Naloxone interventions

Primary care

1) Co-prescription of naloxone as a Universal Precautions model for patients on chronic opioid therapy-Observational study.

Takeda MY, Katzman JG, Dole E, Bennett MH, Alchbli A, Duhigg D, Yonas H.

Subst Abus. 2016 Apr 19:1-6. [Epub ahead of print]

Comment: A pilot of naloxone co-prescribing.

2) Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain.

Mueller SR, Koester S, Glanz JM, Gardner EM, Binswanger IA.

J Gen Intern Med. 2016 Oct 31. [Epub ahead of print]

Comment: Shows that naloxone for patients prescribed opioids must be appropriately framed.

3) Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain.

Behar E, Rowe C, Santos GM, Coffa D, Turner C, Santos NC, Coffin PO.

J Gen Intern Med. 2016 Nov 4. [Epub ahead of print]

Comment: When actually implemented, providers really like adding naloxone to opioid-related care. One of five papers out of the Naloxone for Opioid Safety Evaluation of a naloxone co-prescribing study in San Francisco.

Emergency department

4) Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing.

Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg AR, Bernstein E.

Acad Emerg Med. 2016 Apr;23(4):455-65. doi: 10.1111/acem.12910.

Comment: There needs to be some high-level leadership in emergency medicine before we see real movement from emergency docs.

5) Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment.

Drainoni ML, Koppelman EA, Feldman JA, Walley AY, Mitchell PM, Ellison J, Bernstein E.

BMC Res Notes. 2016 Oct 18;9(1):465.

Comment: Uptake of naloxone provision from emergency departments has been surprisingly challenging.

6) Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users.

Kestler A, Buxton J, Meckling G, Giesler A, Lee M, Fuller K, Quian H, Marks D, Scheuermeyer F.

Ann Emerg Med. 2016 Oct 10. pii: S0196-0644(16)30407-3. doi: 10.1016/j.annemergmed.2016.07.027. [Epub ahead of print]

Comment: If you offer it from emergency departments, you’ll get reasonable uptake. Interesting in the context of our other ED naloxone papers from this month.

Corrections

7)  Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths.

Parmar MK, Strang J, Choo L, Meade AM, Bird SM.

Addiction. 2016 Oct 24. doi: 10.1111/add.13668. [Epub ahead of print]

Comment: Interesting piece on the N-ALIVE trial, which was possibly our last real hope for a definitive randomized controlled trial of naloxone provision. Unfortunately it didn’t work out, but there is still room for some innovative trial designs to try to get close to such definitive data.

8) Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England.

Sondhi A, Ryan G, Day E.

Harm Reduct J. 2016 Feb 3;13:5. doi: 10.1186/s12954-016-0094-1.

Comment: Interesting elements of the challenges of providing naloxone in prisons, including identifying eligible inmates, inmate and staff perceptions, and logistical barriers.

Substance use treatment

9) 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.

Comment: If you don’t give them naloxone, they don’t go get it themselves. This is like a flu vaccination. People don’t go out of their way for preventive interventions.

Distribution program

10) 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: As above.

Law enforcement / emergency medical service response

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

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

Prehosp Emerg Care. 2016 Nov-Dec;20(6):675-680.

Comment: A relief that few patients become combative in this situation.

12) Law Enforcement Attitudes towards Naloxone Following Opioid OverdoseTraining.

Purviance D, Ray B, Tracy A, Southard E.

Subst Abus. 2016 Aug 11:0. [Epub ahead of print]

Comment: Changes in the role of police for people who use drugs is a meaningful element of this process.

13) Implementation of online opioid overdose prevention, recognition and response trainings for professional first responders: Year 1 survey results.

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

Drug Alcohol Depend. 2016 Oct 11;169:1-4. doi: 10.1016/j.drugalcdep.2016.10.003. [Epub ahead of print]

Comment: Evaluation of online naloxone training, with some innovative elements.

These two papers address early release by emergency medical personnel after naloxone administration.

14) Do heroin overdose patients require observation after receiving naloxone?

Willman MW, Liss DB, Schwarz ES, Mullins ME.

Clin Toxicol (Phila). 2016 Nov 16:1-7. [Epub ahead of print]

Comment: The short answer is “no”. Nice summary.

15) Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?

Kolinsky D, Keim SM, Cohn BG, Schwarz ES, Yealy DM.

J Emerg Med. 2016 Oct 18. pii: S0736-4679(16)30777-6. doi: 10.1016/j.jemermed.2016.09.015. [Epub ahead of print]

Comment: Probably per this paper. Yes per the parallel one that came out this month.

Miscellaneous

16) Can Naloxone Be Used to Treat Synthetic Cannabinoid Overdose?

Jones JD, Nolan ML, Daver R, Comer SD, Paone D.

Biol Psychiatry. 2016 Aug 18. pii: S0006-3223(16)32710-X. doi: 10.1016/j.biopsych.2016.08.013. [Epub ahead of print] No abstract available.

Comment: Interesting that naloxone seemed to help in these cases, in the absence of presence of opioids. There is an interaction between the opioid and cannabinoid receptor systems (which was actually an element of my undergraduate work with cannabinoids and pain – a theory suggested by the late J Michael Walker from Brown University).

Prescription opioids and chronic pain

17) Prescription drug abuse – A timely update.

Monheit B, Pietrzak D, Hocking S.

Aust Fam Physician. 2016 Dec;45(12):862-866.

Comment: Prescription opioids in Australia. And buprenorphine is really safe.

18) Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults.

Chang YP, Compton P.

J Gerontol Nurs. 2016 Dec 1;42(12):21-30. doi: 10.3928/00989134-20161110-06.

Comment: Hopefully the new efforts at opioid prescribing will help. I remain concerned that, without substantial investments in funding other pain management strategies, feelings of patient abandonment will worsen.

19) Challenges to Treatment of Chronic Pain and Addiction During the “Opioid Crisis”.

Krashin D, Murinova N, Sullivan M.

Curr Pain Headache Rep. 2016 Dec;20(12):65. Review.

Comment: Per title.

20) Turning the Tide or Riptide? the Changing Opioid Epidemic.

Kertesz SG.

Subst Abus. 2016 Nov 18:0. [Epub ahead of print]

Comment: A pointed analysis of issues with the continued focus on opioid prescribing, when reforms have been followed by explosions in the use and consequences of street opioids.

21) Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.

Wilder CM, Miller SC, Tiffany E, Winhusen T, Winstanley EL, Stein MD.

J Addict Dis. 2016;35(1):42-51. doi: 10.1080/10550887.2016.1107264.

Comment: Everybody underestimates their overdose risk. The next question is what does this mean (e.g. does this apply to most medical disorders?) and what do we do with the information?

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

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

J Addict Med. 2016 Nov/Dec;10(6):382-386.

Comment: Can’t access this case report of a patient with comorbid chronic pain and substance use disorder who had a heroin overdose.

23) Declines in Opioid Prescribing After a Private Insurer Policy Change – Massachusetts, 2011-2015.

