There’s some sophisticated work here – innovative epidemiology, interventions, and reviews of overdose. We’ve come a long way from the 1990s, but clearly not quickly enough for the dynamic urgency of this issue.

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

Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.

PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.

Comments: Interesting approach and data.

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

Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.

Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30.

Comments: Yeah … this is really complicated.

3) Hypoglycemia and Sudden Death During Treatment With Methadone for Opiate Detoxification.

Plescia CJ, Manu P.

Am J Ther. 2017 Nov 14. doi: 10.1097/MJT.0000000000000692. [Epub ahead of print]

Comments: This is an iatrogenic methadone and benzodiazepine overdose during simultaneous alcohol and opioid detoxification.

4) Revisiting Naloxone: A different take on overdose guidelines from Lee County, Fla.

Hamel MG.

JEMS. 2016 Nov;41(11):46-8. No abstract available.

Comments: No abstract. Can’t access.

5) Naloxone Conundrum: Reduce risk in managing the opioid overdose patient.

Wirth SR.

JEMS. 2016 Nov;41(11):14-5. No abstract available.

Comments: Same journal, again no abstract, and can’t access.

6) Evaluation of the Southern Harm Reduction Coalition for HIV Prevention: Advocacy Accomplishments.

Story CR; Members of the Southern Harm Reduction Coalition, Kao WK, Currin J, Brown C, Charles V.

Health Promot Pract. 2017 Nov 1:1524839917742850. doi: 10.1177/1524839917742850. [Epub ahead of print]

Comments: Paper on the advocacy efforts for harm reduction.

7) Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus.

Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M.

Expert Opin Pharmacother. 2017 Dec;18(18):1987-1999. doi: 10.1080/14656566.2017.1409722. Epub 2017 Dec 3.

Comments: We have good medications. Use them.

8) Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review.

Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O’Reilly C, Grusing S, Daya M.

Ann Intern Med. 2017 Dec 19;167(12):867-875. doi: 10.7326/M17-2224. Epub 2017 Nov 28.

Comments: As with many systematic reviews, there are insufficient data to really answer the questions. Open access.

9) Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution.

Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM.

Pain Med. 2017 Jun 15. doi: 10.1093/pm/pnx140. [Epub ahead of print]

Comments: This is a unique survey at Mayo Clinic in Minnesota. Kudos to the authors. Most providers weren’t comfortable with the care they provided. Few (2%) routinely prescribed naloxone. Many weren’t registered with the PDMP. We’re kind of in a mess.

10) Payer Policy Behavior Towards Opioid Pharmacotherapy Treatment in Ohio.

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

J Addict Med. 2017 Nov 15. doi: 10.1097/ADM.0000000000000369. [Epub ahead of print]

Comments: Everyone pays for opioids for pain but treating opioid use disorder is not paid for unless paired with behavioral therapy and duration of treatment is limited. These are not evidence-based decisions. There are strong data that buprenorphine treatment are effective with or without behavioral therapy. And stopping treatment is always associated with increased mortality. How about we put a limit on the duration of insulin for diabetes?

11) Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington.

Glick SN, Burt R, Kummer K, Tinsley J, Banta-Green CJ, Golden MR.

Drug Alcohol Depend. 2017 Nov 16;182:86-92. doi: 10.1016/j.drugalcdep.2017.10.011. [Epub ahead of print]

Comments: The opioid epidemic is also a stimulant issue.

12) Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue.

Huxley-Reicher Z, Maldjian L, Winkelstein E, Siegler A, Paone D, Tuazon E, Nolan ML, Jordan A, MacDonald R, Kunins HV.

Addict Behav. 2017 Nov 16. pii: S0306-4603(17)30437-9. doi: 10.1016/j.addbeh.2017.11.029. [Epub ahead of print]

Comments: Great results from an innovative program to reach those at risk for overdose. Impressive work from NYC!

13) PHArmacists’ perspective oN the Take hOme naloxone prograM (The PHANTOM Study).

Edwards J, Bates D, Edwards B, Ghosh S, Yarema M.

Can Pharm J (Ott). 2017 Jul 7;150(4):259-268. doi: 10.1177/1715163517711960. eCollection 2017 Jul-Aug.

Comments: Pharmacists in Alberta highly supportive of screening patients and providing naloxone.

14) Overdose prevention training with naloxone distribution in a prison in Oslo, Norway: a preliminary study.

Petterson AG, Madah-Amiri D.

Harm Reduct J. 2017 Nov 21;14(1):74. doi: 10.1186/s12954-017-0200-z.

Comments: Training in naloxone prior to release was associated with improved knowledge.

15) Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999-2014: An Age-Period-Cohort Analysis.

Huang X, Keyes KM, Li G.

Am J Public Health. 2018 Jan;108(1):131-136. doi: 10.2105/AJPH.2017.304142. Epub 2017 Nov 21.

Comments: Fascinating results. Two cohorts are involved. Baby boomers 1947 through 1964 have elevated rates of prescription opioid as well as heroin overdose death. A second cohort, born 1979-1992, is at elevated risk of heroin overdose death. I can’t access full article unfortunately.

16) ‘I have it just in case’ – Naloxone access and changes in opioid use behaviours.

Heavey SC, Chang YP, Vest BM, Collins RL, Wieczorek W, Homish GG.

Int J Drug Policy. 2017 Nov 17;51:27-35. doi: 10.1016/j.drugpo.2017.09.015. [Epub ahead of print]

Comments: This is a qualitative study (N=20) at a residential treatment center (presumably in Buffalo NY where authors are based). Authors report that some respondents reported behaviors related to naloxone that may put them at higher risk. The is the first research to suggest this finding. The examples they provide, however, are not entirely concordant with the purported themes, with the exception of one example in which a respondent reported using something that he thought was fentanyl because there was someone with naloxone present in case it was in fact fentanyl. The other examples include: a person who overdosed three days in a row and was reversed by paramedics each time which is described as “opioid use after naloxone”, and “naloxone behaviors that may increase overdose mortality risk” which include mistaking an overdose for a nod (this doesn’t seem relevant to naloxone) and people who tend to use alone (again, unclear how this is related to naloxone). Finally, conducting this study in a residential treatment center brings extensive biases that affect how people (re)interpret their own history.

17) Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015.

Curtin SC, Tejada-Vera B, Warmer M.

NCHS Data Brief. 2017 Aug;(282):1-8.

Comments: Wow. Increased heroin deaths among kids. This suggests that we are dealing with increased opioid use, not just increased risk with the shift to heroin and emergence of fentanyl.

18) Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.

Lee JD, Nunes EV Jr, Novo P, Bachrach K, Bailey GL, Bhatt S, Farkas S, Fishman M, Gauthier P, Hodgkins CC, King J, Lindblad R, Liu D, Matthews AG, May J, Peavy KM, Ross S, Salazar D, Schkolnik P, Shmueli-Blumberg D, Stablein D, Subramaniam G, Rotrosen J.

Lancet. 2017 Nov 14. pii: S0140-6736(17)32812-X. doi: 10.1016/S0140-6736(17)32812-X. [Epub ahead of print]

Comments: In randomized-controlled trials, we care about the intent-to-treat analysis. The per-protocol analysis is a distant second that doesn’t usually get a place of prominence in the abstract of a major paper, making this abstract unusual. Moreover, describing the intent-to-treat findings as “it is harder to initiate patients” is very unusual. The most important finding from this study is, of course, that those assigned to XR-NTX had higher rates of relapse and more opioid-positive urines – and this should be the conclusion by traditional RCT standards. While the authors are likely correct that this finding is because it is harder (and presumably more dangerous) to induct people onto XR-NTX, from a clinical perspective this makes XR-NTX inferior to buprenorphine. That does not mean it’s not valuable, but it does mean that relying exclusively on it is inconsistent with quality care. I really hope they are following people longer than 24 weeks, given that this is a lifelong disease and, while buprenorphine is usually provided longterm, XR-NTX is rarely provided for more than 6 months. Of note, there are several author COIs related to Alkermes which I consider relevant given the unusual presentation of intent-to-treat results.

19) Is naloxone the best antidote to reverse tramadol-induced neuro-respiratory toxicity in overdose? An experimental investigation in the rat.

Lagard C, Malissin I, Indja W, Risède P, Chevillard L, Mégarbane B.

Clin Toxicol (Phila). 2017 Nov 17:1-7. doi: 10.1080/15563650.2017.1401080. [Epub ahead of print]

Comments: Works, but increases seizure risk.

20) Extracorporeal membrane oxygenation used successfully in a near fatal case of opioid-induced acute respiratory distress syndrome.

Greenberg K, Kohl B.

Am J Emerg Med. 2017 Nov 8. pii: S0735-6757(17)30928-2. doi: 10.1016/j.ajem.2017.11.020. [Epub ahead of print]

Comments: ARDS is a nasty lung disease that is difficult to ventilate, with a high mortality rate.

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

Mack KA, Jones CM, Ballesteros MF.

Am J Transplant. 2017 Dec;17(12):3241-3252. doi: 10.1111/ajt.14555.

Comments: Why is this in a transplantation journal? Also, an earlier paper in this review suggests that youth opioid use has picked up since the end of the study period for this article.

22) Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study.

McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, Strang J.

Addiction. 2017 Nov 16. doi: 10.1111/add.14033. [Epub ahead of print]

Comments: 2mg IN similar to 0.4mg IM … as one would expect!

23) Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial.

Molfenter T, Knudsen HK, Brown R, Jacobson N, Horst J, Van Etten M, Kim JS, Haram E, Collier E, Starr S, Toy A, Madden L.

Implement Sci. 2017 Nov 15;12(1):135. doi: 10.1186/s13012-017-0665-x.

Comments: Description of an impending implementation science study to increase provision of addiction treatment for opioid use disorder.

24) Reversal of Opioid-Induced Toxicity.

Ostwal SP, Salins N, Deodhar J.

Indian J Palliat Care. 2017 Oct-Dec;23(4):484-486. doi: 10.4103/IJPC.IJPC_117_17.

Comments: Case report of a person on palliative opioids successfully reversed with naloxone.

25) Epidemiologic incidence of rhabdomyolysis in opioid overdose in ICU of poisoning center in Iran, 2014.

Khoshideh B, Arefi M, Ghorbani M, Akbarpour S, Taghizadeh F.

Epidemiol Health. 2017 Nov 8. doi: 10.4178/epih.e2017050. [Epub ahead of print]

Comments: Rhabdomyolysis is a disease produced by breakdown of muscle cells, resulting in buildup of creatine kinase which is toxic to the kidneys. Usually it occurs when someone is “down” for a prolonged period (i.e. unconscious on the floor), resulting in pressure on muscles. Sometimes we see it with extreme exposure to stimulants, such as cocaine or methamphetamine, with excessive tensing of muscles for prolonged periods. We also see it as a rare side effect of statin exposure, and several other causes.

26) Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose.

Freeman LK, Bourque S, Etches N, Goodison K, O’Gorman C, Rittenbach K, Sikora CA, Yarema M.

Can J Public Health. 2017 Nov 9;108(4):e398-e402. doi: 10.17269/cjph.108.5989.

Comments: 9572 kits distributed and 472 reversals reported in Alberta’s 953 naloxone sites in 2016.

27) Availability of naloxone in Canadian pharmacies: a population-based survey.

Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN.

CMAJ Open. 2017 Nov 8;5(4):E779-E784. doi: 10.9778/cmajo.20170123.

Comments: Half of pharmacies had naloxone available in British Columbia, one-third in Maritimes, a quarter in Ontario and central and northern Canada; 0.9% in Quebec.

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

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

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

Comments: I’m still stuck on “this sucks.”

29) Is systematic training in opioid overdose prevention effective?

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

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

Comments: 40% of people who inject opioids that received naloxone used it to reverse an overdose.

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

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

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

Comments: Motivational interviewing-based intervention among naloxone recipients resulted in substantial reduction in occurrence of subsequent overdose events.

31) Drug related deaths in Scotland double in 10 years.

Iacobucci G.

BMJ. 2017 Aug 21;358:j3941. doi: 10.1136/bmj.j3941. No abstract available.

