-Chase H, Chan M, Callis BP, Kuramoto-Crawford J, Nields HM, Walley AY.

MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):382-386. doi: 10.15585/mmwr.mm6614a2.

Comment: Just read it. It’s too important to summarize.

99) Fentanyl laced heroin and its contribution to a spike in heroin overdose in Miami-Dade County.

Bode AD, Singh M, Andrews J, Kapur GD, Baez AA.

Am J Emerg Med. 2017 Feb 28. pii: S0735-6757(17)30158-4. doi: 10.1016/j.ajem.2017.02.043. [Epub ahead of print] No abstract available.

Comment: Authors report increased opioid overdose and a greater increase in naloxone, arguing that this means the increase was likely driven by fentanyl. I’m not sure I buy this analysis, in part because of some basic math errors (e.g. “The greatest increase in OOD was observed during the month of September with 65 cases in 2015 and 266 cases in 2016 (182% [sic – should read 326%]) (Fig. 1a/Table 1). The number of naloxone vials used from July–September rose from 212 in 2015 to 1221 in 2016, a 476% increase (Table 2a).” The analysis also doesn’t account for the number of naloxone doses actually used on individual cases (not all naloxone administrations are coded as overdose events).

100) Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014.

Mercado MC, Sumner SA, Spelke MB, Bohm MK, Sugerman DE, Stanley C.

Pain Med. 2017 Mar 6. doi: 10.1093/pm/pnx015. [Epub ahead of print]

Comment: Ugh.

101) Addressing the Fentanyl Threat to Public Health.

Frank RG, Pollack HA.

N Engl J Med. 2017 Feb 16;376(7):605-607. doi: 10.1056/NEJMp1615145. No abstract available.

Comment: Nope, still don’t like street use of fentanyl.

102) High Concomitant Misuse of Fentanyl in Subjects on Opioid Maintenance Treatment.

Krause D, Plörer D, Koller G, Martin G, Winter C, Adam R, Canolli M, Al-Iassin J, Musselmann R, Walcher S, Schäfer F, Pogarell O.

Subst Use Misuse. 2017 Apr 16;52(5):639-645. doi: 10.1080/10826084.2016.1246571. Epub 2017 Feb 3.

Comment: Interesting – high rates of fentanyl use in a population of users in Munich, Germany.

103) Multiple Fentanyl Overdoses – New Haven, Connecticut, June 23, 2016.

Tomassoni AJ, Hawk KF, Jubanyik K, Nogee DP, Durant T, Lynch KL, Patel R, Dinh D, Ulrich A, D’Onofrio G.

MMWR Morb Mortal Wkly Rep. 2017 Feb 3;66(4):107-111. doi: 10.15585/mm6604a4.

Comment: Again, just read it.

104) Illicit Fentanyl-Related Fatalities in Florida: Toxicological Findings.

Lee D, Chronister CW, Broussard WA, Utley-Bobak SR, Schultz DL, Vega RS, Goldberger BA.

J Anal Toxicol. 2016 Oct;40(8):588-594.

Comment: Lots of it.

105) Fentanyl misuse.

Ruzycki S, Yarema M.

CMAJ. 2016 Jun 14;188(9):673. doi: 10.1503/cmaj.151378. Epub 2016 Apr 18. No abstract available.

Comment: Brief overview.

Injection Facilities

106) Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility.

Irwin A, Jozaghi E, Weir BW, Allen ST, Lindsay A, Sherman SG.

Harm Reduct J. 2017 May 12;14(1):29. doi: 10.1186/s12954-017-0153-2.

Comment: The data support these facilities as an important element of the overdose response.

107) Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study.

Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD.

Harm Reduct J. 2017 Feb 20;14(1):13. doi: 10.1186/s12954-017-0139-0.

Comment: The opioid users who could most benfit from an injection facility are the most likely to want to use an injection facility.

108) Another Senseless Death – The Case for Supervised Injection Facilities.

Wakeman SE.