García MC, Dodek AB, Kowalski T, Fallon J, Lee SH, Iademarco MF, Auerbach J, Bohm MK.

MMWR Morb Mortal Wkly Rep. 2016 Oct 21;65(41):1125-1131. doi: 10.15585/mmwr.mm6541a1.

Comment: Opioid stewardship interventions reduced opioid prescribing in Massachusetts. No surprise there. But no analysis of what happened to patients who were no longer prescribed opioids. We’re in the midst of a crisis and really need to go further than just looking at opioid prescribing.

24) Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic.

Becker WC, Merlin JS, Manhapra A, Edens EL.

Addict Sci Clin Pract. 2016 Jan 28;11(1):3. doi: 10.1186/s13722-016-0050-0.

Comment: It takes a lot of work to manage patients well; many providers do not have the resources to pull this off.

25) Efficacy and safety of two methadone titration methods for the treatment of cancer-related pain: The EQUIMETH2 trial (methadone for cancer-related pain).

Poulain P, Berleur MP, Lefki S, Lefebvre D, Chvetzoff G, Serra E, Tremellat F, Derniaux A, Filbet M; EQUIMETH2 Study Group..

J Pain Symptom Manage. 2016 Sep 29. pii: S0885-3924(16)30312-8. doi: 10.1016/j.jpainsymman.2016.05.022. [Epub ahead of print]

Comment: Use of methadone as second-line pain control in cancer patients.

26) Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system.

Boscarino JA, Kirchner HL, Pitcavage JM, Nadipelli VR, Ronquest NA, Fitzpatrick MH, Han JJ.

Subst Abuse Rehabil. 2016 Sep 16;7:131-141.

Comment: Nice, large study, no surprising results.

27) Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates.

Dowell D, Zhang K, Noonan RK, Hockenberry JM.

Health Aff (Millwood). 2016 Oct 1;35(10):1876-1883.

Comment: Wow this is complicated. And I’m unsure that amalgamated national data can appropriately reflect the reasons for such complicated results. The real impact in terms of overdose mortality, if there is one, is from prescribed opioids. It seems a stretch to say these data show a reduction in overall opioid overdose mortality.

Toxicology reports:

28) Risk Factors for Mortality and Endotracheal Intubation after MethadoneIntoxication.

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

Basic Clin Pharmacol Toxicol. 2016 Mar;118(3):231-7. doi: 10.1111/bcpt.12476.

Comment: Interesting that age seemed to predict the worst outcomes in methadone overdose. Again makes me wonder about what makes older opioid users seem more likely to die of overdose while younger users overdose more frequently.

27) Non-cardiogenic pulmonary edema, rhabdomyolysis and myocardial injury following heroin inhalation: a case report.

Bazoukis G, Spiliopoulou A, Mourouzis K, Grigoropoulou P, Yalouris A.

Hippokratia. 2016 Jan-Mar;20(1):84-87.

Comment: Title says it all.

28) An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram.

Sammon M, Dawood A, Beaudoin S, Harrigan RA.

J Emerg Med. 2016 Oct 7. pii: S0736-4679(16)30686-2. doi: 10.1016/j.jemermed.2016.08.027. [Epub ahead of print]

Comment: An overdose reversal case that led to the diagnosis of a variant of Wolff-Parkinson White, which is a cardiac disorder that can be life threatening.

29) Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.

Toce MS, Burns MM, O’Donnell KA.

Clin Toxicol (Phila). 2016 Oct 19:1-6. [Epub ahead of print]

Comment: Effects are similar to other opioids for infants/toddlers, and duration of observation required is dependent upon dose.

Substance use disorder treatment

30) Striatal H3K27 Acetylation Linked to Glutamatergic Gene Dysregulation in Human Heroin Abusers Holds Promise as Therapeutic Target.

Egervari G, Landry J, Callens J, Fullard JF, Roussos P, Keller E, Hurd YL.

Biol Psychiatry. 2016 Sep 28. pii: S0006-3223(16)32833-5. doi: 10.1016/j.biopsych.2016.09.015. [Epub ahead of print]

Comment: Interesting exploration of novel interventions for opioid use disorder.

31)  Fifty Years in the Development of a Glutaminergic-Dopaminergic Optimization Complex (KB220) to Balance Brain Reward Circuitry in Reward Deficiency Syndrome: A Pictorial.

Blum K, Febo M, Badgaiyan RD.

Austin Addict Sci. 2016;1(2). pii: 1006.

Comment: More on novel pharmacotherapies for opioid use disorder.

32) Treatment utilization among persons with opioid use disorder in the United States.

Wu LT, Zhu H, Swartz MS.

Drug Alcohol Depend. 2016 Oct 19;169:117-127. doi: 10.1016/j.drugalcdep.2016.10.015. [Epub ahead of print]

Comment: Yup, the United States has issues with providing appropriate treatments for opioid use disorder. These issues are multi-faceted, ranging from the unbelievable stigma faced by a person who even admits to any drug use in a medical setting, to the finance issues in a fragmented, barely hung together healthcare system slated to be further trampled in the next couple of years.

Epidemilogy / qualitative results

33) Assessing gender disparities in excess mortality of heroin or cocaine users compared to the general population.

Brugal MT, Molist G, Sarasa-Renedo A, de la Fuente L, Espelt A, Mesías B, Puerta C, Guitart AM, Barrio G; Spanish Working Group for the Study of Mortality amongDrug Users..

Int J Drug Policy. 2016 Nov 11;38:36-42. doi: 10.1016/j.drugpo.2016.10.009. [Epub ahead of print]

Comment: Gender comparison in overdose.

34) [Harm reduction interventions in drug users: current situation and recommendations].

Bosque-Prous M, Brugal MT.

Gac Sanit. 2016 Nov;30 Suppl 1:99-105. doi: 10.1016/j.gaceta.2016.04.020. Spanish.

Comment: Review of harm reduction strategies from Spain.

35) Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia.

Scott N, Carrotte ER, Higgs P, Cogger S, Stoové MA, Aitken CK, Dietze PM.

Drug Alcohol Depend. 2016 Nov 1;168:140-146. doi: 10.1016/j.drugalcdep.2016.08.638.

Comment: Psychological distress is a major and fascinating domain in substance use disorders.

36) Drug use in business bathrooms: An exploratory study of manager encounters in New York City.

Wolfson-Stofko B, Bennett AS, Elliott L, Curtis R.

Int J Drug Policy. 2016 Oct 18;39:69-77. doi: 10.1016/j.drugpo.2016.08.014. [Epub ahead of print]

Comment: Interesting argument for supervised injection facilities.

36) County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States.

Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, Bohm MK, Jones CM, Flanagan BE, Siddiqi AE, Iqbal K, Dent AL, Mermin JH, McCray E, Ward JW, Brooks JT.

J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):323-331.

Comment: Great paper. Innovative approach and analysis. Kudos.

37) Performance measures of diagnostic codes for detecting opioid overdose in the emergency department.

