1)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.

Comment: Methods paper for another amazing data linkage study – this one in Australia. Color me jealous.

2)The impact of medically supervised injectioncentres on drug-related harms: A meta-analysis.

May T, Bennett T, Holloway K.

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

Comment: I’m not clear there are enough data for a useful meta-analysis.

3)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 Jul 19;290:219-226. doi: 10.1016/j.forsciint.2018.07.009. [Epub ahead of print]

Comment: Interesting way to look at heroin dose – always a challenge in detailed research.

4)Development and implementation of procedures for outpatient naloxoneprescribing 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]

Comment: Streamlined process utilizing pharmacists in large medical center. Neat.

5)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. Comment: Fascinating curriculum, including naloxone training, for high school students.

6)Awareness and access to naloxonenecessary but not sufficient: Examining gaps in the naloxonecascade.

Tobin K, Clyde C, Davey-Rothwell M, Latkin C.

Int J DrugPolicy. 2018 Jul 31;59:94-97. doi: 10.1016/j.drugpo.2018.07.003. [Epub ahead of print]

Comment: 90% were aware of naloxone, of whom 69% had ever received it, of whom 26% always carried it. 45% of those who had ever received naloxone had used it to reverse an overdose. Women and those who had used naloxone before were more likely to carry it on their person. Great data in a cohort of 353 adults who have used heroin.

7)Adoption and Utilization of an Emergency Department NaloxoneDistribution and Peer Recovery Coach Consultation Program.

Samuels EA, Baird J, Yang ES, Mello M.

Acad Emerg Med. 2018 Aug 3. doi: 10.1111/acem.13545. [Epub ahead of print]

Comment: Naloxone increased from none to over a third, while referrals to treatment more than doubled.

8)Addressing Intersecting Housing and OverdoseCrises in Vancouver, Canada: Opportunities and Challenges from a Tenant-Led OverdoseResponse Intervention in Single Room Occupancy Hotels.

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

J Urban Health. 2018 Aug 2. doi: 10.1007/s11524-018-0294-y. [Epub ahead of print]

Comment: This is super cool. A tenant-led naloxone training and overdose response program in SROs. So so important to reach that population.

9)Initial results of a drugchecking pilot program to detect fentanyl adulteration in a Canadian setting.

Tupper KW, McCrae K, Garber I, Lysyshyn M, Wood E.

DrugAlcohol Depend. 2018 Sep 1;190:242-245. doi: 10.1016/j.drugalcdep.2018.06.020. Epub 2018 Jul 24.

Comment: 90.6% of “heroin” samples contained fentanyl; 5.9% of speed/meth contained fentanyl.

10)Methadonemaintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada.

Russolillo A, Moniruzzaman A, Somers JM.

PLoS Med. 2018 Jul 31;15(7):e1002625. doi: 10.1371/journal.pmed.1002625. eCollection 2018 Jul.

Comment: Methadone prevents death.

11)MakingNaloxoneRescue Part of Basic Life Support Training for Medical Students.

Jack HE, Warren KE, Sundaram S, Gheihman G, Weems J, Raja AS, Miller ES.

AEM Educ Train. 2018 Mar 30;2(2):174-177. doi: 10.1002/aet2.10095. eCollection 2018 Apr.

Comment: Nice.

12)[Interest of take-home naloxonefor opioidoverdose].

Frauger E, Kheloufi F, Boucherie Q, Monzon E, Jupin L, Richard N, Mallaret M, Micallef J.

Therapie. 2018 Jul 7. pii: S0040-5957(18)30119-7. doi: 10.1016/j.therap.2018.07.001. [Epub ahead of print] French.

Comment: French authorities authorized lay use of naloxone nasal spray.

13)Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority’s Opioid Initiative.

Hedberg K, Bui LT, Livingston C, Shields LM, Van Otterloo J.

J Public Health Manag Pract. 2018 Jul 18. doi: 10.1097/PHH.0000000000000849. [Epub ahead of print]

Comment: This is a good example of how not to report on interventions and overdose outcomes. Opioid prescribing went down and prescription opioid overdose deaths went down … for one year. How can you report on death “trends” from two years of data? Overdose is not a stable outcome – it varies from year-to-year. To base conclusions on a drop from one year to the next is unwise to say the least. And not to mention that heroin deaths went up is disingenuous.

