1) High buprenorphine-related mortality is persistent in Finland.

Kriikku P, Häkkinen M, Ojanperä I.

Forensic Sci Int. 2018 Aug 17;291:76-82. doi: 10.1016/j.forsciint.2018.08.010. [Epub ahead of print]

Comments: This is an interesting topic. Finland seems to have a lot of buprenorphine injection, in the absence of much other injection opioid use. There is also high levels of alcohol and benzodiazepine use and that is the context of the deaths.

2) A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality.

Weiner SG, Price CN, Atalay AJ, Harry EM, Pabo EA, Patel R, Suzuki J, Anderson S, Ashley SW, Kachalia A.

Jt Comm J Qual Patient Saf. 2018 Aug 28. pii: S1553-7250(18)30088-6. doi: 10.1016/j.jcjq.2018.07.003. [Epub ahead of print]

Comments: Metrics of opioid prescribing declined with no change in overdose.

3) Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016-June 2017.

Mattson CL, O’Donnell J, Kariisa M, Seth P, Scholl L, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2018 Aug 31;67(34):945-951. doi: 10.15585/mmwr.mm6734a2.

Comments: This is an amazing piece that finallystarts to flesh out the basic epidemiology of overdose in the post-heroin world. Conducting enhanced surveillance of opioid overdose deaths in 11 cities, they identified 17.4% were from opioid analgesics only, 18.5% for both analgesics and illicit opioids, and 58.7% for illicit opioids only – rates varied substantially by region/state. 10% had been released from an institutional setting in the month before death (mostly hospital for prescription-only and mostly jail/prison for illicit-only, with a mix for combined deaths). There was evidence of injection in 49.2% of illicit-only deaths and 6.6% of prescription opioid-only deaths. Bystanders were present in 41.6% of prescription-only, 44.0% of illicit-only, and 45.0% of combined deaths. Naloxone was administered by 0.8%, 4.3%, and 4.4% of cases, respectively. As in prior studies, prescription-only were more likely to contain benzodiazepines whereas illicit-only deaths were more likely to have cocaine or methamphetamine, with combined deaths a blend of those two categories. Prescription-only deaths were evenly split between male and femaile, whereas other categories were nearly three-quarters male. These results are long-awaited and critical to beginning to understand fundamental elements of the evolving opioid crisis. Kudos to the CDC for this.

4) Addressing the Fentanyl Analog Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood.

Skov-Skov Bergh M, Bogen IL, Wilson SR, Øiestad ÅML.

Ther Drug Monit. 2018 Aug 27. doi: 10.1097/FTD.0000000000000564. [Epub ahead of print]

Comments: Method to look for both fentanyl/analogs and naloxone.

5) Opioid Analgesics in Georgia Medicaid: Trends in Potential Inappropriate Prescribing Practices by Demographic Characteristics, 2009-2014.

Jayawardhana J, Abraham AJ, Perri M.

J Manag Care Spec Pharm. 2018 Sep;24(9):886-894. doi: 10.18553/jmcp.2018.24.9.886.

Comments: Patients in “missing race” category are at high risk … ok that’s a strange outcome.

6) Opioid toxicity with underlying tumour lysis syndrome in a patient with CMML: a diagnostic and therapeutic challenge.

Vig S, Mishra S, Rustagi K, Bhan S.

BMJ Case Rep. 2018 Aug 27;2018. pii: bcr-2018-225646. doi: 10.1136/bcr-2018-225646.

Comments: Interesting case of opioid overdose induced by kidney failure caused by tumor lysis syndrome.

7) Identifying Missed Clinical Opportunities in Delivery of Overdose Prevention and Naloxone Prescription to Adolescents Using Opioids.

Wilson JD, Berk J, Adger H, Feldman L.

J Adolesc Health. 2018 Aug;63(2):245-248. doi: 10.1016/j.jadohealth.2018.05.011.

Comments: Pediatricians, opioids, and naloxone.

8) Government Patent Use to Address the Rising Cost of Naloxone: 28 U.S.C. § 1498 and Evzio.

Wang A, Kesselheim AS.

J Law Med Ethics. 2018 Jun;46(2):472-484. doi: 10.1177/1073110518782954.

Comments: Interesting approach to deal with out of control pharmaceutical pricing.

9) Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician’s Perspective.

Bone C, Eysenbach L, Bell K, Barry DT.

J Law Med Ethics. 2018 Jun;46(2):268-271. doi: 10.1177/1073110518782933.

Comments: Yes.

10) Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths – United States, 2007-2012.

Harduar Morano L, Steege AL, Luckhaupt SE.