Rowe C, Vittinghoff E, Santos GM, Behar E, Turner C, Coffin P.

Acad Emerg Med. 2016 Oct 20. doi: 10.1111/acem.13121. [Epub ahead of print]

Comment: ICD coding for opioid poisoning in a safety net hospital detected only a quarter of opioid overdose cases, suggesting that surveillance of this issue based on billing codes in emergency departments may vastly underestimate the number of cases. It is also possible that there is huge variation in how cases are coded. Unfortunately, this is another strike against using “big data” in substance use research. The reasons for poor coding are many, including stigma.

38) Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre.

Latimer J, Ling S, Flaherty I, Jauncey M, Salmon AM.

Int J Drug Policy. 2016 Oct 14;37:111-114. doi: 10.1016/j.drugpo.2016.08.004. [Epub ahead of print]

Comment: Nice work by this team! Fentanyl injection had twice the risk of overdose of heroin injection and eight times the risk of injection other prescribed opioids. Although this is observational, it’s the first data we have to start to paint the picture.

39) Communicating risk in the context of methadone formulation changes: A qualitative study of overdose warning posters in Vancouver, Canada.

Markwick N, McNeil R, Anderson S, Small W, Kerr T.

Int J Drug Policy. 2016 Jan;27:178-81. doi: 10.1016/j.drugpo.2015.10.013. No abstract available.

Comment: Warnings should emphasize the specific risks for harm, not the potency.

40) Emergence of methadone as a street drug in St. Petersburg, Russia.

Heimer R, Lyubimova A, Barbour R, Levina OS.

Int J Drug Policy. 2016 Jan;27:97-104. doi: 10.1016/j.drugpo.2015.10.001.

Comment: Methadone use has increased from 4% in 2010 to 53% in 2012/13, and its use is associated with fewer HIV risk behaviors than heroin use.

41) Do drug seizures predict drug-related emergency department presentations or arrests for drug use and possession?

Wan WY, Weatherburn D, Wardlaw G, Sarafidis V, Sara G.

Int J Drug Policy. 2016 Jan;27:74-81. doi: 10.1016/j.drugpo.2015.09.012.

Comment: Not really, in Australia at least.

Reviews

42) Drugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go.

Dodington J, Violano P, Baum CR, Bechtel K.

Pediatr Res. 2016 Oct 26. doi: 10.1038/pr.2016.193. [Epub ahead of print] Review.

Comment: So interesting to merge these three areas in thinking about public health interventions.

43) In Response to: “The Evolution of Recommended Naloxone Dosing for OpioidOverdose by Medical Specialty”.

Lombardi J, Villeneuve E, Gosselin S.

J Med Toxicol. 2016 Oct 24. [Epub ahead of print] No abstract available.

In Reply: “The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty”.

Connors NJ, Nelson LS.

J Med Toxicol. 2016 Oct 24. [Epub ahead of print] No abstract available.

Comment: Can’t access these letters

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

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

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

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

2) Heroin use.

Salani DA, Zdanowicz M, Joseph L.

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

Comments: Epidemiologic review.

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

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

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

Comments: Qualitative interviews with medical providers.

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

Elzey MJ, Barden SM, Edwards ES.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Managing syndemics in Malaysia.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Extended-release naltrexone studies.

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

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

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

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

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

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

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

Comments: Description of a planned study.

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

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

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

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

16) Opioid agonist treatment for pharmaceutical opioid dependent people.

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

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

Comments: Agonist treatment works, maintenance is best.

17) Naloxone access increases, as does price.

Thompson CA.

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

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

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

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

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

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

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

U S Department Of Health And Human Services.

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

Comments: Yup.

1) New Drugs of Abuse.

Rech MA, Donahey E, Cappiello Dziedzic JM, Oh L, Greenhalgh E.

Pharmacotherapy. 2014 Dec 4. doi: 10.1002/phar.1522. [Epub ahead of print]

Comment: Review of management of drug toxicities among novel, synthetic compounds.

2) Police officer attitudes towards intranasal naloxone training.

Ray B, O’Donnell D, Kahre K.

Drug Alcohol Depend. 2015 Jan 1;146:107-10. doi: 10.1016/j.drugalcdep.2014.10.026. Epub 2014 Nov 8.

Comment: Police officers like being trained to carry naloxone.

3) Intranasal naloxone administration for treatment of opioid overdose.

Robinson A, Wermeling DP.

Am J Health Syst Pharm. 2014 Dec 15;71(24):2129-35. doi: 10.2146/ajhp130798.

Comment: Review of intranasal naloxone for overdose reversal.

4) Observed transition from opioid analgesic deaths toward heroin.

Dasgupta N, Creppage K, Austin A, Ringwalt C, Sanford C, Proescholdbell SK.

Drug Alcohol Depend. 2014 Dec 1;145:238-41. doi: 10.1016/j.drugalcdep.2014.10.005. Epub 2014 Oct 18.

Comment: Heroin overdoses are increasing.

5) Brief overdose education can significantly increase accurate recognition of opioid overdose amongheroin users.

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

Int J Drug Policy. 2014 Jan;25(1):166-70. doi: 10.1016/j.drugpo.2013.05.006. Epub 2013 Jun 15.

Comment: Brief overdose training works for naloxone distribution. This is important because many places are requiring prolonged trainings that end up limiting access to those who are unable or unwilling to invest that degree of time.

6) Brief overdose education is sufficient for naloxone distribution to opioid users.

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

Drug Alcohol Depend. 2015 Mar 1;148:209-12. doi: 10.1016/j.drugalcdep.2014.12.009. Epub 2014 Dec 19.

Comment: Again, brief overdose training works for naloxone distribution.

7) Novel Interventions to Prevent HIV and HCV Among Persons Who Inject Drugs.

Coffin PO, Rowe C, Santos GM.

Curr HIV/AIDS Rep. 2015 Jan 15. [Epub ahead of print]

Comment: Review of interventions for PWIDs in 2013 and 2014, including naloxone.

8) Supervised injection services: What has been demonstrated? A systematic literature review.

Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B.

Drug Alcohol Depend. 2014 Dec 1;145C:48-68. doi: 10.1016/j.drugalcdep.2014.10.012. Epub 2014 Oct 23. Review.

Comment: The attract the most marginalized drug users, promote safer injection, enhance primary care access, reduce overdose frequency, reduce public injecting and improper syringe disposal. They don’t increase drug injecting, drug trafficking or crime.

9) What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose.

Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM.

Drug Alcohol Depend. 2014 Dec 1;145C:34-47. doi: 10.1016/j.drugalcdep.2014.10.001. Epub 2014 Oct 14. Review.

Comment: We don’t know anything

10) Drug scene, drug use and drug-related health consequences and responses in Kulob and Khorog, Tajikistan.

Latypov A, Otiashvili D, Zule W.

Int J Drug Policy. 2014 Oct 7;25(6):1204-1214. doi: 10.1016/j.drugpo.2014.09.011. [Epub ahead of print]

Comment: Takikistan has a dire need for vast expansion in agonist maintenance and naloxone services.