14)Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and HeroinEpidemic.

Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA.

Pain Physician. 2018 Jul;21(4):309-326.

Comment: Education, expanding non-opioid pain options, and expanding buprenorphine for pain and opioid use disorder. Interesting.

15)Comparison of lower-dose versus higher-dose intravenous naloxoneon time to recurrence of opioid toxicity in the emergency department.

Wong F, Edwards CJ, Jarrell DH, Patanwala AE.

Clin Toxicol (Phila). 2018 Jul 23:1-6. doi: 10.1080/15563650.2018.1490420. [Epub ahead of print]

Comment: Initial dose of IV naloxone does not affect time to opioid effect recurrence. Good to know. Likely the story is different for nasal.

16)Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk.

Strand MA, Eukel H, Burck S.

Res Social Adm Pharm. 2018 Jul 17. pii: S1551-7411(18)30219-5. doi: 10.1016/j.sapharm.2018.07.011. [Epub ahead of print]

Comment: I remain reluctant to recommend such screening tools in practice. They generally don’t do well prospectively (if they have been evaluated at all), can lead to stigma/discrimination, and can also raise medico-legal concerns about patient management.

17)Implementation and assessment of a naloxone-training program for first-year student pharmacists.

Schartel A, Lardieri A, Mattingly A, Feemster AA.

Curr Pharm Teach Learn. 2018 Jun;10(6):717-722. doi: 10.1016/j.cptl.2018.03.016. Epub 2018 Apr 5.

Comment: Short training helps.

18)Student pharmacist perceptions of participation in hands-on naloxonecounseling.

Hines J, Deja E, Black EP.

Curr Pharm Teach Learn. 2018 Jun;10(6):712-716. doi: 10.1016/j.cptl.2018.03.002. Epub 2018 Apr 9.

Comment: I like this survey. To me it supports the notion that the more providers feel they have to offer people who use drugs, the less stigma they will bring to the table.

19)OpioidOverdoseMortality Among Former North Carolina Inmates: 2000-2015.

Ranapurwala SI, Shanahan ME, Alexandridis AA, Proescholdbell SK, Naumann RB, Edwards D Jr, Marshall SW.

Am J Public Health. 2018 Sep;108(9):1207-1213. doi: 10.2105/AJPH.2018.304514. Epub 2018 Jul 19.

Comment: Risk in the first two weeks post-release was 40 fold higher than the general population for opioid overdose death and 74 fold for heroin death.

20)Spatial Methods to Enhance Public Health Surveillance and Resource Deployment in the Opioid Epidemic.

Dodson ZM, Enki Yoo EH, Martin-Gill C, Roth R.

Am J Public Health. 2018 Sep;108(9):1191-1196. doi: 10.2105/AJPH.2018.304524. Epub 2018 Jul 19.

Comment: Geocoding work is always intriguing.

21)Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone.

Dworkis DA, Weiner SG, Liao VT, Rabickow D, Goldberg SA.

West J Emerg Med. 2018 Jul;19(4):641-648. doi: 10.5811/westjem.2018.4.37054. Epub 2018 May 15.

Comment: Again, the idea of putting naloxone boxes around in communities with lots of overdose events. The challenge is maintaining them, of course.

22)Public attitudes and beliefs about Virginia community pharmacists dispensing and administering naloxone.

Haggerty LC, Gatewood SS, Goode JKR.

J Am Pharm Assoc (2003). 2018 Jul – Aug;58(4S):S73-S77.e1. doi: 10.1016/j.japh.2018.04.034.

Comment: About two-thirds of respondents liked the idea of pharmacists providing naloxone.

23)Identifying barriers to dispensing naloxone: A survey of community pharmacists in North Carolina.

Rudolph SE, Branham AR, Rhodes LA, Hayes HH Jr, Moose JS, Marciniak MW.

J Am Pharm Assoc (2003). 2018 Jul – Aug;58(4S):S55-S58.e3. doi: 10.1016/j.japh.2018.04.025.

Comment: Over half of the pharmacists were not comfortable providing naloxone, but most were interested in learning more.

