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.

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

Dahlem CH, Horstman MJ, Williams BC.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

5) Long-term course of opioid addiction.

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

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

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

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

Connery HS.

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

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

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

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

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

Comments: A paper describing a planned paper. Hmm.

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

Aljarallah S, Al-Hussain F.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Walley AY.

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

Comments: Yup.

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

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

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

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

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

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

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

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

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

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

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

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

16) Prescription opioid abuse: Problems and responses.

Compton WM, Boyle M, Wargo E.

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

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

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

Kim HK, Nelson LS.

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

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

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

Davis CS, Walley AY, Bridger CM.

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

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

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

Furlano E.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wakeland W, Nielsen A, Geissert P.

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

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

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

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

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

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

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

Meiman J, Tomasallo C, Paulozzi L.

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

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

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

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

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

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

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

Farrell M, Marsden J, Strang J.

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

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

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

Strang J.

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

Comments: Let’s move on to implementation science?

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

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

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

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

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

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

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

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

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

Marteau D, McDonald R, Patel K.

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

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

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

Coe MA, Walsh SL.

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

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

37) Responding to illicit drug use in family practice.

Robertson JR, Robertson AR.

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

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

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

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

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

Comments: Nobody knows yet.

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

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

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

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

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

Sansone RA, Sansone LA.

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

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

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

Clausen T.

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

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

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

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

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

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

43) Take home naloxone for Ireland.

Bury G.

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

Comments: can’t access.

44) [The message from heroin overdoses].

Pap Á, Hegedűs K.

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

Comments: Review of overdose / prevention in Hungary.

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

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

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

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

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

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

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

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

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

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

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

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

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

Kuehn BM.

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

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

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

Weimer MB, Chou R.

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

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

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

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

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

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

5) Intranasal naloxone for treatment of opioid overdose.

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

Comments: Can’t access.

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

Facey C, Brooks D.

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

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

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

Poloméni P, Schwan R.

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

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

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

Chou R, Weimer MB, Dana T.

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

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

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

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

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

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

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

Connelly P, Wu H.

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

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

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

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

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

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

12) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

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

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

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

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

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

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

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

Jones CM.

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

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

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

Jozaghi E.

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

Comments: Personal level experience in heroin treatment programs.

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

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

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

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

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

Gjersing L, Bretteville-Jensen AL.

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

Comments: Yes.

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

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

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

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

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

Even KM, Armsby CC, Bateman ST.

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

Comments: An increasing proportion of pediatric poisonings involve opioids.

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

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

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

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

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

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

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

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

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

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

Comments: They are similar.

23) [No opiates against cannabis hyperemesis syndrome].

Bonnet U, Stratmann U, Isbruch K.

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

Comments: An odd case report.

24) Analyzing methadone-related deaths.

Newman RG.

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

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