N Engl J Med. 2017 Mar 16;376(11):1011-1013. doi: 10.1056/NEJMp1613651. No abstract available.

Comment: See title.

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) Pharmacokinetic Properties and Human Use Characteristics of an FDA Approved IntranasalNaloxone Product for the Treatment of Opioid Overdose.

Krieter P, Chiang N, Gyaw S, Skolnick P, Crystal R, Keegan F, Aker J, Beck M, Harris J.

J Clin Pharmacol. 2016 May 5. doi: 10.1002/jcph.759. [Epub ahead of print]

Comment: Details on the pharmacokinetics and usability studies for the new nasal device.

2) The use of public health infrastructure probably the best strategy for national and large-scalenaloxone distribution programmes.

Madah-Amiri D, Clausen T.

Addiction. 2016 May 3. doi: 10.1111/add.13400. [Epub ahead of print] No abstract available.

Comment: Large-scale naloxone requires public health support.

3) The Opioid Epidemic in the United States.

Wilkerson RG, Kim HK, Windsor TA, Mareiniss DP.

Emerg Med Clin North Am. 2016 May;34(2):e1-e23. doi: 10.1016/j.emc.2015.11.002. Epub 2016 Feb 17. Review.

Comment: Focuses on risk factors for problematic opioid use and naloxone.

4) Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

Kunøe N, Opheim A, Solli KK, Gaulen Z, Sharma-Haase K, Latif ZE, Tanum L.

BMC Pharmacol Toxicol. 2016 Apr 28;17(1):18. doi: 10.1186/s40360-016-0061-1.

Comment: Methods paper for above planned study.

5) Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

Arelin V, Schmidt JJ, Kayser N, Kühn-Velten WN, Suhling H, Eden G, Kielstein JT.

Clin Nephrol. 2016 Apr 27. [Epub ahead of print]

Comment: Doesn’t really remove methadone, so not useful in an overdose but also not problematic for patients on methadone undergoing light-chain removal.

6) Utilizing a train-the-trainer model for multi-site naloxone distribution programs.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2016 Apr 14. pii: S0376-8716(16)30034-5. doi: 10.1016/j.drugalcdep.2016.04.007. [Epub ahead of print]

Comment: Title is self-explanatory.

7) Opioid-related Policies in New England Emergency Departments.

Weiner SG, Raja AS, Bittner JC, Curtis KM, Weimersheimer P, Hasegawa K, Espinola JA, Camargo CA Jr.

Acad Emerg Med. 2016 Apr 21. doi: 10.1111/acem.12992. [Epub ahead of print]

Comment: Intriguing look at ED policies in New England. 18% had an opioid screening tool, 78% used the PDMP, 41% alerted the primary doctor when prescribing opioids, 70% gave substance use treatment referrals, and 12% offered take-home naloxone.

8) Opioid Overdose Prevention in a Residential Care Setting: Naloxone Education and Distribution.

Pade P, Fehling P, Collins S, Martin L.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: Naloxone in a residential treatment program. Hopefully the first bit of data with much more to come.

9) Co-prescription of Naloxone as a Universal Precautions Model for Patients on Chronic Opioid Therapy – Observational Study.

Takeda MY, Katzman JG, Dole E, Bennett MH, Alchbli A, Duhigg D, Yonas H.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: New Mexico study of 164 chronic pain patients on opioids who were provided naloxone. There were no overdoses.

10) Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status.

Friedman MS, Manini AF.

J Med Toxicol. 2016 Apr 15. [Epub ahead of print]

Comment: Fascinating abstract – I don’t have full access. They set up “naloxone criteria” of (1) respiratory rate <12, miotic pupils, or drug paraphernalia, and (2) altered mental status by AVPU or GCS and then looked to see if those criteria predicted a beneficial effect of naloxone. They did – with an OR of 7 and 83% sensitivity. Miotic pupils were the best predictor of a response to naloxone. Authors also found that naloxone was underutilized – in only 44.2% of cases where it may have been beneficial. This is a fascinating area, as we don’t yet understand the reasons why naloxone is or is not administered in emergency services.