11) “It’s Russian roulette”: Adulteration, adverse effects and drug use transitions during the 2010/2011 United Kingdom heroin shortage.

Harris M, Forseth K, Rhodes T.

Int J Drug Policy. 2015 Jan;26(1):51-8. doi: 10.1016/j.drugpo.2014.09.009. Epub 2014 Sep 28.

Comment: A discussion of the downsides of a heroin drought and how drug users cope.

12) Coverage of overdose prevention programs for opiate users and injectors: a cross-sectional study.

Arribas-Ibar E, Sánchez-Niubò A, Majó X, Domingo-Salvany A, Brugal MT.

Harm Reduct J. 2014 Nov 22;11(1):33. doi: 10.1186/1477-7517-11-33.

Comment: I’m not entirely clear that these programs involve naloxone distribution, but it looks like they do with a 1-hour training. When they recruited from sites with programs, 43.5% of drug users had participated.

13) Evaluation of drug-drug interaction between daclatasvir and methadone orbuprenorphine/naloxone.

Garimella T, Wang R, Luo WL, Wastall P, Kandoussi H, Demicco M, Bruce D, Hwang C, Bertz R, Bifano M.

J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19628. doi: 10.7448/IAS.17.4.19628. eCollection 2014.

Comment: Another hepatitis C medication being tested for use in people on opioid agonist maintenance treatment. No meaningful interaction.

14) Effect of steady-state faldaprevir on the pharmacokinetics of steady-state methadone andbuprenorphine-naloxone in subjects receiving stable addiction management therapy.

Joseph D, Schobelock MJ, Riesenberg RR, Vince BD, Webster LR, Adeniji A, Elgadi M, Huang F.

Antimicrob Agents Chemother. 2015 Jan;59(1):498-504. doi: 10.1128/AAC.04046-14. Epub 2014 Nov 10.

Comment: Another hepatitis C medication being tested for use in people on opioid agonist maintenance treatment. No meaningful interaction.

15) Take-home emergency naloxone to prevent deaths from heroin overdose.

Strang J, Bird SM, Dietze P, Gerra G, McLellan AT.

BMJ. 2014 Nov 4;349:g6580. doi: 10.1136/bmj.g6580. No abstract available.

Comment: England seems to be creeping forward with naloxone even in the absence of final data from large randomized trials.

16) Diversion of methadone and buprenorphine from opioid substitution treatment: a staff perspective.

Johnson B, Richert T.

J Psychoactive Drugs. 2014 Nov-Dec;46(5):427-35. doi: 10.1080/02791072.2014.960109.

Comment: This is an interesting issue. Agonist agents are often in short supply and can help people in withdrawal, who want to self-detox, etc. As the authors write: “Patients who share their medication with opioid-dependent friends are seen as less culpable than those who sell to anyone for money.”

17) Naloxone for opioid overdose prevention: pharmacists’ role in community-based practice settings.

Bailey AM, Wermeling DP.

Ann Pharmacother. 2014 May;48(5):601-6. doi: 10.1177/1060028014523730. Epub 2014 Feb 12.

Comment: Pharmacists and naloxone!

18) Opiate- and cocaine-related fatal overdoses in Luxembourg from 1985 to 2011: a study on gender differences.

Origer A, Lopes da Costa S, Baumann M.

Eur Addict Res. 2014;20(2):87-93. doi: 10.1159/000355170. Epub 2013 Oct 31.

Comment: Interesting look at male versus female decedents. While men were more likely to die, women were more likely to die earlier in their drug use career and to use other psychoactive prescription medicaitons.

19) Assisted injection among people who inject drugs in Thailand.

Lee WK, Ti L, Hayashi K, Kaplan K, Suwannawong P, Wood E, Kerr T.

Subst Abuse Treat Prev Policy. 2013 Sep 10;8:32. doi: 10.1186/1747-597X-8-32.

Comment: This study found no association between needing assistance with injection and non-fatal overdose. The data on this has been mixed, with some studies finding an association and some finding no association. As women are more likely to get assistance with injection and men are more likely to overdose, I wonder if the effect may wash out and more gender-specific analyses may make sense.

20) Associations between injection risk and community disadvantage among suburban injection drugusers in southwestern Connecticut, USA.

Heimer R, Barbour R, Palacios WR, Nichols LG, Grau LE.

AIDS Behav. 2014 Mar;18(3):452-63. doi: 10.1007/s10461-013-0572-3.

Comment: Interesting use of geocoding by mapping overdose deaths on top of the sample for the study. Frequent overdoses and poor knowledge about overdose in rural CT. Important work.

21) Sublingual buprenorphine for chronic pain: a survey of clinician prescribing practices.

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

Clin J Pain. 2014 Apr;30(4):295-300. doi: 10.1097/AJP.0b013e318298ddad.

Comment: Interesting survey of American Pain Society members showing that buprenorphine is indeed being used to treat chronic pain and is viewed as safer due to partial agonist activity (and reduced overdose risk).

22) Increased somatic morbidity in the first year after leaving opioid maintenance treatment: results from a Norwegian cohort study.

Skeie I, Brekke M, Clausen T, Gossop M, Lindbaek M, Reinertsen E, Thoresen M, Waal H.

Eur Addict Res. 2013;19(4):194-201. doi: 10.1159/000345229. Epub 2012 Dec 21.

Comment: As has been well-documented in the past, terminating opioid agonist maintenance therapy has a heighted risk of overdose.

23) Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses.

Bretteville-Jensen AL, Lillehagen M, Gjersing L, Andreas JB.

Drug Alcohol Depend. 2014 Dec 13. pii: S0376-8716(14)01981-4. doi: 10.1016/j.drugalcdep.2014.12.002. [Epub ahead of print]

Comment: Interesting assessment of overdose risk among those who use diverted substitution medications. The only associated with overdose was infrequent buprenorphine use. As using buprenorphine requires one to detox beforehand, and detox is associated with overdose, I wonder if this is picking up people who are really trying to cut back their use and thus increasing overdose risks.

24) Alcohol-induced sedation and synergistic interactions between alcohol and morphine: A key mechanistic role for Toll-like receptors and MyD88-dependent signaling.

Corrigan F, Wu Y, Tuke J, Coller JK, Rice KC, Diener KR, Hayball JD, Watkins LR, Somogyi AA, Hutchinson MR.

Brain Behav Immun. 2014 Dec 24. pii: S0889-1591(14)00608-4. doi: 10.1016/j.bbi.2014.12.019. [Epub ahead of print]

Comment: Morphine and alcohol appear to interact in surprising ways neurochemically, perhaps accounting for heightened overdose risk.

25) Preventing Iatrogenic Overdose: A Review of In-Emergency Department Opioid-Related Adverse Drug Events and Medication Errors.

Beaudoin FL, Merchant RC, Janicki A, McKaig DM, Babu KM.

Ann Emerg Med. 2014 Dec 17. pii: S0196-0644(14)01514-5. doi: 10.1016/j.annemergmed.2014.11.016. [Epub ahead of print]

Comment: The majority of events were due to medication error.