Comments: Ugh. Overdose death is way more complicated than a simple reversal agent. There are clearly economic and social elements to the epidemic we are facing today.

32) 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 Nov;35(11):1706-1708. doi: 10.1016/j.ajem.2017.05.003. Epub 2017 May 8.

Comments: We are still a long way from effectively utilizing clinical data systems.

33) Deadly chemistry.

McLaughlin K.

Science. 2017 Mar 31;355(6332):1364-1366. doi: 10.1126/science.355.6332.1364. No abstract available.

Comments: Fentanyl and analogues.

34) 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.

Comments: Home induction works well, even in low resource settings.

35) A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence.

Chetty M, Kenworthy JJ, Langham S, Walker A, Dunlop WC.

Addict Sci Clin Pract. 2017 Feb 24;12(1):6. doi: 10.1186/s13722-017-0071-3. Review.

Comments: 18 models in total, with widely varying approaches and quality, a tiny number given the impact of opioid use disorder and treatment.

36) 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.

Comments: >60%

37) The impact of benzodiazepine use in patients enrolled in opioid agonist therapy in Northern and rural Ontario.

Franklyn AM, Eibl JK, Gauthier G, Pellegrini D, Lightfoot NE, Marsh DC.

Harm Reduct J. 2017 Jan 26;14(1):6. doi: 10.1186/s12954-017-0134-5. Erratum in: Harm Reduct J. 2017 Mar 28;14 (1):15.

Comments: Benzodiazepine use complicated opioid use disorder treatment, for sure. One of the questions is why? Is it comorbid use disorder? Is it anxiety? Depression?

38) Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know.

Kerensky T, Walley AY.

Addict Sci Clin Pract. 2017 Jan 7;12(1):4. doi: 10.1186/s13722-016-0068-3. Review.

Comments: Nice review of key issues related to naloxone provision.

1) Factors associated with knowledge of a Good Samaritan Law among young adults who use prescription opioids non-medically.

Evans TI, Hadland SE, Clark MA, Green TC, Marshall BD.

Harm Reduct J. 2016 Jul 26;13(1):24. doi: 10.1186/s12954-016-0113-2.

Comments: Less than half knew about it.

2) Reasons for Benzodiazepine Use Among Persons Seeking Opioid Detoxification.

Stein MD, Kanabar M, Anderson BJ, Lembke A, Bailey GL.

J Subst Abuse Treat. 2016 Sep;68:57-61. doi: 10.1016/j.jsat.2016.06.008. Epub 2016 Jun 16.

Comments: Important work, as there’s an effort to also reduce benzodiazepine prescribing among people who are on opioids. Understanding the drivers of BDZ use should be helpful in structuring interventions. Anxiety and managing opioid withdrawal were two main reasons.

3) Trends in Methadone Distribution for Pain Treatment, Methadone Diversion, and Overdose Deaths – United States, 2002-2014.

Jones CM, Baldwin GT, Manocchio T, White JO, Mack KA.

MMWR Morb Mortal Wkly Rep. 2016 Jul 8;65(26):667-71. doi: 10.15585/mmwr.mm6526a2.

Comments: Interesting analysis of methadone prescribing, overdose, and diversion. It seems that efforts to reduce methadone, beginning in 2006, corresponded with reduced diversion and overdose; unfortunate that opioid overdose death overall continued to escalate.

4) Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine.

Makarenko I, Mazhnaya A, Polonsky M, Marcus R, Bojko MJ, Filippovych S, Springer S, Dvoriak S, Altice FL.

Drug Alcohol Depend. 2016 Aug 1;165:213-20. doi: 10.1016/j.drugalcdep.2016.06.011. Epub 2016 Jun 17.

Comments: Barriers to enrolling in agonist treatment in Ukraine.

5) The next three letters were responding to an earlier paper from several months ago regarding intranasal naloxone:

While we dither, people continue to die from overdose: Comments on ‘Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?’

Coffin P, Rich J, Dailey M, Stancliff S, Beletsky L.

Addiction. 2016 Jul 14. doi: 10.1111/add.13412. [Epub ahead of print] No abstract available.

Comments on Strang et al. (2016): ‘Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?’

Doe-Simkins M, Banta-Green C, Davis CS, Green TC, Walley AY.

Addiction. 2016 Jul 14. doi: 10.1111/add.13399. [Epub ahead of print] No abstract available.

Letters to Addiction from Coffin et al. and Doe-Simpkins et al. re: ‘For Debate’ on clinical use of improvised nasal naloxone sprays: authors’ response.

Strang J, Mcdonald R.

Addiction. 2016 Jul 13. doi: 10.1111/add.13468. [Epub ahead of print] No abstract available.

6) Opioid agonist treatment for pharmaceutical opioid dependent people.

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

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

Comment: Low to moderate evidence to support this intervention, but it appears more effective than other options.

7) [Death from fentanyl: Causative and preventive approaches in Bavaria].

Erbas B, Arnold M.

MMW Fortschr Med. 2016 Feb 18;158(3):54-6. doi: 10.1007/s15006-016-7821-0. Review. German. No abstract available.

Comments: Can’t access.

8) Australia reschedules naloxone for opioid overdose.

Lenton SR, Dietze PM, Jauncey M.

Med J Aust. 2016 Mar 7;204(4):146-7. No abstract available.

Comments: In Australia this means it is now available for over-the-counter purchase!

9) Take-home naloxone programs and calls to emergency services.

Kirwan A, Curtis M, van Beek IA, Cantwell K, Dietze PM.

Med J Aust. 2016 Mar 7;204(4):143. No abstract available.

Comments: Can’t access.

10) Increase in Naloxone Prescriptions Dispensed in US Retail Pharmacies Since 2013.

Jones CM, Lurie PG, Compton WM.

Am J Public Health. 2016 Apr;106(4):689-90. doi: 10.2105/AJPH.2016.303062. Epub 2016 Feb 18.

Comments: 1170% increase in naloxone dispensed from US retail pharmacies from 2013-2015. Not sure the actual numbers because I can’t access the article.

11) Recurring Epidemics of Pharmaceutical Drug Abuse in America: Time for an All-Drug Strategy.

Herzberg D, Guarino H, Mateu-Gelabert P, Bennett AS.