11) The toxicology of heroin-related death: estimating survival times.

Darke S, Duflou J.

Addiction. 2016 Apr 15. doi: 10.1111/add.13429. [Epub ahead of print]

Comment: 6-MAM, the best way to confirm heroin as a cause of overdose death, is only present if the death occurs in under 30 minutes. In this study, 6-MAM was present in 43% of heroin overdose cases, suggesting that most people took longer to expire.

12) Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.

Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG.

Am J Public Health. 2016 Apr 14:e1-e4. [Epub ahead of print]

Comment: Distribution program increased self-efficacy.

13) Findings and lessons learnt from implementing Australia’s first health service based take-home naloxone program.

Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze P, Lenton S, Kearley J, van Beek I.

Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12400. [Epub ahead of print]

Comment: First data on an Australian naloxone program. 83 people given naloxone. Among the 42% completing follow-up, 30 overdoses were successfully reversed and participants still felt informed and able to use naloxone.

14) OVERDOSED ON OPIOIDS: A deadly opioid epidemic sweeping the country has lawmakers working hard to find solutions.

Hoback J.

State Legis. 2016 Apr;42(4):9-13. No abstract available.

Comment: On a quick glance, seems a bit inflammatory.

15) Safety concerns with long-term opioid use.

Harned M, Sloan P.

Expert Opin Drug Saf. 2016 Apr 26:1-8. [Epub ahead of print]

Comment: Prospective trials are needed to evaluate longterm opioid therapy for chronic pain.

16) Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA Jr, Wilson D, McDonald R, Rotrosen J, Gourevitch MN, Gordon M, Fishman M, Chen DT, Bonnie RJ, Cornish JW, Murphy SM, O’Brien CP.

N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

Comment: Pretty good data on extended-release naltrexone and low overdose risk. Unfortunately, overdose wasn’t specifically asked about, but instead was treated as any other adverse events in a clinical trial and had to be reported by the participants.

17) Overdose Deaths in West Virginia.

Yablonsky TA, Thompson GL.

W V Med J. 2016 Mar-Apr;112(2):16-7. No abstract available.

Comment: Can’t access, but there are a lot.

18) [Accidental ingestion of methadone by children and suggestions for better prevention].

Hein H, Püschel K, Schaper A, Iwersen-Bergmann S.

Arch Kriminol. 2016 Jan-Feb;237(1-2):38-46. German.

Comment: Lockboxes.

19) FASTER RESPONSE. Hospitals backing increased use of opioid antidote.

Asplund J.

Hosp Health Netw. 2016 Jan;90(1):20, 22, 2.

Comment: This is apparently about police and naloxone.

20) Increases in Drug and Opioid Overdose Deaths–United States, 2000-2014.

Rudd RA, Aleshire N, Zibbell JE, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1378-82. doi: 10.15585/mmwr.mm6450a3.

Comment: Really well done. Discusses opioids in a sophisticated and honest manner. Impressive work from the CDC.

21) Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.

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

Ann Intern Med. 2016 Jan 5;164(1):1-9. doi: 10.7326/M15-0038. Epub 2015 Dec 29.

Comment: Patients who have an overdose usually continue to receive opioids. If opioids stop, they have a lower risk of recurrent overdose.

22) Prescription opioid related deaths in New York City: a 2 year retrospective analysis prior to the introduction of the New York State I-STOP law.

Sgarlato A, deRoux SJ.

Forensic Sci Med Pathol. 2015 Sep;11(3):388-94. doi: 10.1007/s12024-015-9699-z. Epub 2015 Aug 2.

Comment: 36.7% of decedents had a valid opioid prescription; benzos were involved in 68.4% of cases with alprazolam the most common (35.1%).

23) Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohort.

Darke S, Slade T, Ross J, Marel C, Mills KL, Tessson M.

Addict Behav. 2015 Nov;50:78-83. doi: 10.1016/j.addbeh.2015.06.030. Epub 2015 Jun 14.