MMWR Morb Mortal Wkly Rep. 2018 Aug 24;67(33):925-930. doi: 10.15585/mmwr.mm6733a3.

Comments: Construction, extraction, and healthcare industries – fascinating.

11) Using Publicly Available Data to Understand the Opioid Overdose Epidemic: Geospatial Distribution of Discarded Needles in Boston, Massachusetts.

Bearnot B, Pearson JF, Rodriguez JA.

Am J Public Health. 2018 Aug 23:e1-e3. doi: 10.2105/AJPH.2018.304583. [Epub ahead of print]

Comments: These analyses are interesting and need to be carefully done.

12) Supervised Injectable Opioid Treatment for the Management of Opioid Dependence.

Bell J, Belackova V, Lintzeris N.

Drugs. 2018 Aug 21. doi: 10.1007/s40265-018-0962-y. [Epub ahead of print] Review.

Comments: Interesting review of supervised opioid injection for treatment of opioid use disorder – another intervention that is often limited by politics.

13) Naloxone distribution and possession following a large-scale naloxone program.

Madah-Amiri D, Gjersing L, Clausen T.

Addiction. 2018 Aug 20. doi: 10.1111/add.14425. [Epub ahead of print]

Comments: The longer a naloxone program is around the more likely people are to carry naloxone. Actually an interesting conclusion – as time and intensity of programming may lead to a culture of overdose prevention in a given locality.

14) Comparison between buprenorphine provider availability and opioid deaths among US counties.

Jones CW, Christman Z, Smith CM, Safferman MR, Salzman M, Baston K, Haroz R.

J Subst Abuse Treat. 2018 Oct;93:19-25. doi: 10.1016/j.jsat.2018.07.008. Epub 2018 Jul 20.

Comments: Lots of variability in access that doesn’t always correspond to need.

15) A Randomized Usability Assessment of Simulated Naloxone Administration by Community Members.

Eggleston W, Sullivan RW, Pacelli L, Podolak C, Keenan M, Wojcik S.

Addiction. 2018 Aug 14. doi: 10.1111/add.14416. [Epub ahead of print]

Comments: Study showing the obvious: lay people not comfortable with needles can more easily administer the FDA-approved nasal spray than vial and syringe intramuscular. For people who inject drugs, the less costly vial and syringe allows for far broader reach of programming.

16) The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible.

Carroll JJ, Rich JD, Green TC.

J Addict Med. 2018 Aug 7. doi: 10.1097/ADM.0000000000000436. [Epub ahead of print]

Comments: The main reasons for use are managing withdrawal and opioid use disorder. 12% of those reporting diverted buprenorphine use reported that they had used it to get high.

17) Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy.

Harrison TK, Kornfeld H, Aggarwal AK, Lembke A.

Anesthesiol Clin. 2018 Sep;36(3):345-359. doi: 10.1016/j.anclin.2018.04.002. Epub 2018 Jul 11. Review.

Comments: There are some messed up guidelines out there that suggest stopping buprenorphine when admitted / heading to surgery – this is almost always a bad idea. People do much, much better with regard to pain when kept on buprenorphine.

18) Change and variability in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007.

Tempalski B, Cleland CM, Williams LD, Cooper HLF, Friedman SR.

Subst Abuse Treat Prev Policy. 2018 Aug 9;13(1):28. doi: 10.1186/s13011-018-0165-2.

Comments: Not enough.

19) On the front lines of the opioid epidemic: Rescue by naloxone.

Skolnick P.

Eur J Pharmacol. 2018 Sep 15;835:147-153. doi: 10.1016/j.ejphar.2018.08.004. Epub 2018 Aug 7.

Comments: Nasal naloxone works well at the higher concentrations.

20) Naloxone Administration Frequency During Emergency Medical Service Events – United States, 2012-2016.

Cash RE, Kinsman J, Crowe RP, Rivard MK, Faul M, Panchal AR.

MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):850-853. doi: 10.15585/mmwr.mm6731a2.

Comments: Exciting to see the work coming out of the expanded surveillance and research efforts.

21) Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study.

Larney S, Hickman M, Fiellin DA, Dobbins T, Nielsen S, Jones NR, Mattick RP, Ali R, Degenhardt L.

BMJ Open. 2018 Aug 5;8(8):e025204. doi: 10.1136/bmjopen-2018-025204.

Comments: Protocol for study exploring adverse outcomes during and after methadone and buprenorphine treatment.

22) The impact of medically supervised injection centres on drug-related harms: A meta-analysis.

May T, Bennett T, Holloway K.

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

Comments: This paper is weird. They ask a slew of questions with often one or two observational papers for each question. Strange for a meta-analysis… Also, the paper the list as showing no decrease in overdose mortality is a dead link – appears it was a report posted but nothing ever published and not publicly available. The group that did the report also since published a paper showing a dramatic decrease in ambulance callouts for overdose with the facility.