Am J Public Health. 2016 Mar;106(3):408-10. doi: 10.2105/AJPH.2015.302982. Epub 2016 Jan 21.

Comments: Fascinating take. And timely, as we’ve already started seeing some – albeit still spotty – policy movements away from the calls for humane treatment in the current opioid epidemic in the U.S.

1) Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria.

McDonald R, Strang J.

Addiction. 2016 Mar 30. doi: 10.1111/add.13326. [Epub ahead of print] Review.

Comments: Take-home naloxone meets all Bradford Hill criteria for causality in reducing opioid overdose mortality. Incidence of fatality among overdoses in the setting of take-home naloxone was 0.8%.

2) Managing Opioid Abuse in Older Adults: Clinical Considerations and Challenges.

Loreck D, Brandt NJ, DiPaula B.

J Gerontol Nurs. 2016 Apr 1;42(4):10-5. doi: 10.3928/00989134-20160314-04.

Comments: A review of the U.S. situation and treatments for opioid use disorder.

3) Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015.

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

Drug Alcohol Depend. 2016 May 1;162:206-10. doi: 10.1016/j.drugalcdep.2016.03.010. Epub 2016 Mar 18.

Comments: Heroin use is associated with 25-50 years of life lost. Over half of deaths and nearly two-thirds of years of life lost were due to opioid overdose.

4) Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.

Olsson MO, Bradvik L, Öjehagen A, Hakansson A.

Drug Alcohol Depend. 2016 May 1;162:176-81. doi: 10.1016/j.drugalcdep.2016.03.009. Epub 2016 Mar 17.

Comments: Accidental overdose death and suicide are distinct entities, with distinct predictive variables. This is important.

5) An Initial evaluation of law enforcement overdose training in Rhode Island.

Saucier CD, Zaller N, Macmadu A, Green TC.

Drug Alcohol Depend. 2016 May 1;162:211-8. doi: 10.1016/j.drugalcdep.2016.03.011. Epub 2016 Mar 19.

Comments: Harm reduction programs training law enforcement, a critical step forward.

6) Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

Levine M, Sanko S, Eckstein M.

Prehosp Emerg Care. 2016 Mar 28:1-4. [Epub ahead of print]

Comments: Studies of pre-hospital naloxone without transport to the hospital have uniformly shown extremely low rates of re-overdose or death in the ensuing 24 hours. This study examined 205 people over a much longer period and identified 3 deaths in the subsequent month. Again, this supports the relative safety of naloxone management and yet emphasizes the high risk of mortality in this population.

7) Opioid overdose and naloxone education in a substance use disorder treatment program.

Lott DC, Rhodes J.

Am J Addict. 2016 Apr;25(3):221-6. doi: 10.1111/ajad.12364. Epub 2016 Mar 22.

Comments: Education is excellent, but providing the medication on-site is critical.

8) Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses.

Kitch BB, Portela RC.

Prehosp Emerg Care. 2016 Mar-Apr;20(2):226-9. doi: 10.3109/10903127.2015.1076097.

Comments: Police administering naloxone in the setting of fentanyl overdoses.

9) Could chest wall rigidity be a factor in rapid death from illicit fentanyl abuse?

Burns G, DeRienz RT, Baker DD, Casavant M, Spiller HA.

Clin Toxicol (Phila). 2016 Mar 21:1-4. [Epub ahead of print]

Comments: Fascinating article! Many of us have wondered why fentanyl is such an extreme problem when used illicitly. This paper describes the phenomenon of chest wall rigidity with rapid IV administration of fentanyl, a possible explanation for the high risk of death in the setting of increased illicit fentanyl availability.

10) A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs.

Riley ED, Evans JL, Hahn JA, Briceno A, Davidson PJ, Lum PJ, Page K.

Am J Public Health. 2016 May;106(5):915-7. doi: 10.2105/AJPH.2016.303084. Epub 2016 Mar 17.

Comments: Increased use is associated with increased overdose. This has been a persistent finding, potentially in conflict with the findings that periods of abstinence are associated with overdose. That is to say, even though low tolerance is a risk for overdose, it seems that more regular rather than more sporadic use increases overdose risk. Prevention messaging on this topic remains challenging.

11) Reducing the Risks of Relief – The CDC Opioid-Prescribing Guideline.

Frieden TR, Houry D.

N Engl J Med. 2016 Mar 15. [Epub ahead of print]

Comments: An editorial on the new CDC guidelines described below.

12) CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016.

Dowell D, Haegerich TM, Chou R.

JAMA. 2016 Mar 15. doi: 10.1001/jama.2016.1464. [Epub ahead of print]

Comments: New guidelines for opioid prescribing that emphasize reliance upon other therapies first and limited doses of opioids. They do recommend use of opioid agonist treatments for patients with co-morbid chronic pain and opioid use disorder, such as buprenorphine which can be prescribed by general practitioners in the U.S., and co-prescription of naloxone to patients on higher doses (>50 morphine equivalent milligrams) or other risk factors.

13) Engagement in a National Naloxone Programme among people who inject drugs.

McAuley A, Munro A, Bird SM, Hutchinson SJ, Goldberg DJ, Taylor A.

Drug Alcohol Depend. 2016 May 1;162:236-40. doi: 10.1016/j.drugalcdep.2016.02.031. Epub 2016 Mar 3.

Comments: Increased utilization but reduced likelihood of participants actually carrying naloxone on their person.

14) Improving Outcomes of Opioid Overdose: Preparing Nursing Students to Intervene.

Dion KA.

J Addict Nurs. 2016 Jan-Mar;27(1):7-11. doi: 10.1097/JAN.0000000000000106.

Comments: Training nursing students in opioid overdose management.

15) What is known about community pharmacy supply of naloxone? A scoping review.

Nielsen S, Van Hout MC.

Int J Drug Policy. 2016 Feb 15. pii: S0955-3959(16)30014-7. doi: 10.1016/j.drugpo.2016.02.006. [Epub ahead of print]

Comments: There’s some information out there but much more needed.