Comment: Heavy drinking was associated with overdose (OR 1.6).

1) Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic.

Becker WC, Merlin JS, Manhapra A, Edens EL.

Addict Sci Clin Pract. 2016 Jan 28;11(1):3. doi: 10.1186/s13722-016-0050-0.

Comment: Fascinating article. Worth a read if you’re interested in management of pain and opioids.

2) Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City.

Harocopos A, Allen B, Paone D.

Int J Drug Policy. 2015 Dec 29. pii: S0955-3959(15)00374-6. doi: 10.1016/j.drugpo.2015.12.021. [Epub ahead of print]

Comment: Great to see some of the path from prescription opioids to heroin. Makes sense that first step is moving from a drug co-formulated with acetaminophen.

3) Emergency Department-Based Opioid Harm Reduction: moving physicians from willing to doing.

Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg A, Bernstein E.

Acad Emerg Med. 2016 Jan 27. doi: 10.1111/acem.12910. [Epub ahead of print]

Comment: To get EDs to enhance practices will require pressure from the top.

4) Internal Medicine Resident Knowledge, Attitudes and Barriers to Naloxone Prescription in Hospital and Clinic Settings.

Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L.

Subst Abus. 2016 Jan 28:0. [Epub ahead of print]

Comment: Nice article from Baltimore finding that young physicians are ready and willing to prescribe naloxone, but aren’t routinely doing so yet.

5) Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?

Strang J, McDonald R, Tas B, Day E.
Addiction. 2016 Feb 3. doi: 10.1111/add.13209. [Epub ahead of print]

Comment: There are significant issues with this proscriptive publication. First, as noted in the disclosures, the author has interest as an inventor in a patent on a new formulation of naloxone owned by his employer that would address the concerns upon which he bases his conclusions. This is a quite a conflict of interest for an academic commentary that directs clinicians in how to act.

Second, a quote from the Discussion section describes where the authors have gone off course:

“In this situation [lay naloxone administration] the failure of effect of i.n. naloxone, for whatever reason, can delay the time to naloxone injection until an ambulance arrives.”

And what would occur if there was no naloxone, besides delay in the time of naloxone administration until an ambulance arrives? As we know from experience, getting a needle into places like pre-release prison is impossible in most settings – whereas getting the nasal device was achievable. While we have long sought a superior nasal device, the absence of such a product did not obviate the benefits of nasal naloxone. The authors’ views in this case are, I believe, inconsistent with public health aims.

Third, the authors ignore the years of on-the-ground experience that emergency medical providers in the United States have with the jerry-rigged nasal naloxone device in question. Numerous systems adopted the product because it took the risk of needle-sticks out of the equation and was as – or nearly as – effective as when injected. Some investigators have suggested, and many anesthesiologists would agree, that this relatively low dose of naloxone may be all that is needed in most cases since the goal isn’t to restore a Glasgow Coma Scale of 15 – that may actually complicate lay management of overdose – but to restore breathing. (On a slight tangent, some have suggested the fascinating hypothesis that the clinical response to nasal naloxone – which is better than would be expected based on peripheral blood concentrations – may be due to exposure to naloxone through the cribriform plate directly into the central nervous system.)

Finally, to suggest that there are ethical concerns in having used this device to expand access because it was not the perfect device ignores the reality of overdose – this isn’t something we can wait to address until everything is perfect. People’s lives are on the line. Public health providers would have been at far greater fault if they had done nothing. The lead author, based in England where naloxone provision has long been delayed, should be well aware of this problem.

This “debate” seems particularly odd from the U.S. perspective, where off-label prescription and use of medications is authorized by the Food and Drug Administration and common practice. This paper is apparently the first salvo in a discussion that will involve four additional papers coming out in April.

6) Naloxone (Narcan) nasal spray for opioid overdose.

Med Lett Drugs Ther. 2016 Jan 4;58(1485):1-2. No abstract available.

