1) Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS.

J Stud Alcohol Drugs. 2016 Sep;77(5):774-81.

Comments: Really interesting results with regard to methamphetamine – co-use of methamphetamine increased overdose risk in San Diego but not Tijuana, suggesting that risk may have been behavioral rather than pharmacologic.

2) 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.

Comments: Review of naloxone literature with an eye toward how it influences nursing.

3) Prescription opioids prior to injection drug use: Comparisons and public health implications.

Al-Tayyib AA, Koester S, Riggs P.

Addict Behav. 2016 Aug 19. pii: S0306-4603(16)30296-9. doi: 10.1016/j.addbeh.2016.08.016. [Epub ahead of print]

Comments: Those who initiated injection with prescription opioids were higher risk than those who started with heroin in the Denver Colorado’s NHBS cohort.

4) Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention.

Kirane H, Ketteringham M, Bereket S, Dima R, Basta A, Mendoza S, Hansen H.

J Subst Abuse Treat. 2016 Oct;69:44-9. doi: 10.1016/j.jsat.2016.07.005. Epub 2016 Jul 18.

Comments: Investigators asked patients and providers how they thought things *would* change if they gave/received naloxone kits and found quite a few thought use would increase. In contrast, looking at what “did” happen suggests the opposite (see next month’s PubMed Update).

5) Application of human factors engineering (HFE) to the design of a naloxone auto-injector for the treatment of opioid emergencies.

Raffa RB, Taylor R Jr, Pergolizzi JV Jr, Nalamachu S, Edwards ES, Edwards ET.

Drug Deliv Transl Res. 2016 Aug 25. [Epub ahead of print]

Comments: This is a paper about the naloxone auto-injector.

6) The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence – An assessment of demographic and substance use trends, United States, 2003-2014.

Jones CM.

Addict Behav. 2016 Aug 17. pii: S0306-4603(16)30306-9. doi: 10.1016/j.addbeh.2016.08.027. [Epub ahead of print]

Comments: We are not nearly out of the woods yet.

7) Increases in Fentanyl-Related Overdose Deaths – Florida and Ohio, 2013-2015.

Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, Halpin J, Zibbell J, McCarty CL, DeFiore-Hyrmer J, DiOrio M, Goldberger BA.

MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):844-9. doi: 10.15585/mmwr.mm6533a3.

Comments: Ugh.

8) Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid-Involved OverdoseDeaths – 27 States, 2013-2014.

Gladden RM, Martinez P, Seth P.

MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):837-43. doi: 10.15585/mmwr.mm6533a2.

Comments: Ugh.

9) OPAL: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain. Trial protocol.

Lin CW, McLachlan AJ, Latimer J, Day RO, Billot L, Koes BW, Maher CG.

BMJ Open. 2016 Aug 24;6(8):e011278. doi: 10.1136/bmjopen-2016-011278.

Comments: Interesting study protocol. Worthwhile effort.

10) A case of U-47700 overdose with laboratory confirmation and metabolite identification.

Jones MJ, Hernandez BS, Janis GC, Stellpflug SJ.

Clin Toxicol (Phila). 2016 Aug 23:1-5. [Epub ahead of print]

Comments: U-47700 can be detected in serum and the demethylated metabolites in urine.

11) Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic.

Harris BR.

Prev Med. 2016 Aug 18. pii: S0091-7435(16)30227-4. doi: 10.1016/j.ypmed.2016.08.022. [Epub ahead of print]

Comments: SBIRT for adolescents. I’m mixed on this as SBIRT hasn’t fared so well in recent studies.

12) Development of a Proto-Typology of Opiate Overdose Onset.

Neale J, Bradford J, Strang J.

Addiction. 2016 Aug 20. doi: 10.1111/add.13589. [Epub ahead of print]

Comments: Totally fascinating and much needed work to elucidate different typologies of overdose.

13) Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology.

John A, Okolie C, Porter A, Moore C, Thomas G, Whitfield R, Oretti R, Snooks H.

BMJ Open. 2016 Aug 18;6(8):e011049. doi: 10.1136/bmjopen-2016-011049.

Comments: Review of ambulance calls for poisoning in Wales.

14) Opioid Overdose: Risk Assessment and Mitigation in Outpatient Treatment.

Lin LA, Hosanagar A, Park TW, Bohnert AS.

J Addict Med. 2016 Aug 11. [Epub ahead of print]

Comments: A discussion of a case. Can’t access.

15) NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale.

Lee JD, Nunes EV, Mpa PN, Bailey GL, Brigham GS, Cohen AJ, Fishman M, Ling W, Lindblad R, Shmueli-Blumberg D, Stablein D, May J, Salazar D, Liu D, Rotrosen J.