The next series of articles are all related to the lead author’s thesis that nasal naloxone is problematic; the final 5 being responses to the lead author’s recent article inAddiction critiquing nasal naloxone. Dr Strang has been a longtime advocate of naloxone, but not nasally administered. It’s important to note, as can be seen in the disclosures of his papers, that he/his employer hold a patent for buccal naloxone (#17 & 18). I’ll withhold any further comments.

16) Naloxone without the needle – systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal.

Strang J, McDonald R, Alqurshi A, Royall P, Taylor D, Forbes B.

Drug Alcohol Depend. 2016 Mar 9. pii: S0376-8716(16)00141-1. doi: 10.1016/j.drugalcdep.2016.02.042. [Epub ahead of print] Review.

17) Amorphous Formulation and in Vitro Performance Testing of Instantly Disintegrating Buccal Tablets for the Emergency Delivery of Naloxone.

Alqurshi A, Kumar Z, McDonald R, Strang J, Buanz A, Ahmed S, Allen E, Cameron P, Rickard JA, Sandhu V, Holt C, Stansfield R, Taylor D, Forbes B, Royall PG.

Mol Pharm. 2016 Mar 28. [Epub ahead of print]

18) New approved nasal naloxone welcome, but unlicensed improvised naloxone spray kits remain a concern: proper scientific study must accompany innovation.

Strang J, Mcdonald R.

Addiction. 2016 Apr;111(4):590-2. doi: 10.1111/add.13319. No abstract available.

19) Ensure global access to naloxone for opioid overdose management.

Balster RL, Walsh SL.

Addiction. 2016 Apr;111(4):589-90. doi: 10.1111/add.13274. No abstract available.

20) Ethical issues and stakeholders matter.

Dale O.

Addiction. 2016 Apr;111(4):587-9. doi: 10.1111/add.13267. No abstract available.

21) Radical red tape reduction by government supported nasal naloxone: the Norwegian pilot project is innovative, safe and an important contribution to further development and dissemination of take-home naloxone.

Lobmaier PP, Clausen T.

Addiction. 2016 Apr;111(4):586-7. doi: 10.1111/add.13261. No abstract available.

22) Intranasal naloxone soon to become part of evolving clinical practice around opioid overdose prevention.

Dietze P, Cantwell K.

Addiction. 2016 Apr;111(4):584-6. doi: 10.1111/add.13260. No abstract available.

23) Tangled-up and blue: releasing the regulatory chokehold on take-home naloxone.

Winstanley EL.

Addiction. 2016 Apr;111(4):583-4. doi: 10.1111/add.13255. No abstract available.

1) As opioid overdose deaths reach record highs, call for systematic changes grows louder.

ED Manag. 2016 Feb;28(2):13-9.

Comments: Review of the new CDC opioid prescribing guidelines.

2) Australia reschedules naloxone for opioid overdose.

Lenton SR, Dietze PM, Jauncey M.

Med J Aust. 2016 Mar 7;204(4):146-7. No abstract available.

Comments: Naloxone can now be over the counter in Australia, but there’s some work to be done in product design.

3) Science Over Stigma: Saving Lives-Implementation of Naloxone Use in the School Setting.

King R.

NASN Sch Nurse. 2016 Mar;31(2):96-101. doi: 10.1177/1942602X16628890.

Comments: Naloxone for school nurses in Delaware.

4) Electrocardiogram Abnormality Associated with Methadone Overdose.

Agahi M, Shakoori V, Marashi SM.

Sultan Qaboos Univ Med J. 2016 Feb;16(1):e113-4. doi: 10.18295/squmj.2016.16.01.022. Epub 2016 Feb 2. No abstract available.

Comments: Long QT interval is a side effect of high methadone doses.

5) Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving.

Ahlner J, Holmgren A, Jones AW.

Forensic Sci Int. 2016 Feb 3;265:138-143. doi: 10.1016/j.forsciint.2016.01.036. [Epub ahead of print]

Comments: Yet another population that may benefit from overdose prevention programming – persons arrested for impaired driving.

6) Increase in Naloxone Prescriptions Dispensed in US Retail Pharmacies Since 2013.

Jones CM, Lurie PG, Compton WM.

Am J Public Health. 2016 Apr;106(4):689-90. doi: 10.2105/AJPH.2016.303062. Epub 2016 Feb 18.

Comments: Some increase in sales; much of this increase may be accounted for by a selected number of programs. These data were also presented at the FDA meeting on naloxone in July 2015.

7) Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction.

Butler MM, Ancona RM, Beauchamp GA, Yamin CK, Winstanley EL, Hart KW, Ruffner AH, Ryan SW, Ryan RJ, Lindsell CJ, Lyons MS.

Ann Emerg Med. 2016 Feb 10. pii: S0196-0644(15)01567-X. doi: 10.1016/j.annemergmed.2015.11.033. [Epub ahead of print]

Comments: 59% of opioid dependent participants were initially exposed via a medical prescription to them and 29% of those prescriptions came from emergency departments.

8) “There’s nothing here”: Deindustrialization as risk environment for overdose.

McLean K.

Int J Drug Policy. 2016 Mar;29:19-26. doi: 10.1016/j.drugpo.2016.01.009. Epub 2016 Jan 18.

Comments: This is fascinating. Poverty and social isolation.

9) Changes in the medical management of patients on opioid analgesics following a diagnosis of substance abuse.

Paulozzi LJ, Zhou C, Jones CM, Xu L, Florence CS.

Pharmacoepidemiol Drug Saf. 2016 Feb 10. doi: 10.1002/pds.3980. [Epub ahead of print]

Comments: Studying opioid prescribing is really complicated, because it involves making sense of – and trying to quantify – very complex and confusing medical decisions. This is an interesting analysis attempting to determine how much documentation of concerning opioid use behaviors results in changes in opioid prescribing.

10) Assessment of provider attitudes toward #naloxone on Twitter.

Haug NA, Bielenberg J, Linder SH, Lembke A.

Subst Abus. 2016 Jan-Mar;37(1):35-41. doi: 10.1080/08897077.2015.1129390.

Comments: Naloxone-trained individuals on Twitter “had the highest optimism and the lowest amount of burnout and stigma.”

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

Hawk KF, Vaca FE, D’Onofrio G.

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

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

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

Brady KT, McCauley JL, Back SE.