Comment: As a follow-up to the oddly-timed prior article, we finally have an approved intranasal device. This is exciting and the product is priced within reach of a lot of insurers – less so community programs unfortunately. The one other potential issue is the pharmacokinetic data for this product, which suggest that the recipient may be exposed to the equivalent of around five times the standard 0.4mg intramuscular dose. Hopefully this won’t be an issue at all – and perhaps will instead be helpful for the fentanyl overdoses  seen with increasing frequency – but we will have to keep close watch for problems related to precipitated withdrawal.

7) Legal regimes surrounding naloxone access: considerations for prescribers.

Brodrick JE, Brodrick CK, Adinoff B.

Am J Drug Alcohol Abuse. 2016 Jan 25:1-12. [Epub ahead of print]

Comment: Another legal review of naloxone access.

8) A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

Dugosh K, Abraham A, Seymour B, McLoyd K, Chalk M, Festinger D.

J Addict Med. 2016 Jan 19. [Epub ahead of print]

Comment: I like the title of this article, as it hints at the primacy of medication.

9) Neighborhood-Level and Spatial Characteristics Associated with Lay NaloxoneReversal Events and Opioid Overdose Deaths.

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

J Urban Health. 2016 Jan 22. [Epub ahead of print]

Comment: How can we use geocoding data to enhance the public health response to overdose surveillance?

10) Relationship between Nonmedical Prescription-Opioid Use and Heroin Use.

Compton WM, Jones CM, Baldwin GT.

N Engl J Med. 2016 Jan 14;374(2):154-63. doi: 10.1056/NEJMra1508490. Review. No abstract available.

Comment: Interesting take on the trend of increasing heroin-related deaths. Most likely there is truth to both sides of this argument – opioid prescribing got lots of people hooked and taking away the opioids leaves a hole filled by illicit opioids.

11) Evaluation of Overdose Prevention Trainings in NYC: Knowledge and Self-efficacy among Participants Twelve Months after Training.

Maldjian L, Siegler A, Kunins HV.

Subst Abus. 2016 Jan 5:0. [Epub ahead of print]

Comment: Happy we have these data, and the lack of an age or racial differentiation in knowledge is very promising. The conclusions – that we need to improve training – is based on a pre-set idea of what knowledge is necessary to effectively respond to an overdose. I’m not sure we know that, so it’s hard to say that the trainings are insufficient. Also, with regard to the finding that some participants didn’t know naloxone could reverse opioids besides heroin, I’m curious if that finding translates to some emergency medical providers as well…

12) Risk factors of prescription opioid overdose among Colorado Medicaid beneficiaries.

Dilokthornsakul P, Moore G, Campbell JD, Lodge R, Traugott C, Zerzan J, Allen R, Page RL 2nd.

J Pain. 2015 Dec 22. pii: S1526-5900(15)00985-2. doi: 10.1016/j.jpain.2015.12.006. [Epub ahead of print]

Comment: Dose, use of methadone, substance use disorder, other psychiatric illness, benzodiazepine use, and number of pharmacies utilized.

13) An Initial Evaluation of Web-Based Opioid Overdose Education.

Roe SS, Banta-Green CJ.

Subst Use Misuse. 2015 Dec 28:1-8. [Epub ahead of print]

Comment: Web-based naloxone training!

14) Focused use of drug screening in overdose patients increases impact on management.

Erdmann A, Werner D, Hugli O, Yersin B.

Swiss Med Wkly. 2015 Dec 28;145:w14242. doi: 10.4414/smw.2015.14242. eCollection 2015.

Comment: Drug screening helps manage toxidromes in the ED.

15) An Evaluation of Naloxone Use for Opioid Overdoses in West Virginia: A Literature Review.

Beheshti A, Lucas L, Dunz T, Haydash M, Chiodi H, Edmiston B, Ford C, Bohn N, Stein JH, Berrett A, Sobota B, Horzempa J.

Am Med J. 2015 Jul 9;6(1):9-13.

Comment: Naloxone emerging in West Virginia, which has a remarkably high rate of opioid overdose mortality.