23) Determining the effective dose of street-level heroin: A new way to consider fluctuations in heroinpurity, mass and potential contribution to overdose.

Stam NC, Gerostamoulos D, Gerstner-Stevens J, Scott N, Smith K, Drummer OH, Pilgrim JL.

Forensic Sci Int. 2018 Sep;290:219-226. doi: 10.1016/j.forsciint.2018.07.009. Epub 2018 Jul 19.

Comments: Heroin seized in Victoria had a median effective dose of heroin of 12.0mg; 8% had 1.5-2 doses and 6% had over a double dose. The “effective dose” approach has some logic.

24) Development and implementation of procedures for outpatient naloxone prescribing at a large academic medical center.

Zschoche JH, Nesbit S, Murtaza U, Sowell A, Waldfogel JM, Arwood N, Rush J, McNamara L, Swarthout M, Nesbit T, Ortmann M.

Am J Health Syst Pharm. 2018 Aug 3. pii: ajhp170759. doi: 10.2146/ajhp170759. [Epub ahead of print]

Comments: Pharmacy, nursing, and physician collaboration.

25) Rx for addiction and medication safety: An evaluation of teen education for opioid misuse prevention.

Patry E, Bratberg JP, Buchanan A, Paiva AL, Balestrieri S, Matson KL.

Res Social Adm Pharm. 2018 Jul 7. pii: S1551-7411(18)30287-0. doi: 10.1016/j.sapharm.2018.07.006. [Epub ahead of print]

Comments: Teaching students how to recognize overdose and administer naloxone.

26) Abuse of fentanyl: An emerging problem to face.

Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB.

Forensic Sci Int. 2018 Aug;289:207-214. doi: 10.1016/j.forsciint.2018.05.042. Epub 2018 Jun 2. Review.

Comments: Yes.

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) Wearable Biosensors to Evaluate Recurrent Opioid Toxicity After Naloxone Administration: A Hilbert Transform Approach.

Chintha KK, Indic P, Chapman B, Boyer EW, Carreiro S.

Proc Annu Hawaii Int Conf Syst Sci. 2018 Jan;2018:3247-3252. Epub 2018 Jan 3.

Comment: Unable to access. Abstract indicates that authors studied 11 participants to identify physiologic signs that naloxone effect was wearing off.

2) Using medical examiner case narratives to improve opioid overdose surveillance.

Hurstak E, Rowe C, Turner C, Behar E, Cabugao R, Lemos NP, Coffin P.

Int J Drug Policy. 2018 Jan 17;54:35-42. doi: 10.1016/j.drugpo.2017.12.017. [Epub ahead of print]

Comment: Opioid overdose surveillance is remarkably limited in its ability to explain the issue. This paper involved manual review of medical examiner case narratives in an attempt to identify consistently reported elements that could help us establish the populations at highest risk for death. This issue arose in the early 2000s, when opioid overdose deaths transitioned from heroin to prescription opioids – was it the same population, just using different substances? Was it a new population? How much of a mix was it? This paper looked at evidence of drug injection as a marker for a “heroin use” population versus non-injection, which may represent a distinct risk population.

3) Drug involvement in fatal overdoses.

Ruhm CJ.

SSM Popul Health. 2017 Jan 31;3:219-226. doi: 10.1016/j.ssmph.2017.01.009. eCollection 2017 Dec.

Comment: Recounts the transition to heroin as causal opioid and reminds us of the importance of polydrug involvement – a critical issue that has proven notoriously challenging to study.

4) Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

Rafful C, Orozco R, Rangel G, Davidson P, Werb D, Beletsky L, Strathdee SA.

Addiction. 2018 Jan 14. doi: 10.1111/add.14159. [Epub ahead of print]

Comment: Heroin users with recent involuntary treatment were nearly twice as likely to overdose.

5) Promising roles for pharmacists in addressing the U.S. opioid crisis.

Compton WM, Jones CM, Stein JB, Wargo EM.

Res Social Adm Pharm. 2017 Dec 31. pii: S1551-7411(17)30977-4. doi: 10.1016/j.sapharm.2017.12.009. [Epub ahead of print]

Comment: As addiction medicine truly becomes part of the medical system, the role for pharmacists – as well as other health professionals – becomes paramount.

6) Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014.

Caupp S, Steffan J, Shi J, Wheeler KK, Spiller HA, Casavant MJ, Xiang H.

Clin Toxicol (Phila). 2018 Jan 11:1-8. doi: 10.1080/15563650.2018.1424889. [Epub ahead of print]

Comment: Demographics from the poison center.

7) Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy.

Glanz JM, Narwaney KJ, Mueller SR, Gardner EM, Calcaterra SL, Xu S, Breslin K, Binswanger IA.

J Gen Intern Med. 2018 Jan 29. doi: 10.1007/s11606-017-4288-3. [Epub ahead of print]

Comment: Nice work by this team. They developed a model of overdose risk among people prescribed opioids longterm and validated it. The validation was not as good as expected, as it seems the validation population was higher risk for overdose, so the model didn’t pick up all the at-risk people. It’s also not clear that this model would transfer to other settings where the demographics of opioid use and overdose are quite different (e.g. they found that patients aged 55-65 were at lowest risk, whereas we see the opposite in San Francisco). The authors also note the important caveat that most people with the model characteristics (on long-acting opioids, tobacco use, mental health diagnoses, substance use disorders, and age via a quadratic equation) do not experience overdose, so this model should not be used to target reduced prescribing. Most interesting perhaps, opioid dose did NOT make it into their model, which points to the fallacy of focusing on that outcome as the goal of opioid stewardship efforts. Finally, the authors suggest that this model could be used to target naloxone prescription; I would suggest that this model may be a minimum guideline, although this may not account for overdose in the immediate social circle of the patient (naloxone may be used by a patient on someone else who suffers an overdose, whether a family member or friend who uses opioids or someone who accidentally or intentionally accesses the patient’s medication).

8) Drug Overdose Deaths in the United States, 1999-2016.

Hedegaard H, Warner M, Miniño AM.

NCHS Data Brief. 2017 Dec;(294):1-8.

Comment: Over 63,600 deaths in 2016, a further 21% more than 2015, and highest in West Virginia, Ohio, New Hampshire, DC, and Pennsylvania.

9) Naloxone dosage for opioid reversal: current evidence and clinical implications.

Rzasa Lynn R, Galinkin JL.

Ther Adv Drug Saf. 2018 Jan;9(1):63-88. doi: 10.1177/2042098617744161. Epub 2017 Dec 13. Review.

Comment: The naloxone dose controversy. It’s pretty clear that medical personnel should use the lowest dose they can to get effect. Lay use is more complex because it has to be simpler. The jerry-rigged nasal devise is pretty clearly insufficient for the fentanyl crisis. The other devices – from 0.4mg IM to 4mg nasal – seem to mostly work pretty consistently. Another reason for difficult resuscitations in the fentanyl era is that fentanyl overdoses may result in rapid cessation of respiration. In contrast to a heroin overdose, whereby when the witness wakes up from a ‘nod’ their friend has slowly declining respirations but still has a pulse, in the event of a fentanyl overdose the victim may have already progressed to cardiac arrest – which requires advanced medical management.

10) Diagnosis of Heroin Overdose in an 8-Year-Old Boy: Reliable Contribution of Toxicological Investigations.

Soichot M, Julliand S, Filatriau J, Hurbain A, Bourgogne E, Mihoubi A, Gourlain H, Delhotal-Landes B.

J Anal Toxicol. 2017 Dec 28. doi: 10.1093/jat/bkx111. [Epub ahead of print]

Comment: Advanced toxicology identified findings consistent with heroin exposure.

11) Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large U.S. EMS System.

Grover JM, Alabdrabalnabi T, Patel MD, Bachman MW, Platts-Mills TF, Cabanas JG, Williams JG.

Prehosp Emerg Care. 2018 Jan 3:1-9. doi: 10.1080/10903127.2017.1387628. [Epub ahead of print]

Comment: Sensitivity of EMS naloxone administration for overdose was 57% and positive predictive value 60%. Unfortunately big data is failing us again – we need boots on the ground.

12) Prescription Opioid Dependence in Western New York: Using Data Analytics to Find an Answer to the Opioid Epidemic.

Sinha S, Burstein GR, Leonard KE, Murphy TF, Elkin PL.

Stud Health Technol Inform. 2017;245:594-598.

Comment: It’s a lot of work to glean good data from electronic medical records.

13) Increasing diversion of methadone in Vancouver, Canada, 2005-2015.

Reddon H, Ho J, DeBeck K, Milloy MJ, Liu Y, Dong H, Ahamad K, Wood E, Kerr T, Hayashi K.

J Subst Abuse Treat. 2018 Feb;85:10-16. doi: 10.1016/j.jsat.2017.11.010. Epub 2017 Nov 28.

Comment: The abstract seems to suggest that the increasing availability of diverted methadone is from agonist treatment, although couldn’t much of it be related to prescribing for pain, as is the case in the US?

14) Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency.