26) High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study.

Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL.

Int J Drug Policy. 2014 Dec 2. pii: S0955-3959(14)00334-X. doi: 10.1016/j.drugpo.2014.11.010. [Epub ahead of print]

Comment: Amazing to have this work out of Malaysia. Shows more or less standard rates of overdose that have been documented in multiple other settings.

27) Administration of Naloxone in a Home or Community Setting: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Jun 20.

Comment: There are no data comparing lay naloxone to healthcare professional administered naloxone.

28) Reversal of Opioid Overdose Syndrome in Morphine-Dependent Rats Using Buprenorphine.

Zamani N, Hassanian-Moghaddam H, Hossein Bayat A, Haghparast A, Shadnia S, Rahimi M, Demaneh BH.

Toxicol Lett. 2014 Dec 12. pii: S0378-4274(14)01514-8. doi: 10.1016/j.toxlet.2014.12.007. [Epub ahead of print]

Comment: “Buprenorphine recovers opioid-overdose in morphine-dependent rats and bypasses the withdrawal-syndrome due to administration of naloxone.”

29) Adolescents at Risk: Pain Pills to Heroin: Part II.

Fogger S, McGuinness TM.

J Psychosoc Nurs Ment Health Serv. 2015 Feb 1;53(2):27-30. doi: 10.3928/02793695-20150106-01.

Comment: A review of substituting prescription opioids with heroin due to cost of the former, and using opioid substitution therapy.

30) Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access.

Wermeling DP.

Ther Adv Drug Saf. 2015 Feb;6(1):20-31. doi: 10.1177/2042098614564776. Review.

Comment: As the title says.

31) Evaluation of poly-drug use in methadone-related fatalities using segmental hair analysis.

Nielsen MK, Johansen SS, Linnet K.

Forensic Sci Int. 2015 Mar;248:134-9. doi: 10.1016/j.forsciint.2015.01.004. Epub 2015 Jan 12.

Comment: Interesting work. No evidence of decreased exposure to methadone (so reduced tolerance of methadone unlikely a factor here). Evidence of multiple other depressant agents, including frequent heroin exposure.

32) Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study.

Teesson M, Marel C, Darke S, Ross J, Slade T, Burns L, Lynskey M, Memedovic S, White J, Mills KL.

Addiction. 2015 Jan 23. doi: 10.1111/add.12860. [Epub ahead of print]

Comment: Really useful data here. After 11 years, 10.2% of the population had died and 24.8% were still using heroin; 46.6% were in current substance use disorder treatment. Major depression was a driver of poor outcomes.

33) 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 1;175(3):420-427. doi: 10.1001/jamainternmed.2014.6294.

Comment: Methadone was more risky than other opioids, even at low doses (<20mg per day). Still, it’s not possible to tease out all of the differences, such as why methadone was prescribed to one person and morphine to another.

34) The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction.

Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC.

Annu Rev Public Health. 2015 Jan 12. [Epub ahead of print]

Comment: A review of prescription opioid overdose.

35) Community Management of Opioid Overdose.

Geneva: World Health Organization; 2014.

Comment: WHO endorses lay naloxone.

36) Ventricular dysrhythmias associated with poisoning and drug overdose: a 10-year review of statewide poison control center data from california.

Al-Abri SA, Woodburn C, Olson KR, Kearney TE.

Am J Cardiovasc Drugs. 2015 Feb;15(1):43-50. doi: 10.1007/s40256-014-0104-1.

Comment: Stimulants, antidepressants, etc.

37) Overdose Education and Naloxone Rescue Kits for Family Members of Opioid Users: Characteristics, Motivations and Naloxone Use.

Bagley SM, Peterson J, Cheng DM, Jose C, Quinn E, O’Connor PG, Walley AY.

Subst Abus. 2015 Jan 7:0. [Epub ahead of print]

Comment: Makes sense.

38) Methadone and prescription drug overdose.

Hendrikson H, Hansen M.

NCSL Legisbrief. 2014 Dec;22(45):1-2.

Comment: More on methadone as being of high risk when used for pain management.

39) Diversion of methadone and buprenorphine from opioid substitution treatment: a staff perspective.

Johnson B, Richert T.

J Psychoactive Drugs. 2014 Nov-Dec;46(5):427-35. doi: 10.1080/02791072.2014.960109.

Comment: “Patients who share their medication with opioid-dependent friends are seen as less culpable than those who sell to anyone for money.”

40) 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.

Comment: Establishing overdose as caused by heroin can be tricky these days and work like this is important.

41) Risk of anaphylaxis in opioid dependent persons: effects of heroin versus substitution substance.

Maurer U, Kager C, Fellinger C, Loader D, Pollesböck A, Spitzer B, Jarisch R.

Subst Abuse Treat Prev Policy. 2014 Feb 27;9:12. doi: 10.1186/1747-597X-9-12.

Comment: Heroin injectors have high baseline rates of histamine, suggesting that they be at higher risk than others for allergic reactions to substances.

42) The potential threat of acetyl fentanyl: legal issues, contaminated heroin, and acetyl fentanyl “disguised” as other opioids.

Stogner JM.

Ann Emerg Med. 2014 Dec;64(6):637-9. doi: 10.1016/j.annemergmed.2014.07.017. Epub 2014 Aug 18. No abstract available.

Comment: Acetyl fentanyl is a major problem in the eastern half of the U.S. these days.

43) Drug-related deaths between 2002 and 2013 with accent to methadone and benzodiazepines.

Petrushevska T, Jakovski Z, Poposka V, Stefanovska VV.

J Forensic Leg Med. 2015 Apr;31:12-8. doi: 10.1016/j.jflm.2014.12.013. Epub 2015 Jan 7.

Comment: Survey of drug-related deaths in Macedonia.

44) Factors associated with health-related quality of life among injection drug users atmethadone clinics in Taipei, Taiwan.

Yen YF, Chou P, Lin YS, Deng CY.

J Chin Med Assoc. 2015 Feb 26. pii: S1726-4901(15)00005-2. doi: 10.1016/j.jcma.2015.01.001. [Epub ahead of print]

Comment: History of overdose was associated with a poor quality of life.

45) Opioid treatment at release from jail using extended-release naltrexone: a pilot proof-of-concept randomized effectiveness trial.

Lee JD, McDonald R, Grossman E, McNeely J, Laska E, Rotrosen J, Gourevitch MN.

Addiction. 2015 Feb 23. doi: 10.1111/add.12894. [Epub ahead of print]

Comment: Compared to nothing, there was less relapse in the first 4 weeks out of jail with injected naltrexone, which blocks opioid receptors for 4 weeks.

46) [The message of the heroin overdoses].

Pap Á, Hegedűs K.

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

Comment: Comments on overdose and naloxone from Hungary.

47) Take-home emergency naloxone to prevent deaths from heroin overdose.

Strang J, Bird SM, Dietze P, Gerra G, McLellan AT.