16) Opioid Overdose Deaths and Florida’s Crackdown on Pill Mills.

Kennedy-Hendricks A, Richey M, McGinty EE, Stuart EA, Barry CL, Webster DW.

Am J Public Health. 2016 Feb;106(2):291-7. doi: 10.2105/AJPH.2015.302953. Epub 2015 Dec 21.

Comment: While we usually discuss health system-related interventions on this site, there have been a few times when law enforcement-related activities have resulted in many lives saved. The Florida example described here is one of those. Another was in 2007, when the DEA shut down a fentanyl manufacturer in Mexico, ending a dramatic spate of deaths on the eastern seaboard.

17) Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia.

Uusküla A, Raag M, Vorobjov S, Rüütel K, Lyubimova A, Levina OS, Heimer R.

BMC Public Health. 2015 Dec 18;15(1):1255. doi: 10.1186/s12889-015-2604-6.

Comment: Exciting to see these important data. Unfortunately the health of drug users – and the ability to study or intervene – has only worsened in Russia.

18) Barriers to Implementation of Opioid Overdose Prevention Programs in Ohio.

Winstanley EL, Clark A, Feinberg J, Wilder CM.

Subst Abus. 2015 Dec 18:0. [Epub ahead of print]

Comment: Drug use is stigmatized and naloxone’s too expensive.

19) Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution Program in the US Department of Veterans Affairs.

Oliva EM, Nevedal A, Lewis ET, McCaa MD, Cochran MF, Konicki PE, Davis CS, Wilder C.

Subst Abus. 2015 Dec 16:0. [Epub ahead of print]

Comment: Fascinating focus groups on naloxone among veterans.

20) Mortality in the Melbourne injecting drug user cohort study (MIX).

Nambiar D, Agius PA, Stoové M, Hickman M, Dietze P.

Harm Reduct J. 2015 Dec 9;12:55. doi: 10.1186/s12954-015-0089-3.

Comment: Mortality rate was 1.0/100person-years, associated with prior incarceration, recent need for emergency care, and recent overdose. Only half of the deaths were likely accidental overdose, suggesting overall a lower rate of opioid overdose mortality than is standard in the literature – perhaps because 36% were in agonist maintenance treatment.

21) A Question About the Safety of Buprenorphine/Naloxone and Benzodiazepine Drugs.

Howland RH.

J Psychosoc Nurs Ment Health Serv. 2015 Dec 1;53(12):11-4. doi: 10.3928/02793695-20151117-01.

Comment: Buprenorphine is safer than other opioids.

22) Effectiveness of Scotland’s national naloxone programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.

Bird SM, McAuley A, Perry S, Hunter C.

Addiction. 2015 Dec 7. doi: 10.1111/add.13265. [Epub ahead of print]

Comment: Very exciting data from Scotland supporting naloxone among inmates pre-release to reduce opioid-related mortality.

23) Naloxone Administration in US Emergency Departments, 2000-2011.

Frank JW, Levy C, Calcaterra SL, Hoppe JA, Binswanger IA.

J Med Toxicol. 2015 Nov 30. [Epub ahead of print]

Comment: Tough to interpret these data. Only a minority of opioid overdose cases had naloxone administered – this makes sense since overdose can often be safely managed without naloxone in monitored settings. In 14% of cases where naloxone was administered, an opioid agonist was also provided – this would surely be a high rate of iatrogenic overdose … Can’t access full article.

24) Mortality Risk Among Heroin Abusers: Clients and Non-clients of Public Treatment Centers for Drug Addiction.

Pavarin RM.

Subst Use Misuse. 2015;50(13):1690-6. doi: 10.3109/10826084.2015.1027932. Epub 2015 Nov 23.

Comment: The mortality rate was even higher among the cohort of Italian heroin users who sought treatment compared to those just accessing emergency care. This is fascinating. And only 17% of deaths were from opioid overdose.

25) The rise of opioid abuse in Iowa.

Strickler K.