24)Increased use of heroinas an initiating opioid of abuse: Further considerations and policy implications.

Cicero TJ, Kasper ZA, Ellis MS.

Addict Behav. 2018 May 31. pii: S0306-4603(18)30467-2. doi: 10.1016/j.addbeh.2018.05.030. [Epub ahead of print]

Comment: Use of heroin as the opioid of initiation grew from 8.7% in 2005 to 31.6% in 2015.

25)Risks of fatal opioid overdoseduring the first year following nonfatal overdose.

Olfson M, Wall M, Wang S, Crystal S, Blanco C.

DrugAlcohol Depend. 2018 Sep 1;190:112-119. doi: 10.1016/j.drugalcdep.2018.06.004. Epub 2018 Jul 4.

Comment: Ok – fascinating study. Important to note that it represents people who had a non-fatal overdose that reached the medical system, which is not more than half of overdose events and generally represents a more serious event. Among those individuals 64% had filled an opioid prescription in the preceding 6 months. In the ensuing 12 months, the rate of repeat overdose was 295/1000 person-years (so ~29.5%) and fatal overdose was 1154/100k person years (so ~1.2%). These figures are pretty consistent with longstanding overdose epidemiology and more recent prospective work.

26)Fatal and Nonfatal OverdoseAmong Pregnant and Postpartum Women in Massachusetts.

Schiff DM, Nielsen T, Terplan M, Hood M, Bernson D, Diop H, Bharel M, Wilens TE, LaRochelle M, Walley AY, Land T.

Obstet Gynecol. 2018 Aug;132(2):466-474. doi: 10.1097/AOG.0000000000002734.

Comment: Great data on overdose in pregnancy and post-partum period. Highest risk is 7-12 months after delivery. Medication treatment of course lowers risk.

27)Trends and characteristics of naloxonetherapy reported to US poison centers.

Rege SV, Ngo DA, Ait-Daoud N, Sharma S, Verplancken E, Holstege CP.

Addiction. 2018 Jul 10. doi: 10.1111/add.14378. [Epub ahead of print]

Comment: Increasing use.

28)Grievable lives? Death by opioid overdosein Australian newspaper coverage.

Fraser S, Farrugia A, Dwyer R.

Int J DrugPolicy. 2018 Jun 30;59:28-35. doi: 10.1016/j.drugpo.2018.06.004. [Epub ahead of print]

Comment: This is a powerful construct from Australia. “Until the lives of opioid consumers come to be considered grievable, the measures known to reduce overdose deaths may struggle to find support.”

29)Trauma Trainees’ Multiple Competing Goals in Opioid Prescription Communication.

Adams ET, Cohen EL, Bernard A, Darnell W, Helme DW.

Qual Health Res. 2018 Jul 1:1049732318784896. doi: 10.1177/1049732318784896. [Epub ahead of print]

Comment: It’s tough for surgeons to address opioid prescribing. I mean, it’s tough across the board. But surgeons really aren’t in a good position for this practice change.

30)Sociodemographic factors, prescription history and opioid overdosedeaths: a statewide analysis using linked PDMP and mortality data.

Nechuta SJ, Tyndall BD, Mukhopadhyay S, McPheeters ML.

DrugAlcohol Depend. 2018 Sep 1;190:62-71. doi: 10.1016/j.drugalcdep.2018.05.004. Epub 2018 Jun 13.

Comment: 55% of prescribed opioid, 39.2% of fentanyl, and 20.7% of heroin overdoses had an active opioid prescription at the time of overdose death.

31)Primary Care and the Opioid-OverdoseCrisis – BuprenorphineMyths and Realities.

Wakeman SE, Barnett ML.

N Engl J Med. 2018 Jul 5;379(1):1-4. doi: 10.1056/NEJMp1802741. No abstract available.

Comment: Nice article! Good read.

32)Moving Addiction Care to the Mainstream – Improving the Quality of BuprenorphineTreatment.

Saloner B, Stoller KB, Alexander GC.

N Engl J Med. 2018 Jul 5;379(1):4-6. doi: 10.1056/NEJMp1804059. No abstract available.

Comment: Yes, please.

33)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.

Comment: Fentanyl review.

34)As Overdoses Climb, Emergency Departments Begin Treating Opioid Use Disorder.