BMJ. 2014 Nov 4;349:g6580. doi: 10.1136/bmj.g6580. No abstract available.

Comment: Authors state their belief that waiting for data should not delay implementation of naloxone programs.

48) Expanding access to naloxone in the United States.

Doyon S, Aks SE, Schaeffer S; American Academy of Clinical Toxicology; American College of Medical Toxicology; American Association of Poison Control Centers.

Clin Toxicol (Phila). 2014 Dec;52(10):989-92. doi: 10.3109/15563650.2014.968657. Epub 2014 Oct 6. No abstract available.

Comment: Thanks to Corey Davis for sending, this is a position statement strongly in support of naloxone availability.

49) Emergency hospitalizations for unsupervised prescription medication ingestions by young children.

Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS.

Pediatrics. 2014 Oct;134(4):e1009-16. doi: 10.1542/peds.2014-0840. Epub 2014 Sep 15.

Comment: Buprenorphine was associated with quite a number of accidental pediatric ingestions.

50) 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.

Comment: There are lots of barriers to pharmacists serving in this role.

51) Another chance to reformulate racemic methadone.

Karch SB.

J Addict Med. 2014 May-Jun;8(3):217-9. doi: 10.1097/ADM.0000000000000036. No abstract available.

Comment: Unable to access. Racemic methadone may be associated with cardiac arrhythmias like torsades de pointes.

1. Patterns and correlates of non-fatal heroin overdose at 11-year follow-up: Findings from the Australian Treatment Outcome Study.

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

Drug Alcohol Depend. 2014 Sep 16. [Epub ahead of print]

Comment: This study (the ATOS) and the team of investigators have produced some of the most powerful and useful data in substance use research. Once again they have delved into heroin overdose by following treatment patients 11 years out. At least 10.2% of the cohort had died by that time and an additional 9.4% were unaccounted for. Among the 70.1% interviewed, 67.5% had overdosed, 24.4% had experienced five or more overdoses (again suggesting that there are “overdosers” out there who are at very elevated risk of the event). In the past year before the follow-up visit, 4.9% had overdosed (11.8% of those who had used heroin in that period), 95.2% of whom had overdosed previously. Those who overdosed were more likely to report higher levels of non-heroin opiate use, as well as benzodiazepine, cocaine, and methamphetamine use.

2. A new naloxone auto-injection device to treat opioid overdose.

Simonson W.

Geriatr Nurs. 2014 Sep-Oct;35(5):381-2.

Comment: A review of the role of take-home naloxone in the form of the new autoinjector.

3. Increases in heroin overdose deaths – 28 States, 2010 to 2012.

Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A, Gabella B, Hume B, Huntamer T, Kariisa M, Largo TW, Miles J, Newmyer A, Nitcheva D, Perez BE, Proescholdbell SK, Sabel JC, Skiba J, Slavova S, Stone K, Tharp JM, Wendling T, Wright D, Zehner AM.

MMWR Morb Mortal Wkly Rep. 2014 Oct 3;63(39):849-54.

Comment: This report demonstrates declining prescription opioid deaths (-6.6%), but heroin deaths increased so much (+101.7%) that the data actually demonstrate an overall increase in opioid overdose mortality from 2010 to 2012 (+4.3%). There is disagreement as to what is driving the increase in heroin use and overdose. Is it an inevitable consequence of increased availability of opioids? Or is it the result of growing restrictions on access to those opioids? Clearly there are elements of both, leaving us with conflicting duties when it comes to managing those already reliant upon prescription opioids. Western medical ethics is clear on this point: our patient is the person we treat, who may have been harmed by the very same prescribing behavior we are now trying to change and who may be further harmed by those changes. If we truly believe that this epidemic is “iatrogenic” (i.e. caused by medical care, akin to a surgeon leaving scissors in an abdomen), then we have to be extremely cautious and thoughtful in fixing the problem and we can never abandon the patient.

4. Working together: Expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond.

Lenton S, Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C.

Drug Alcohol Rev. 2014 Oct 1. doi: 10.1111/dar.12198. [Epub ahead of print]

Comment: It’s taken an incredibly long time for take-home naloxone to reach Australia, especially given how innovative that country has been with respect to managing drug policy and overdose.

5. Responding to opioid overdose in Rhode Island: where the medical community has gone and where we need to go.

Green TC, Bratberg J, Dauria EF, Rich JD.

R I Med J (2013). 2014 Oct 1;97(10):29-33.

Comment: The first of three articles in this post from Rhode Island, US, which has been facing a surge in opioid overdose deaths and has been responding with expanded naloxone treatment availability. This and the next two articles are free at:http://rimed.org/rimedicaljournal-2014-10.asp.

6. Emergency department naloxone distribution: a rhode island department of health, recovery community, and emergency department partnership to reduce opioid overdosedeaths.

Samuels E.

R I Med J (2013). 2014 Oct 1;97(10):38-9.

Comment: A brief summary of an ED-based naloxone prescription program in Rhode Island, US. I like the emerging use of the term “naloxone rescue kit.”

7. The rhode island community responds to opioid overdose deaths.

Bowman S, Engelman A, Koziol J, Mahoney L, Maxwell C, McKenzie M.

R I Med J (2013). 2014 Oct 1;97(10):34-7.

Comment: A third article on the response in Rhode Island.

8. Emergency hospitalizations for unsupervised prescription medication ingestions by young children.

Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS.

Pediatrics. 2014 Oct;134(4):e1009-16. doi: 10.1542/peds.2014-0840. Epub 2014 Sep 15.

Comment: From 2007-2011 in the US, there were 9,490 hospitalizations among children <6 years of age, 17.6% of which involved opioids. Interestingly, buprenorphine was the most frequent opioid. There are some limitations to this study, including the absence of non-oral ingestions and the lack of narrative detail for the cases.

9. Emergency Medical Services NaloxoneAccess: A National Systematic Legal Review.

Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW.

Acad Emerg Med. 2014 Oct;21(10):1173-1177.

Comment: Most states don’t allow basic life support-trained emergency medical responders to administer naloxone.

10. Supply of buprenorphine waivered physicians: The influence of state policies.

Stein BD, Gordon AJ, Dick AW, Burns RM, Pacula RL, Farmer CM, Leslie DL, Sorbero M.

J Subst Abuse Treat. 2014 Aug 2.

Comment: 43% of US counties have no buprenorphine treatment providers. Hello?

11. Fatal Methadone Toxicity: Potential Role of CYP3A4 Genetic Polymorphism.

Richards-Waugh LL, Primerano DA, Dementieva Y, Kraner JC, Rankin GO.

J Anal Toxicol. 2014 Oct;38(8):541-7.

Comment: There’s much to be learned about risks for opioid overdose mortality. This study evaluated the role of CYP450 isoform known as CYP3A4, involved in hepatic metabolism. Some people are slow metabolizers – single nucleotide polymorphisms (aka common “mutations”) rs2242480 and rs2740574 were more common in methadone-only deaths but not in methadone+benzodiazepine deaths, suggesting that these genetic variations may play a role in overdose risk.