Iowa Med. 2015 Summer;105(3):10-1. No abstract available.

Comment: Can’t access and no abstract.

26) Development and process evaluation of an educational intervention for overdoseprevention and naloxone distribution by general practice trainees.

Klimas J, Egan M, Tobin H, Coleman N, Bury G.

BMC Med Educ. 2015 Nov 20;15(1):206. doi: 10.1186/s12909-015-0487-y.

Comment: Authors utilized the British OOKS/OOAS scales to test their training efficacy.

27) Acetylfentanyl: An Emerging Drug of Abuse.

Rogers JS, Rehrer SJ, Hoot NR.

J Emerg Med. 2015 Nov 14. pii: S0736-4679(15)01148-8. doi: 10.1016/j.jemermed.2015.10.014. [Epub ahead of print]

Comment: Case report of acetyl-fentanyl overdose targeted at emergency providers.

28) Response to Bird et al.: The importance of post-release engagement in treatment in estimating impacts on post-release deaths.

Larney S, Degenhardt L, Farrell M.

Addiction. 2015 Nov 21. doi: 10.1111/add.13208. [Epub ahead of print] No abstract available.

Comment: Opioid agonist treatment in prison helps too.

29) Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada.

Amlani A, McKee G, Khamis N, Raghukumar G, Tsang E, Buxton JA.

Harm Reduct J. 2015 Nov 14;12:54. doi: 10.1186/s12954-015-0088-4.

Comment: 29% of participants tested positive for fentanyl while 73% denied any use – this adulterant is not good news.

30) Emergence of methadone as a street drug in St. Petersburg, Russia.

Heimer R, Lyubimova A, Barbour R, Levina OS.

Int J Drug Policy. 2016 Jan;27:97-104. doi: 10.1016/j.drugpo.2015.10.001. Epub 2015 Oct 19.

Comment: Even when in the illicit market (because it’s not legal in Russia), methadone use is associated with reduced HIV risk behaviors.

31) Short-Term Outcomes for Opiate and Crack Users Accessing Treatment: The Effects of Criminal Justice Referral and Crack Use.

Jones A, Hayhurst KP, Millar T, Pierce M, Dunn G, Donmall M.

Eur Addict Res. 2016;22(3):145-52. doi: 10.1159/000438987. Epub 2015 Nov 17.

Comment: Improvements in drug use behaviors were not mediated by whether or not treatment was due to criminal justice referral.

32) Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.

Wilder CM, Miller SC, Tiffany E, Winhusen T, Winstanley EL, Stein MD.

J Addict Dis. 2016 Jan-Mar;35(1):42-51. doi: 10.1080/10550887.2016.1107264.

Comment: Pain patients underestimate overdose risk.

33) Do drug seizures predict drug-related emergency department presentations or arrests for drug use and possession?

Wan WY, Weatherburn D, Wardlaw G, Sarafidis V, Sara G.

Int J Drug Policy. 2016 Jan;27:74-81. doi: 10.1016/j.drugpo.2015.09.012. Epub 2015 Oct 23.

Comment: Overall, it appears that more drug supply leads to more overdoses. This is a critical issue certainly worthy of additional investigation.

34) Heroin deaths increase by two thirds in two years, UK figures show.

Wise J.

BMJ. 2015 Sep 3;351:h4754. doi: 10.1136/bmj.h4754. No abstract available.

Comment: Increased deaths in England and Wales is concerning. A smaller increase also occurred in Scotland, again suggesting that naloxone programming – while perhaps able to blunt spikes in mortality – can’t avoid the problem altogether.

35) The benefits and potential drawbacks in the approval of EVZIO for lay reversal of opioid overdose.

Beletsky L.

Am J Prev Med. 2015 Mar;48(3):357-9. doi: 10.1016/j.amepre.2014.09.011. Epub 2014 Dec 26. Review. No abstract available.

Comment: Great commentary, emphasizing both the pricing of naloxone and the need for a broader program to prevent overdose mortality.

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. 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.