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

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

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

DeVido J, Connery H, Hill KP.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jackson JL.

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

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

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

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

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

Comment: Really high-risk people inject methadone.

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

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

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

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

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

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

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

Comment: The 6-MAM assay is pretty good.

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

Pirompanich P, Chankrachang S.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1) Naloxone therapy in opioid overdose patients: intranasal or intravenous? A randomized clinical trial.

Sabzghabaee AM, Eizadi-Mood N, Yaraghi A, Zandifar S.

Arch Med Sci. 2014 May 12;10(2):309-14. doi: 10.5114/aoms.2014.42584. Epub 2014 May 13.

PMID: 24904666 [PubMed] Free PMC Article

Comments: More data to support the utility of intranasal naloxone for overdose reversal. There are, however, some odd findings that suggest caution in interpreting the paper. The authors used 0.4mg of naloxone for IV or IN administration, whereas most efforts utilize 2mg for IN administration given the lower bioavailability. Moreover, they had ahigher level of consciousness in the IN group, which seems odd.

2) Brugada Phenocopy in Concomitant Ethanol and Heroin Overdose.

Rambod M, Elhanafi S, Mukherjee D.

Ann Noninvasive Electrocardiol. 2014 Jun 5. doi: 10.1111/anec.12171. [Epub ahead of print]

PMID: 24903622 [PubMed – as supplied by publisher]

Comments: There are cases in which opioids can result in unstable heart rhythms. Usually this is related to high dose methadone, prolongation of the QT interval andtorsades de pointes. In this case, heroin plus alcohol may have resulted in electrical conduction similar to “Brugada syndrome” which, in the interest of having an image in this blog post, I’ve posted an image of here. This type of electrical conduction is usually genetic and can result in sudden death through lethal arrhythmias.

3) A systematic review of community opioid overdose prevention and naloxonedistribution programs.

Clark AK, Wilder CM, Winstanley EL.

J Addict Med. 2014 May-Jun;8(3):153-63. doi: 10.1097/ADM.0000000000000034.

PMID: 24874759 [PubMed – in process]

Comments: An impressive review of existing data for naloxone programs. Big kudos to the authors.

4) Intravenous methadone application as a serious risk factor for an overdose death:methadone-related fatalities in Hamburg from 2007 to 2012.

Iwersen-Bergmann S, Jungen H, Andresen-Streichert H, Müller A, Elakkary S, Püschel K, Heinemann A.

Int J Legal Med. 2014 May 25. [Epub ahead of print]

PMID: 24859230 [PubMed – as supplied by publisher]

Comments: Interesting analysis of methadone-related deaths among methadone maintenance patients suggesting that, while overdose deaths are not common, many may have been related to IV use of methadone.

5) Abnormal intracellular calcium homeostasis associated with vulnerability in the nerve cells from heroin-dependent rat.

Liu X, Wang G, Pu H, Jing H.

Brain Res. 2014 Jul 14;1572:40-9. doi: 10.1016/j.brainres.2014.05.016. Epub 2014 May 20.

PMID: 24854119 [PubMed – in process]

Comments: Intriguing analysis of rat brains suggesting a key role of calcium in neurotoxicity related to heroin use. Do medications like verapamil, generally used to manage hypertension, have a role in preventing neurologic damage from opioids and perhaps even reducing overdose risk?

6) Source of prescription drugs used nonmedically in rural and urban populations.

Wang KH, Fiellin DA, Becker WC.

Am J Drug Alcohol Abuse. 2014 Jul;40(4):292-303. doi: 10.3109/00952990.2014.907301. Epub 2014 May 22.

PMID: 24853143 [PubMed – in process]

Comments: Around a fifth of people using prescription opioids “non-medically” get them directly from a physician.

7) Physician and Nonphysician Health-care Provider Perspectives on Resuscitation of Suspected Drug-related Out-of-Hospital Cardiac Arrest.

Koller AC, Salcido DD, Menegazzi JJ.

Prehosp Emerg Care. 2014 May 15. [Epub ahead of print]

PMID: 24831102 [PubMed – as supplied by publisher]

Comments: A survey mostly of physicians and paramedics showing that healthcare providers manage cardiac arrest differently if it is from drug overdose versus a different etiology. This sounds quite reasonable, actually, since etiology-specific management is encouraged particularly for cardiac arrests due to “pulseless electrical activity” (that is, while we shock most arrhythmias during cardiac arrest, if there is no arrhythmia to shock we generally don’t shock and do a bunch of other things – one of those things is to guess what may be causing the cardiac arrest and administering medications to try to counteract that problem).

8) Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest.

Koller AC, Salcido DD, Callaway CW, Menegazzi JJ.

Resuscitation. 2014 Jun 26. pii: S0300-9572(14)00581-4. doi: 10.1016/j.resuscitation.2014.05.036. [Epub ahead of print]

PMID: 24973558 [PubMed – as supplied by publisher]

Comments: Overdose-related cardiac arrests are more likely to survive. They are also more likely to be younger and to receive different immediate care. These findings are consistent with the above opinion survey.

9) Two cases of intranasal naloxone self-administration in opioid overdose.

Green TC, Ray M, Bowman SE, McKenzie M, Rich JD.

Subst Abus. 2014;35(2):129-32. doi: 10.1080/08897077.2013.825691.

PMID: 24821348 [PubMed – in process]

Comments: There have been rare cases of naloxone self-administration in the setting of lay naloxone programs. This obviously should not be the goal, as most people in need of naloxone will be unconscious by the time they need it.

10) The Correlation Between Prolonged Corrected QT Interval with the Frequency of Respiratory Arrest, Endotracheal Intubation, and Mortality in Acute MethadoneOverdose.

Farsi D, Mirafzal A, Hassanian-Moghaddam H, Azizi Z, Jamshidnejad N, Zehtabchi S.

Cardiovasc Toxicol. 2014 May 9. [Epub ahead of print]

PMID: 24811951 [PubMed – as supplied by publisher]

Comments: Prolonged QT interval in methadone overdose patients predicts respiratory arrest, need for intubation, and death.

11) Timing of income assistance payment and overdose patterns at a Canadian supervised injection facility.