Wallace B, Barber K, Pauly BB.

Int J Drug Policy. 2017 Dec 28;53:83-89. doi: 10.1016/j.drugpo.2017.12.011. [Epub ahead of print]

Comment: Suggests that partial implementation of harm reduction strategies, without full engagement, carries risks.

15) Prescribing Opioid Replacement Therapy in U.S. Correctional Settings.

Farahmand P, Modesto-Lowe V, Chaplin MM.

J Am Acad Psychiatry Law. 2017 Dec;45(4):472-477.

Comment: A good idea, as the authors argue.

16) Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

Davidson PJ, Lopez AM, Kral AH.

Int J Drug Policy. 2017 Dec 23;53:37-44. doi: 10.1016/j.drugpo.2017.12.005. [Epub ahead of print]

Comment: The benefit of being underground is that you’re not constrained by political / institutional factors. There are coincident risks as well.

17) Intranasal and Intramuscular Naloxone for Opioid Overdose in the Pre-Hospital Setting: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet].

Peprah K, Frey N.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Mar 16.

Comment: Limited to absent data.

18) Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study.

Goldman-Hasbun J, DeBeck K, Buxton JA, Nosova E, Wood E, Kerr T.

Harm Reduct J. 2017 Dec 22;14(1):79. doi: 10.1186/s12954-017-0206-6.

Comment: People become more aware of naloxone the longer and more widespread its availability – the limited knowledge in this study is, I suspect, mostly related to the relatively late uptake of take-home naloxone in Canada.

19) Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities.

McCarty D, Priest KC, Korthuis PT.

Annu Rev Public Health. 2017 Dec 22. doi: 10.1146/annurev-publhealth-040617-013526. [Epub ahead of print]

Comment: Review of current strategies in prescribing opioids and managing OUD.

20) Managing opioid overdose in pregnancy with take-home naloxone.

Blandthorn J, Bowman E, Leung L, Bonomo Y, Dietze P.

Aust N Z J Obstet Gynaecol. 2017 Dec 22. doi: 10.1111/ajo.12761. [Epub ahead of print]

Comment: Mostly the same, but there are a couple of important additional pieces to remember. First, you always need to tilt / place visibly pregnant women in emergency situations on their left side – this takes pressure off of the blood supply to the fetus. Second, you should titrate the naloxone a bit more cautiously as precipitated withdrawal could be dangerous to the fetus; that being said, maternal respiratory arrest is clearly more hazardous.

21) Opioid, Overdose.

Schiller EY, Mechanic OJ.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-.
2017 Nov 28.

Comment: A basic description.

22) Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users.

Molist G, Brugal MT, Barrio G, Mesías B, Bosque-Prous M, Parés-Badell O, de la Fuente L; Spanish Working Group for the Study of Mortality among Drug Users.

Int J Drug Policy. 2017 Dec 18;53:8-16. doi: 10.1016/j.drugpo.2017.11.011. [Epub ahead of print]

Comment: Heroin and cocaine users have greatly elevated risk of mortality. Interestingly, and consistent with decades of research, death from overdose declined with age rather than rising.

23) Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

Dasgupta N, Beletsky L, Ciccarone D.

Am J Public Health. 2017 Dec 21:e1-e5. doi: 10.2105/AJPH.2017.304187. [Epub ahead of print]

Comment: This is one of my favorite papers in a long time. It is inspired, deeply moving, and beautifully crafted. There is so much more to this than reducing opioid prescribing, providing opioid use disorder treatment, handing out naloxone, etc. This issue involves economic and social abandonment, and so much more.

24) ED Treatment of Opioid Addiction: An Opportunity to Lead.

Martin A, Mitchell A.

Acad Emerg Med. 2017 Dec 21. doi: 10.1111/acem.13367. [Epub ahead of print]

Comment: Great!

25) Abuse-deterrent opioids: an update on current approaches and considerations.

Pergolizzi JV Jr, Raffa RB, Taylor R Jr, Vacalis S.

Curr Med Res Opin. 2017 Dec 21:1-42. doi: 10.1080/03007995.2017.1419171. [Epub ahead of print]

Comment: Industry-funded promotion of novel formulations of opioids.

26) Clinical Update: The Risk of Opioid Toxicity and Naloxone Use in Operational K9s.

Palmer LE, Gautier A.

J Spec Oper Med. 2017 Winter;17(4):86-92.

Comment: I can’t access this. Naloxone is effective in canines, as well as other animals to the best of my knowledge. Exposure risks, in contrast, are being greatly exaggerated in media of late.

27) Effects of naloxone distribution alone or in combination with addiction treatment with or without pre-exposure prophylaxis for HIV prevention in people who inject drugs: a cost-effectiveness modelling study.