Rubin R.

JAMA. 2018 Jun 5;319(21):2158-2160. doi: 10.1001/jama.2018.4648. No abstract available.

Comment: Review of addressing OUD in the emergency department.

The following papers continue from our last PubMed update on North Carolina experiences:

35)Running the Numbers: County Level Dynamics of HeroinMortality in North Carolina.

Gunn AH, Bartlett B, Feng G, Gayed M, Kanter K, Onuoha E, Thornton M, Muzyk A, Schramm-Sapyta N.

N C Med J. 2018 May-Jun;79(3):195-200. doi: 10.18043/ncm.79.3.195. No abstract available.

36)Meeting Opioid Users Where They Are: A Service Referral Approach to Law Enforcement.

Paul L.

N C Med J. 2018 May-Jun;79(3):172-173. doi: 10.18043/ncm.79.3.172. No abstract available.

37)The Opioid Epidemic in NC: Progress, Challenges, and Opportunities.

Kansagra SM, Cohen MK.

N C Med J. 2018 May-Jun;79(3):157-162. doi: 10.18043/ncm.79.3.157.

1) Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme.

Tjagvad C, Skurtveit S, Linnet K, Andersen LV, Christoffersen DJ, Clausen T.

Eur Addict Res. 2016 Jun 1;22(5):249-258. [Epub ahead of print]

Comments: Patients on very high doses of methadone or also using benzodiazepines were at higher risk of death.

2) Heroin use.

Salani DA, Zdanowicz M, Joseph L.

J Psychosoc Nurs Ment Health Serv. 2016 Jun 1;54(6):30-7. doi: 10.3928/02793695-20160518-05.

Comments: Epidemiologic review.

3) Academic physicians’ and medical students’ perceived barriers toward bystander administered naloxone as an overdose prevention strategy.

Gatewood AK, Van Wert MJ, Andrada AP, Surkan PJ.

Addict Behav. 2016 May 17;61:40-46. doi: 10.1016/j.addbeh.2016.05.013. [Epub ahead of print]

Comments: Qualitative interviews with medical providers.

4) Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review.

Elzey MJ, Barden SM, Edwards ES.

Pain Physician. 2016 May;19(4):215-28.

Comments: Non-fatal events are far more common, not well-predicted by risk factors, and in need of additional research.

5) Incorporation of poison center services in a state-wide overdose education andnaloxone distribution program.

Doyon S, Benton C, Anderson BA, Baier M, Haas E, Hadley L, Maehr J, Rebbert-Franklin K, Olsen Y, Welsh C.

Am J Addict. 2016 Jun;25(4):301-6. doi: 10.1111/ajad.12384. Epub 2016 May 24.

Comments: Interesting case series of naloxone reversals reported to poison control. They report a 75.6% “response rate” although some of the remainder was “unknown” and was there were only 2 deaths among 78 cases, suggesting a rate closer to 97.5%. Response rate to heroin was higher than for prescription opioids. Of the 43 suspected heroin events, 31 went to the ED, 25 were discharged, and 5 required ICU care. Of 31 suspected prescription opioid 20 went to the ED, 9 were discharged, and 6 required ICU care. This is consistent with the more complicated nature of prescription opioid overdose.

6) Police Officers Can Safely and Effectively Administer Intranasal Naloxone.

Fisher R, O’Donnell D, Ray B, Rusyniak D.

Prehosp Emerg Care. 2016 May 24:1-6. [Epub ahead of print]

Comments: About a 65% response rate among 117 administrations and 1 combative individual.

7) Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

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

Subst Abuse Rehabil. 2016 Apr 27;7:27-40. doi: 10.2147/SAR.S81602. eCollection 2016. Review.

Comments: Overdose morality is through the roof when people leave correctional settings. Starting medications in-house is critical.

8) Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia.

Culbert GJ, Pillai V, Bick J, Al-Darraji HA, Wickersham JA, Wegman MP, Bazazi AR, Ferro E, Copenhaver M, Kamarulzaman A, Altice FL.

J Neuroimmune Pharmacol. 2016 May 24. [Epub ahead of print] Review.

Comments: Managing syndemics in Malaysia.

9) Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia.