Zlotorzynska M, Milloy MJ, Richardson L, Nguyen P, Montaner JS, Wood E, Kerr T.

Int J Drug Policy. 2014 Apr 4. pii: S0955-3959(14)00075-9. doi: 10.1016/j.drugpo.2014.03.014. [Epub ahead of print]

PMID: 24795288 [PubMed – as supplied by publisher]

Comments: People overdose when they get their monthly assistance checks. There are some programs that provide “money management” services, doling out participants monthly incomes over time – these may help to reduce binge drug use and related overdose events.

12) Intranasal naloxone for treatment of opioid overdose.

Med Lett Drugs Ther. 2014 Mar 17;56(1438):21-2. No abstract available.

PMID: 24662159 [PubMed – indexed for MEDLINE]

Comments: Unable to access.

13) Clinician beliefs and attitudes about buprenorphine/naloxone diversion.

Schuman-Olivier Z, Connery H, Griffin ML, Wyatt SA, Wartenberg AA, Borodovsky J, Renner JA Jr, Weiss RD.

Am J Addict. 2013 Nov-Dec;22(6):574-80. doi: 10.1111/j.1521-0391.2013.12024.x. Epub 2013 Apr 11.

PMID: 24131165 [PubMed – indexed for MEDLINE]

Comments: About 40% of providers think buprenorphine/naloxone diversion is a problem. I’m unable to access the article, but the abstract says providers who have experience using the medication think diversion is a result of limited access to the medication. I concur with that opinion … but I am also one of those providers.

14) Trends in quetiapine use and non-fatal quetiapine-related ambulance attendances.

Heilbronn C, Lloyd B, McElwee P, Eade A, Lubman DI.

Drug Alcohol Rev. 2013 Jul;32(4):405-11. doi: 10.1111/dar.12028. Epub 2013 Jan 27.

PMID: 23350582 [PubMed – indexed for MEDLINE]

Comments: Quetiapine is a sedating anti-psychotic that is often favored by those with opioid use disorders.

15) SMOKE IT! Promoting a change of opiate consumption pattern – from injecting to inhaling.

Stöver HJ, Schäffer D.

Harm Reduct J. 2014 Jun 27;11(1):18. [Epub ahead of print]

PMID: 24973031 [PubMed – as supplied by publisher] Free Article

Comments: Efforts to transition users from injection to smoking heroin in Europe seem to be growing in popularity with increasing evidence of effectiveness. Of note, one major limitation is the pH of different formulations of heroin. Heroin in the United States, for example, may be too acidic for most users to transition to smoking (which generally requires a “basic” acid/base balance to allow the drug to be vaporized without burning).

15) The Relationship between US Heroin Market Dynamics and Heroin-relatedOverdose, 1992-2008.

Unick G, Rosenblum D, Mars S, Ciccarone D.

Addiction. 2014 Jun 17. doi: 10.1111/add.12664. [Epub ahead of print]

PMID: 24938727 [PubMed – as supplied by publisher]

Comments: Purity of heroin has some association with overdose and there seems to be a difference in the geographic source of the heroin in terms of overdose risk.

16) Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.

Hammett TM, Phan S, Gaggin J, Case P, Zaller N, Lutnick A, Kral AH, Fedorova EV, Heimer R, Small W, Pollini R, Beletsky L, Latkin C, Des Jarlais DC.

BMC Health Serv Res. 2014 Jun 17;14:261. doi: 10.1186/1472-6963-14-261.

PMID: 24938376 [PubMed – in process] Free PMC Article

Comments: Notwithstanding many efforts to expand the role of pharmacists in community health, the legal and social stigma surrounding injection drug use seriously limits the implementation and impact of these policy and programmatic efforts. I can only imagine this is going to get worse before it gets better, as pharmacists are increasingly being held to higher standards of evaluating the appropriateness of prescriptions for patients.

17) Risk Factors for Serious Prescription Opioid-Related Toxicity or Overdose among Veterans Health Administration Patients.

Zedler B, Xie L, Wang L, Joyce A, Vick C, Kariburyo F, Rajan P, Baser O, Murrelle L.

Pain Med. 2014 Jun 14. doi: 10.1111/pme.12480. [Epub ahead of print]

PMID: 24931395 [PubMed – as supplied by publisher]

Comments: Dose, dependence, prior overdose, liver disease and use of long-acting opioids were the primary predictors of overdose.

18) Use of a Medically Supervised Injection Facility Among Street Youth.

Hadland SE, DeBeck K, Kerr T, Nguyen P, Simo A, Montaner JS, Wood E.

J Adolesc Health. 2014 Jun 9. pii: S1054-139X(14)00191-8. doi: 10.1016/j.jadohealth.2014.04.013. [Epub ahead of print]

PMID: 24925493 [PubMed – as supplied by publisher]

Comments: INSITE serves the population of extremely high-risk, young injectors.

19) Expanded Access to Naloxone Among Firefighters, Police Officers, and Emergency Medical Technicians in Massachusetts.

Davis CS, Ruiz S, Glynn P, Picariello G, Walley AY.

Am J Public Health. 2014 Jun 12:e1-e3. [Epub ahead of print]

PMID: 24922133 [PubMed – as supplied by publisher]

Comments: This policy review is, I believe, the first publication in the scientific literature on the relatively new phenomenon of providing non-ACLS trained first responders with naloxone.

20) Clinical and radiological findings in methadone-induced delayed leukoencephalopathy.

Bileviciute-Ljungar I, Häglund V, Carlsson J, von Heijne A.

J Rehabil Med. 2014 Jun 4. doi: 10.2340/16501977-1820. [Epub ahead of print]

PMID: 24909124 [PubMed – as supplied by publisher]

Comments: Methadone overdose has resulted in a delayed leukoencephalopathy – basically a sickness in the white matter of the brain. This can result in substantial and lifelong dysfunction. There is some improvement, but it can require a fair amount of medication and still have at least moderate neurologic dysfunction that may never resolve. If you know someone who had a methadone overdose and they don’t seem to be getting better, this should be considered.

21) Reversing tragedy. Proposed legislation will increase access to an antidote to opioidoverdose.

Mettner J.