Uyei J, Fiellin DA, Buchelli M, Rodriguez-Santana R, Braithwaite RS.

Lancet Public Health. 2017 Mar;2(3):e133-e140. doi: 10.1016/S2468-2667(17)30006-3. Epub 2017 Feb 10. Erratum in: Lancet Public Health. 2017 Apr;2(4):e165.

Comment: Added to naloxone distribution modeling with substance use disorder treatment referral and pre-exposure prophylaxis for HIV – an effort to merge management of syndemics as we see in practice, which can be really helpful for programmatic planning. The results appear reasonable, although I disagree with some of the model parameter estimates (e.g. overdose risk is modeled as 7.7% per year and constant – this leads to outcome estimates that are not reflected in epidemiologic data which suggests a declining overdose risk with age / some people overdose more than others).

28) A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

Maguire MA, Pavlakos RN, Mehta BH, Schmuhl KK, Beatty SJ.

Curr Pharm Teach Learn. 2018 Jan – Feb;10(1):72-77. doi: 10.1016/j.cptl.2017.09.007. Epub 2017 Oct 6.

Comment: That’s cool, and a great way to engage the profession longterm.

29) A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders.

Carpenter DM, Roberts CA, Westrick SC, Ferreri SP, Kennelty KA, Look KA, Abraham O, Wilson C.

Res Social Adm Pharm. 2017 Nov 21. pii: S1551-7411(17)30649-6. doi: 10.1016/j.sapharm.2017.11.011. [Epub ahead of print]

Comment: Talking with patients about naloxone requires a bit of subtlety.

30) A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013.

Marotta PL, McCullagh CA.

Eur J Epidemiol. 2017 Dec 12. doi: 10.1007/s10654-017-0342-z. [Epub ahead of print]

Comment: Implementation of methadone, buprenorphine, and those treatments for incarcerated populations were associate with less drug-related death.

31) Identifying gaps in the implementation of naloxone programs for laypersons in the United States.

Lambdin BH, Zibbell J, Wheeler E, Kral AH.

Int J Drug Policy. 2017 Dec 9;52:52-55. doi: 10.1016/j.drugpo.2017.11.017. [Epub ahead of print]

Comment: 8% of counties had naloxone programs, including only 13% of counties with the highest overdose rates.

32) Comparison of Two Naloxone Regimens in Addicted Methadone-Overdosed Patients, a Clinical Trial Study.

Khosravi N, Zamani N, Hassanian-Moghaddam H, Ostadi A, Rahimi M, Kabir A.

Curr Clin Pharmacol. 2017 Dec 11. doi: 10.2174/1574884713666171212112540. [Epub ahead of print]

Comment: Tintanelli is 0.1mg every 2-3 minutes. Goldfrank is escalating doses every 2-3 minutes. Goldfrank reverses faster but results in more complications due to rapid reversal.

33) Back to the core: A network approach to bolster harm reduction among persons who inject drugs.

Bouchard M, Hashimi S, Tsai K, Lampkin H, Jozaghi E.

Int J Drug Policy. 2017 Dec 8;51:95-104. doi: 10.1016/j.drugpo.2017.10.006. [Epub ahead of print]

Comment: Network interventions make a lot of sense, and are really challenging to design / test.

34) An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study.

Katzman JG, Takeda MY, Bhatt SR, Moya Balasch M, Greenberg N, Yonas H.

J Addict Med. 2017 Dec 7. doi: 10.1097/ADM.0000000000000374. [Epub ahead of print]

Comment: Given naloxone to patients on agonist maintenance treatment leads to reversals in their immediate social networks.

35) Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon.

Ghaddar A, Abbas Z, Haddad R.

Harm Reduct J. 2017 Dec 8;14(1):78. doi: 10.1186/s12954-017-0204-8.

Comment: Treating opioid use disorder with proven medications works in Lebanon as well.

36) Rethinking Naloxone: Overdose drug is only one part of the cycle of narcotic abuse.

Richmond NJ.

JEMS. 2017 Feb;42(2):63. No abstract available.

Comment: Can’t access and no abstract.

37) Housing and overdose: an opportunity for the scale-up of overdose prevention interventions?

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

Harm Reduct J. 2017 Dec 6;14(1):77. doi: 10.1186/s12954-017-0203-9.

Comment: Important target for overdose prevention.

38) Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine.

Krawczyk N, Picher CE, Feder KA, Saloner B.

Health Aff (Millwood). 2017 Dec;36(12):2046-2053. doi: 10.1377/hlthaff.2017.0890.

Comment: Why aren’t we using the proven treatments for opioid use disorder? This is like not providing anti-hyperglycemic agents for a diabetic individual.