Contemp Clin Trials. 2016 Aug 10. pii: S1551-7144(16)30202-6. doi: 10.1016/j.cct.2016.08.004. [Epub ahead of print]

Comments: Title says it all.

16) Commentary on Darke & Duflou (2016): Heroin-related deaths-identifying a window for intervention.

Tas B, McDonald R.

Addiction. 2016 Sep;111(9):1614-5. doi: 10.1111/add.13467. No abstract available.

Comments: Really interesting commentary addressing multiple possible implications of the cited article, which was discussed in a prior PubMed Update.

17) Addiction classics: Heroin overdose.

Darke S.

Addiction. 2016 Aug 10. doi: 10.1111/add.13516. [Epub ahead of print] Review.

Comments: Thanks to the author for reminding us where the current thinking about overdose emerged – since the 1970s there have been investigators proposing the tenets that currently serve as the foundation for our understanding of the field.

18) The Opioid Crisis and the Physician’s Role in Contributing to its Resolution: Step One–Prevention of Overdoses.

Wolfe S, Bouffard DL, Modesto-LoweE V.

Conn Med. 2016 Jun-Jul;80(6):325-34. Review.

Comments: Can’t access the paper, but appears to review for primary care providers the role of overdose prevention education and naloxone.

19) Recognition and response to opioid overdose deaths-New Mexico, 2012.

Levy B, Spelke B, Paulozzi LJ, Bell JM, Nolte KB, Lathrop S, Sugerman DE, Landen M.

Drug Alcohol Depend. 2016 Aug 3. pii: S0376-8716(16)30208-3. doi: 10.1016/j.drugalcdep.2016.07.011. [Epub ahead of print]

Comments: Interesting comparison of heroin to other opioid (OPR) deaths. OPR deaths were more likely to have multiple co-morbidities and prescribed polypharmacy. OPR detahs were just as likely to be witnessed (71.8% for OPR vs 74.5% for heroin), although more likely to be described as “abnormal drowsiness” and “snoring” for OPR than heroin. EMS was just as likely to be called to the scene and naloxone was half as likely to be given by paramedics for OPR vs heroin deaths. Drug paraphernalia or signs of injection were less likely in OPR deaths.

20) An autopsy case of acetyl fentanyl intoxication caused by insufflation of ‘designer drugs’.

Takase I, Koizumi T, Fujimoto I, Yanai A, Fujimiya T.

Leg Med (Tokyo). 2016 Jul;21:38-44. doi: 10.1016/j.legalmed.2016.05.006. Epub 2016 May 18.

Comments: Snored for 12 hours before being attended to.

1) The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009.

Shah NG, Lathrop SL, Flores JE, Landen MG.

Drug Alcohol Depend. 2012 Apr 16.

Comment: An analysis of New Mexico overdose deaths (many of us have been waiting with bated breath for a deeper analysis of deaths there). Authors found that living in a border region was associated with less overdose death, particularly from heroin or methadone; among their hypotheses is that this is a paradoxical benefit of reduced access to medical care and opioid prescriptions.

2) [Differences in depression severity and frequency of relapses in opiate addicts treated with methadone or opiate blocker after detoxification].

Jovanović T, Lazarević D, Nikolić G.

Vojnosanit Pregl. 2012 Apr;69(4):326-32. Serbian.

Comment: Does anyone read Serbian? I’d love to see some additional comment on this intriguing paper. The issues around depot naltrexone versus agonist maintenance are becoming a real issue. The concerns around overdose death in the setting of naltrexone have not been adequately addressed. This paper appears to compare depression scales for patients on those two therapies, but I can’t tell from the abstract exactly what the populations are or what the analysis showed.

3) Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence: First Use of the Buprenorphine-Naloxone Dosage Adequacy Evaluation (BUDAVA) Questionnaire.

D’Amore A, Romano F, Biancolillo V, Lauro G, Armenante C, Pizzirusso A, Del Tufo S, Ruoppolo C, Auriemma F, Cassese F, Oliva P, Amato P.

Clin Drug Investig. 2012 May 4.

Comment: A dosing scale that includes non-fatal overdose as a marker for adjusting buprenorphine dosage. Again, I can’t access the article to get details! I’d love comments from anyone who can.

4) A Novel Case of Transient Right Ventricular Failure in a Patient With Respiratory Distress.

Liu SS, Kovell LC, Horne A Jr, Chang D, Petronis JD, Zakaria S.

J Intensive Care Med. 2012 Apr 29.

Comment: This patient overdosed on opioids and wasn’t breathing. After no response to naloxone she was intubated and eventually recovered. It appears that the right ventricle of her heart stopped working for a while due to hypoxia. This should serve as a reminder that medical intervention is often needed in overdose, particularly if the overdose isn’t addressed quickly.