12. Prescription histories and dose strengths associated with overdose deaths.

Hirsch A, Proescholdbell SK, Bronson W, Dasgupta N.

Pain Med. 2014 Jul;15(7):1187-95.

Comment: The majority of prescription opioid overdose decedents had filled a prescription for that opioid within 60 days of their death. This has to be an argument for co-prescribing naloxone.

13. Patterns of DrugUse, Risky Behavior, and Health Status Among Persons Who Inject Drugs Living in San Diego, California: A Latent Class Analysis.

Roth AM, Armenta RA, Wagner KD, Roesch SC, Bluthenthal RN, Cuevas-Mota J, Garfein RS.

Subst Use Misuse. 2014 Oct 14. [Epub ahead of print]

Comment: Opioid overdose and HCV appear to be associated in this analysis. This is an interesting area of work. We are quickly learning that people who witness overdoses – and thus people most likely to use naloxone to reverse an overdose – are very high risk persons themselves. This makes logical sense but can make interpreting risk data among naloxone recipients quite challenging.

14. Prognostic factors in acute methadone toxicity: a 5-year study.

Aghabiklooei A, Edalatparvar M, Zamani N, Mostafazadeh B.

J Toxicol. 2014;2014:341826. doi: 10.1155/2014/341826. Epub 2014 Aug 12.

Comment: Fascinating study out of Iran. Methadone overdose cases ultimately died from renal failure related to rhabdomyolysis. This likely means that overdose cases were “down” for a while, where the pressure of their bodies on the ground/floor resulted in muscle breakdown, causing release of muscle metabolites that damaged the kidneys. Although they were revived (at least somewhat), the kidney damage from that downtime was ultimately fatal.

15. A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Larney S, Gowing L, Mattick RP, Farrell M, Hall W, Degenhardt L.

Drug Alcohol Rev. 2014 Mar;33(2):115-28. doi: 10.1111/dar.12095. Epub 2013 Dec 3. Review.

Comment: Authors contend that long-acting naltrexone formulations for opioid dependence should be limited to clinical trials only. The depot injection of naltrexone was approved in the US for this indication in 2012 based on a study conducted in Russia. While oral naltrexone clearly should not be used for opioid dependence – as there is a very high overdose death rate after discontinuation of treatment – the long-acting formulations may overcome that by allowing for a slower “tapering” off of the medication when treatment is discontinued. There are several studies in process or planning in the US which should provide more useful data to guide us on the safety of this therapy.

16. Reducing drug related deaths: a pre-implementation assessment of knowledge, barriers and enablers for naloxone distribution through general practice.

Matheson C, Pflanz-Sinclair C, Aucott L, Wilson P, Watson R, Malloy S, Dickie E, McAuley A.

BMC Fam Pract. 2014 Jan 15;15:12. doi: 10.1186/1471-2296-15-12.

Comment: A survey of primary care providers in Scotland (with a fairly low response rate of 55% that biases the results) found limited awareness of the concept of prescribing naloxone.

17. A quantitative and qualitative evaluation of the British Columbia Take Home Naloxoneprogram.

Oluwajenyo Banjo MPHc, Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA.

CMAJ Open. 2014 Jul 22;2(3):E153-61. doi: 10.9778/cmajo.20140008. eCollection 2014 Jul.

Comment: In the first 20 months, take-home naloxone in British Columbia opened in 40 sites, trained 1,318 participants, distributed 836 kits and reported 85 reversed overdose events. They ran into issues with finding providers willing to prescribe, recruiting some high-risk populations (like pain patients), and getting convincing participants it was safe to call emergency medical services.

18. Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons.

Weisberg DF, Becker WC, Fiellin DA, Stannard C.

Int J Drug Policy. 2014 Jul 30.

Comment: An interesting comparison of the US and UK in opioid prescribing and the risks for resultant opioid use disorder and overdose epidemics. Authors suggest that limited use of benzodiazepines and ready access to methadone may be helping to buffer the UK from the effects of opioid prescribing seen in the US.

19. Characteristics of mexican and mexican american adolescents in treatment for “cheese” heroin use.

Walker R, Maxwell JC, Adinoff B, Carmody T, Coton CE, Tirado CF.

J Ethn Subst Abuse. 2014;13(3):258-72. doi: 10.1080/15332640.2014.883582.

Comment: 74% of Hispanic adolescents in treatment for “cheese heroin” dependence reported a prior overdose (70% of females, 80% of males).

20. Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services.

Klimas J, O’Reilly M, Egan M, Tobin H, Bury G.

Am J Emerg Med. 2014 Jul 31.

Comment: Ambulances in Dublin Ireland attended 469 opioid overdoses, 2.8% of which were fatal and 26% of which were among persons who had been attended to for at least one prior overdose. These are useful data for understanding the epidemiology of EMS-attended overdose cases.

21 and 22. Pitfalls of intranasal naloxone

Zuckerman M, Weisberg SN, Boyer EW.

Prehosp Emerg Care. 2014 Oct-Dec;18(4):550-4

Intranasal Naloxone for Opioid Overdose Reversal.

Davis CS, Banta-Green CJ, Coffin P, Dailey MW, Walley AY.

Prehosp Emerg Care. 2014 Aug 25. [Epub ahead of print].

Comment: The lead article is a case report of an overdose that didn’t respond to initial paramedic-administered intranasal naloxone and an unrelated opinion piece critiquing both intranasal and take-home naloxone. There are randomized trials of intranasal naloxone and high-quality observational studies of take-home naloxone that are useful in this discussion – this article constitutes neither. The response letter pointing out these and other concerns has an entire page of disclosures because the lead article authors and journal editor determined that federal research funding is a conflict of interest. The disclosures are worth a read.

23. High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users.

Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, Teper A.

Int J Drug Policy. 2014 Jul 31.

Comment: Qualitative interviews among young prescription opioid users in New York City identified substantial experiences with personal and witnessed overdose and little to no connection with the networks and services that provide overdose prevention services.

24. Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden.

Richert T.

Int J Drug Policy. 2014 Jul 21.

Comment: Qualitative interviews with heroin users in Sweden identifies concerns with responding to overdose (in a setting without naloxone access) including police harassment and not wanting to disturb a high.

25. Quality Assessment of Acute Inpatient Pain Management in an Academic Health Center.

Lin RJ, Reid MC, Chused AE, Evans AT.

Am J Hosp Palliat Care. 2014 Aug 8. pii: 1049909114546545. [Epub ahead of print]

Comment: Authors reviewed pain management in a New York City hospital. Over 6 months, they found 5 cases of naloxone administration for an in-hospital opioid overdose related to prescribed opioids.

26. Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data.

Seaman EL, Levy MJ, Lee Jenkins J, Godar CC, Seaman KG.

Prehosp Disaster Med. 2014 Aug 4:1-5. [Epub ahead of print]

Comment: Younger adolescents use prescription drugs, older adolescents use illicit drugs.