39) Opiate use disorders and overdose: Medical students’ experiences, satisfaction with learning, and attitudes toward community naloxone provision.

Tobin H, Klimas J, Barry T, Egan M, Bury G.

Addict Behav. 2017 Nov 22. pii: S0306-4603(17)30436-7. doi: 10.1016/j.addbeh.2017.11.028. [Epub ahead of print]

Comment: There is always a need for more education on this topic.

40) Factors associated with naloxone administration in an opioid dependent sample.

Kenney SR, Anderson BJ, Bailey GL, Stein MD.

J Subst Abuse Treat. 2018 Jan;84:17-20. doi: 10.1016/j.jsat.2017.10.008. Epub 2017 Oct 18.

Comment: Interesting analysis of people entering opioid detox. Only heroin users (i.e. no prescription opioid users) had administered naloxone and few African Americans had done so.

41) 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.

Comment: Vaccines have long been a goal of some for substance use disorders. There remain many challenges.

42) Case 37-2017. A 36-Year-Old Man with Unintentional Opioid Overdose.

Raja AS, Miller ES, Flores EJ, Wakeman SE, Eng G.

N Engl J Med. 2017 Nov 30;377(22):2181-2188. doi: 10.1056/NEJMcpc1710563. Comment: Exciting to see the NEJM taking a deep dive into a patient with an opioid use disorder!

43) Elderly Man in Respiratory Arrest.

Mackle T, Rhine D.

Ann Emerg Med. 2017 Oct;70(4):599-604. doi: 10.1016/j.annemergmed.2017.04.035. No abstract available.

Comment: Gastric perforation due to resuscitation. Complications of well-intentioned medical interventions … suck.

44) Detection of Carfentanil by LC-MS-MS and Reports of Associated Fatalities in the USA.

Shanks KG, Behonick GS.

J Anal Toxicol. 2017 Jul 1;41(6):466-472. doi: 10.1093/jat/bkx042.

Comment: Go low.

45) Naloxone Access and Use for Suspected Opioid Overdoses.

Ann Emerg Med. 2017 Jul;70(1):112-113. doi: 10.1016/j.annemergmed.2017.03.031. No abstract available.

Comment:  The American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the American College of Medical Toxicology (ACMT) affirm naloxone access for all emergency responders and lay persons by prescription, as well as the ability for pharmacists to furnish without prescription.

46) Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine.

Dempsey SK, Poklis JL, Sweat K, Cumpston K, Wolf CE.

J Anal Toxicol. 2017 Jul 1;41(6):547-550. doi: 10.1093/jat/bkx034.

Comment: A tricyclic antidepressant approved in Europe (not in the US) overdose that responded to naloxone … authors presume that this was managing the tricyclic overdose although one might wonder if there was an undetected synthetic opioid on board.

Consumption spaces

47) Changes in public order after the opening of an overdose monitoring facility for people who inject drugs.

León C, Cardoso LJP, Johnston S, Mackin S, Bock B, Gaeta JM.

Int J Drug Policy. 2017 Dec 30;53:90-95. doi: 10.1016/j.drugpo.2017.12.009. [Epub ahead of print]

Comment: There were fewer people on the streets oversedated.

48) Perceptions about supervised injection facilities among people who inject drugs in Philadelphia.

Harris RE, Richardson J, Frasso R, Anderson ED.

Int J Drug Policy. 2017 Dec 10;52:56-61. doi: 10.1016/j.drugpo.2017.11.005. [Epub ahead of print]

Comment: Again, people who use drugs support a safe consumption space.

OxyContin reformulation

49) The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study.

Larance B, Dobbins T, Peacock A, Ali R, Bruno R, Lintzeris N, Farrell M, Degenhardt L.

Lancet Psychiatry. 2018 Jan 10. pii: S2215-0366(18)30003-8. doi: 10.1016/S2215-0366(18)30003-8. [Epub ahead of print]

Comment: “This formulation of controlled-release oxycodone reduced tampering with pharmaceutical opioids among people who inject drugs, but did not affect population-level opioid use or harm.”

50) The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons.

Jauncey M, Livingston M, Salmon AM, Dietze P.

Int J Drug Policy. 2017 Dec 18;53:17-22. doi: 10.1016/j.drugpo.2017.11.025. [Epub ahead of print]

Comment: More on the unintended consequence of OxyContin reformulation.

Fentanyl papers

51) The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016.

Creppage KE, Yohannan J, Williams K, Buchanich JM, Songer TJ, Wisniewski SR, Fabio A.