Deonarine A, Amlani A, Ambrose G, Buxton JA.

Harm Reduct J. 2016 May 21;13(1):17. doi: 10.1186/s12954-016-0106-1.

Comments: Interesting qualitative study of drug users and police regarding naloxone.

10) [Overdose of heroin and influencing factors in intravenous drug users in parts of Yunnan].

Zhou Y, Luo W, Cao XB, Zhang B, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2016 May 10;37(5):648-52. doi: 10.3760/cma.j.issn.0254-6450.2016.05.012. Chinese.

Comments: 42% had ever overdosed and 16% had done so in the past year, a relatively low rate.

11) Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review.

Bauer LK, Brody JK, León C, Baggett TP.

J Health Care Poor Underserved. 2016;27(2):846-59. doi: 10.1353/hpu.2016.0075.

Comments: Of 219 homeless individuals who died of overdose in Boston, 81% of deaths involved opioids, 85% of decedents had substance use disorders, 61% had psychiatric illness, 45% had chronic pain, and 32% had all three of those issues. This is really complex clinical care.

12) The SOMATICS collaborative: Introduction to a National Institute on Drug Abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings.

Chandler RK, Finger MS, Farabee D, Schwartz RP, Condon T, Dunlap LJ, Zarkin GA, McCollister K, McDonald RD, Laska E, Bennett D, Kelly SM, Hillhouse M, Mitchell SG, O’Grady KE, Lee JD.

Contemp Clin Trials. 2016 May;48:166-72. doi: 10.1016/j.cct.2016.05.003. Epub 2016 May 11.

Comments: Extended-release naltrexone studies.

13) Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.

Bogdanowicz KM, Stewart R, Chang CK, Downs J, Khondoker M, Shetty H, Strang J, Hayes RD.

Drug Alcohol Depend. 2016 Jul 1;164:82-8. doi: 10.1016/j.drugalcdep.2016.04.036. Epub 2016 May 6.

Comments: Overdose death was associated with unsafe injecting and clinically-appraised suicidality.

14) Extended-release naltrexone opioid treatment at jail re-entry (XOR).

McDonald RD, Tofighi B, Laska E, Goldfeld K, Bonilla W, Flannery M, Santana-Correa N, Johnson CW, Leibowitz N, Rotrosen J, Gourevitch MN, Lee JD.

Contemp Clin Trials. 2016 May 10. pii: S1551-7144(16)30059-3. doi: 10.1016/j.cct.2016.05.002. [Epub ahead of print]

Comments: Description of a planned study.

15) Opioid Overdose Prevention Through Pharmacy-based Naloxone Prescription Program: Innovations in Healthcare Delivery.

Bachyrycz A, Shrestha S, Bleske BE, Tinker D, Bakhireva LN.

Subst Abus. 2016 May 10:0. [Epub ahead of print]

Comments: First paper I’ve seen on the uptake of naloxone from pharmacies. Promising data!

16) Opioid agonist treatment for pharmaceutical opioid dependent people.

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

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

Comments: Agonist treatment works, maintenance is best.

17) Naloxone access increases, as does price.

Thompson CA.

Am J Health Syst Pharm. 2015 Sep 1;72(17):1426-7. doi: 10.2146/news150056. No abstract available.

Comments: Nothing new here. Unfortunately, for the most effective approach – giving the medication away at low-threshold programs – the cost needs to be in the low single digits.

18) Opioid Use Trajectories, Injection Drug Use, and Hepatitis C Virus Risk Among Young Adult Immigrants from the Former Soviet Union Living in New York City.

Guarino H, Marsch LA, Deren S, Straussner SL, Teper A.

J Addict Dis. 2015;34(2-3):162-77. doi: 10.1080/10550887.2015.1059711.

Comments: Many participants got syringes only from a pharmacy to avoid being “outed” as a drug injector and did not receive any information about overdose – or other safety messaging – from that source.

19) Opioid abuse in the United States and Department of Health and Human Services actions to address opioid-drug-related overdoses and deaths.

U S Department Of Health And Human Services.

J Pain Palliat Care Pharmacother. 2015 Jun;29(2):133-9. doi: 10.3109/15360288.2015.1037530.

Comments: Yup.