Minn Med. 2014 Apr;97(4):10-1. No abstract available.

PMID: 24868924 [PubMed – indexed for MEDLINE]

Comments: Can’t access.

22) Heroin: life, death, and politics.

Jacobson J.

Am J Nurs. 2014 May;114(5):22-3. doi: 10.1097/01.NAJ.0000446774.91899.b5. No abstract available.

PMID: 24759473 [PubMed – indexed for MEDLINE]

Comments: A news article on naloxone.

23) High-risk use by patients prescribed opioids for pain and its role in overdose deaths.

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

JAMA Intern Med. 2014 May;174(5):796-801.

PMID: 24589873 [PubMed – indexed for MEDLINE]

Comments: Opioid overdose deaths in Tennessee had, compared to national data, an abundance of what is referred to as “doctor shopping.” Among patients prescribed opioids, 7.6% had >4 prescribers and 2.5% >4 pharmacies. While one should be cautious about overinterpreting the number of prescribers (as perhaps they were urgent care or other affiliated providers filling in for the primary prescriber), most analyses suggest that around 1% of patients fit the pharmacy criteria. These patients were the most likely to die of opioid overdose.

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

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

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

PMID: 24186493 [PubMed – indexed for MEDLINE] Free Article

Comments: In-prison methadone maintenance.

25) Evaluation of metabolite/drug ratios in blood and urine as a tool for confirmation of a reduced tolerance in methadone-related deaths in Denmark.

Nielsen MK, Johansen SS, Linnet K.

Drug Alcohol Depend. 2013 Dec 1;133(2):447-51. doi: 10.1016/j.drugalcdep.2013.07.001. Epub 2013 Jul 25.

PMID: 23891033 [PubMed – indexed for MEDLINE]

Comments: Investigators were unable to establish a methodology that would allow them to distinguish between those who had reduced tolerance and those who did not, among methadone overdose deaths.

1) Illicit drug overdose – Prevalence and acute management.

Li W, Gunja N.

Aust Fam Physician. 2013 Jul;42(7):481-5.

Comment: Unable to access.  Appears to be a general review of managing illicit drug toxicities.

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

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

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

Comment: Unable to access. There have been several papers describing the initial experience of naloxone programs and this is a welcome addition to that literature.

3) Vital signs: overdoses of prescription opioid pain relievers and other drugs among women – United States, 1999-2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2013 Jul 5;62(26):537-42.

Comment: A review of drug overdose mortality data among women, demonstrating that women have been particularly affected by the recent epidemic.

4) Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal in Russian cities.

Coffin PO, Sullivan SD.

J Med Econ. 2013 Jun 19. [Epub ahead of print]

Comments: An adaptation of the model developed for the United States, taking into account structural differences, epidemiologic data, and costs in Russia. Because of limitations in emergency medical services in Russia, the high rate at which overdoses are witnessed, and the very low costs of naloxone, this intervention is likely to be even more cost-effective in Russia than it appears to be in the United States.

5) Use of Naloxone for Clonidine Intoxication in the Pediatric Age Group: Case Report and Review of the Literature.

Ahmad SA, Scolnik D, Snehal V, Glatstein M.

Am J Ther. 2013 Jun 18. [Epub ahead of print]

Comment: I was curious as to why one would use naloxone in this circumstance – and no surprise it did not work.

6) Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users.

Jones JD, Roux P, Stancliff S, Matthews W, Comer SD.

Int J Drug Policy. 2013 Jun 14. doi:pii: S0955-3959(13)00080-7.

Comment: Brief training on overdose prevention works.

7) Efforts to Reduce Overdose Deaths.

Sherman SG, Han J, Welsh C, Chaulk P, Serio-Chapman C.

Am J Public Health. 2013 Jun 13. [Epub ahead of print]

Schwartz et al. Respond.

Schwartz RP, Gryczynski J, O’Grady KE, Sharfstein JM, Warren G, Olsen YK, Mitchell SG, Jaffe JH.

Am J Public Health. 2013 Jun 13. [Epub ahead of print]

Comment: An intriguing dialogue about the Baltimore paper on opioid agonist treatment and overdose. That’s all I’ll say.

8) Methadone-induced toxic brain damage.

Corré J, Pillot J, Hilbert G.

Case Rep Radiol. 2013;2013:602981. doi: 10.1155/2013/602981. Epub 2013 May 22.

Comment: Cerebellar and basal ganglia damage from methadone overdose.

9) The feasibility of pharmacy-based naloxone distribution interventions: a qualitative study with injection drug users and pharmacy staff in Rhode Island.

Zaller ND, Yokell MA, Green TC, Gaggin J, Case P.

Subst Use Misuse. 2013 Jun;48(8):590-9. doi: 10.3109/10826084.2013.793355. Epub 2013 Jun 10.

Comment: Unable to access. Interviews with 21 drug injectors and 21 pharmacy staff. Overall there was good acceptance of the concept, although some misinformation about naloxone, some concerns about drug user and pharmacy staff interactions, and some concerns about cost.

10) Supply-side response to declining heroin purity: fentanyl overdose episode in New Jersey.

Hempstead K, Yildirim EO.

Health Econ. 2013 Jun 6. doi: 10.1002/hec.2937. [Epub ahead of print]

Comment: Fascinating.

11) EMS Runs for Suspected Opioid Overdose: Implications for Surveillance and Prevention.

Knowlton A, Weir BW, Hazzard F, Olsen Y, McWilliams J, Fields J, Gaasch W.

Prehosp Emerg Care. 2013 Jul-Sep;17(3):317-29. doi: 10.3109/10903127.2013.792888.

Comments: Unable to access, so I’m unclear on details from this paper.

12) A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray.

Wermeling DP.

Drug Deliv Transl Res. 2013 Feb 1;3(1):63-74.

Comments: Unable to access. A review of the rationale for nasal delivery of naloxone.

13) Sublingual Buprenorphine for Chronic Pain: A Survey of Clinician Prescribing Practices.

Rosen K, Gutierrez A, Haller D, Potter JS.

Clin J Pain. 2013 May 30. [Epub ahead of print]

Comments: The use of buprenorphine for chronic pain is an exciting idea whose time has come.