27. Time for universal provision of take-home naloxone.

Crocker-Buque T, Lovitt C.

Lancet. 2014 Jul 26;384(9940):308. doi: 10.1016/S0140-6736(14)61240-X. No abstract available.

Comment: A letter calling for lay naloxone in the UK.

28. Naloxone auto-injector gains FDA approval.

Knopf A.

Behav Healthc. 2014 May-Jun;34(3):48-9. No abstract available.

Comment: Unable to access.

29. A multifactorial intervention for hospital opioid management.

Akce M, Suneja A, Genord C, Singal B, Hopper JA.

J Opioid Manag. 2014 Sep-Oct;10(5):337-44. doi: 10.5055/jom.2014.0223.

Comment: Can’t access full article. An educational intervention among hospital residents had no impact on pain. Naloxone use was an outcome but is not reported in the abstract.

30. Swift recovery of severe acute hypoxemic respiratory failure under non-invasive ventilation.

Pichot C, Petitjeans F, Ghignone M, Quintin L.

Anaesthesiol Intensive Ther. 2014 Oct 27. doi: 10.5603/AIT.a2014.0053. [Epub ahead of print]

Comment: Interesting successful case report of non-invasive ventilation in an opioid overdose with severe respiratory failure.

31. Safety studies of post-surgical buprenorphinetherapy for mice.

Traul KA, Romero JB, Brayton C, DeTolla L, Forbes-McBean N, Halquist MS, Karnes HT, Sarabia-Estrada R, Tomlinson MJ, Tyler BM, Ye X, Zadnik P, Guarnieri M.

Lab Anim. 2014 Oct 10. pii: 0023677214554216. [Epub ahead of print]

Comment: Can’t access full article. The abstract is confusing to me, but it appears to involve efforts to improve analgesia for lab mice through use of buprenorphine. Unlike human studies, investigators here conducted intentional overdoses.

32. Body packing: a review of general background, clinical and imaging aspects.

Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M.

Radiol Med. 2014 Oct 10. [Epub ahead of print]

Comment: Lots of badness can result from this.

1) Effectiveness of Naltrexone in the Prevention of Delayed Respiratory Arrest in Opioid-Naive Methadone-Intoxicated Patients.

Aghabiklooei A, Hassanian-Moghaddam H, Zamani N, Shadnia S, Mashayekhian M, Rahimi M, Nasouhi S, Ghoochani A.

Biomed Res Int. 2013;2013:903172. Epub 2013 Sep 9.

Comments: Interesting use of the long-acting opioid antagonist naltrexone in this study from Iran. The likely downside of this approach of course is that, in those with opioid dependence (constituting the vast majority of overdose cases), it doesn’t allow for titration of antagonist effect to minimize withdrawal symptoms.

2) An investigation of the interactions between methadone and elvitegravir/cobicistat in subjects receiving chronic methadone maintenance.

Bruce RD, Winkle P, Custodio JM, Wei X, Rhee MS, Kearney BP, Ramanathan S, Friedland GH.

Antimicrob Agents Chemother.2013 Sep 30. [Epub ahead of print]

Comments: This is a promising finding for the new HIV regimen.

3) Interaction of Different Antidepressants with Acute and Chronic Methadone in Mice, and Possible Clinical Implications.

Schreiber S, Barak Y, Hostovsky A, Baratz-Goldstein R, Volis I, Rubovitch V, Pick CG.

J MolNeurosci.2013 Sep 22. [Epub ahead of print]

Comments: Really interesting study, since many opioid overdoses occur in the presence of anti-depressant medications. These results are too preliminary to draw strong conclusions, but it’s an important pursuit.

4) Law enforcement attitudes toward overdose prevention and response.

Green TC, Zaller N, Palacios WR, Bowman SE, Ray M, Heimer R, Case P.

Drug Alcohol Depend.2013 Sep 2.doi:pii: S0376-8716(13)00334-7. 10.1016/j.drugalcdep.2013.08.018. [Epub ahead of print]

Comments: Interesting qualitative analysis of police attitudes toward lay naloxone.

5) Days of heroin use predict poor self-reported health in hospitalized heroin users.

Meshesha LZ, Tsui JI, Liebschutz JM, Crooks D, Anderson BJ, Herman DS, Stein MD.

Addict Behav. 2013 Aug 14;38(12):2884-2887. doi:

Comments: More days of heroin use is associated with worse self-reported health and worse self-reported health is associated with non-fatal overdose events.

6) Assisted injection among people who inject drugs in Thailand.

Lee WK, Ti L, Hayashi K, Kaplan K, Suwannawong P, Wood E, Kerr T.

Subst Abuse Treat Prev Policy. 2013 Sep 10;8(1):32. [Epub ahead of print]

Comments: This is a useful contribution to overdose literature. There has long been a concern that people who require assistance to inject (often women) would overdose more. This hasn’t held up in studies and this study corroborates that lack of association. It may be well worth exploring further, but thus far we don’t have any evidence that assistance with injecting increases overdose risk.

7) BET 3: Is nebulised naloxone effective in opioid overdose?

Emerg Med J. 2013 Oct;30(10):860. doi: 10.1136/emermed-2013-203100.3.

Comments: Yes, in breathing patients.

8) The lethal burden of drug overdose.

Lancet. 2013 Sep 7;382(9895):833. doi: 10.1016/S0140-6736(13)61844-9. No abstract available.

Comments: Brief commentary on opioid overdose mortality in UK and US. Notable that there is no mention of naloxone.

9) [Maintaining opioid abstinence long after inpatient treatment with opioid substitution in an addictology hospital unit].

Bouab O, Lahmek P, Meunier N, Aubin HJ, Michel L.

Rev Med Brux. 2013 May-Jun;34(3):132-40. French.

Comments: Basically inpatient withdrawal from agonist maintenance treatment.

10) The pharmacokinetic and pharmacodynamic interactions betweenbuprenorphine/naloxone and elvitegravir/cobicistat in subjects receiving chronicbuprenorphine/naloxone treatment.

Bruce RD, Winkle P, Custodio JM, Wei LX, Rhee MS, Kearney BP, Ramanathan S, Friedland GH.

J Acquir Immune DeficSyndr. 2013 Aug 1;63(4):480-4. doi: 10.1097/QAI.0b013e3182961d31.

Comments: The new combined HIV med (Stribild) modestly increases buprenorphine levels.

11) Problem based review: The patient taking methadone.

Arora A, Williams K.

Acute Med. 2013;12(1):51-4. Review.

Comments: Methadone maintenance review.

12) Low-frequency heroin injection among out-of-treatment, street-recruited injection drug users.

Harris JL, Lorvick J, Wenger L, Wilkins T, Iguchi MY, Bourgois P, Kral AH.

J Urban Health. 2013 Apr;90(2):299-306. doi: 10.1007/s11524-012-9720-8.

Comments: Another useful contribution – infrequent heroin injectors had a lower risk of non-fatal overdose. As with most overdose epidemiology, the relationship between use frequency and overdose risk is likely complex.