Public Health Rep. 2018 Jan 1:33354917753119. doi: 10.1177/0033354917753119. [Epub ahead of print]

Comment: Per title.

52) Newly Emerging Drugs of Abuse and Their Detection Methods: An ACLPS Critical Review.

Liu L, Wheeler SE, Venkataramanan R, Rymer JA, Pizon AF, Lynch MJ, Tamama K.

Am J Clin Pathol. 2018 Jan 29;149(2):105-116. doi: 10.1093/ajcp/aqx138.

Comment: New standard for untargeted drug identification.

53) Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study.

Hayashi K, Milloy MJ, Lysyshyn M, DeBeck K, Nosova E, Wood E, Kerr T.

Drug Alcohol Depend. 2017 Dec 5;183:1-6. doi: 10.1016/j.drugalcdep.2017.10.020. [Epub ahead of print]

Comment: Lots of fentanyl exposure.

54) Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD.

Mars SG, Ondocsin J, Ciccarone D.

J Psychoactive Drugs. 2017 Dec 6:1-10. doi: 10.1080/02791072.2017.1394508. [Epub ahead of print]

Comment: Critical ethnography.

55) 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. Review.

Comment: Way more complicated than just pain meds.

56) Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn.

Shoff EN, Zaney ME, Kahl JH, Hime GW, Boland DM.

J Anal Toxicol. 2017 Jul 1;41(6):484-492. doi: 10.1093/jat/bkx041.

Comment: Another paper on identifying fentanyl analogs.

57) Fatalities Involving Carfentanil and Furanyl Fentanyl: Two Case Reports.

Swanson DM, Hair LS, Strauch Rivers SR, Smyth BC, Brogan SC, Ventoso AD, Vaccaro SL, Pearson JM.

J Anal Toxicol. 2017 Jul 1;41(6):498-502. doi: 10.1093/jat/bkx037.

Comment: And another!

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) 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) Pharmacokinetic Properties and Human Use Characteristics of an FDA Approved IntranasalNaloxone Product for the Treatment of Opioid Overdose.

Krieter P, Chiang N, Gyaw S, Skolnick P, Crystal R, Keegan F, Aker J, Beck M, Harris J.

J Clin Pharmacol. 2016 May 5. doi: 10.1002/jcph.759. [Epub ahead of print]

Comment: Details on the pharmacokinetics and usability studies for the new nasal device.

2) The use of public health infrastructure probably the best strategy for national and large-scalenaloxone distribution programmes.

Madah-Amiri D, Clausen T.

Addiction. 2016 May 3. doi: 10.1111/add.13400. [Epub ahead of print] No abstract available.

Comment: Large-scale naloxone requires public health support.

3) The Opioid Epidemic in the United States.

Wilkerson RG, Kim HK, Windsor TA, Mareiniss DP.

Emerg Med Clin North Am. 2016 May;34(2):e1-e23. doi: 10.1016/j.emc.2015.11.002. Epub 2016 Feb 17. Review.

Comment: Focuses on risk factors for problematic opioid use and naloxone.

4) Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

Kunøe N, Opheim A, Solli KK, Gaulen Z, Sharma-Haase K, Latif ZE, Tanum L.

BMC Pharmacol Toxicol. 2016 Apr 28;17(1):18. doi: 10.1186/s40360-016-0061-1.

Comment: Methods paper for above planned study.

5) Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

Arelin V, Schmidt JJ, Kayser N, Kühn-Velten WN, Suhling H, Eden G, Kielstein JT.

Clin Nephrol. 2016 Apr 27. [Epub ahead of print]

Comment: Doesn’t really remove methadone, so not useful in an overdose but also not problematic for patients on methadone undergoing light-chain removal.

6) Utilizing a train-the-trainer model for multi-site naloxone distribution programs.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2016 Apr 14. pii: S0376-8716(16)30034-5. doi: 10.1016/j.drugalcdep.2016.04.007. [Epub ahead of print]

Comment: Title is self-explanatory.

7) Opioid-related Policies in New England Emergency Departments.

Weiner SG, Raja AS, Bittner JC, Curtis KM, Weimersheimer P, Hasegawa K, Espinola JA, Camargo CA Jr.

Acad Emerg Med. 2016 Apr 21. doi: 10.1111/acem.12992. [Epub ahead of print]

Comment: Intriguing look at ED policies in New England. 18% had an opioid screening tool, 78% used the PDMP, 41% alerted the primary doctor when prescribing opioids, 70% gave substance use treatment referrals, and 12% offered take-home naloxone.

8) Opioid Overdose Prevention in a Residential Care Setting: Naloxone Education and Distribution.

Pade P, Fehling P, Collins S, Martin L.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: Naloxone in a residential treatment program. Hopefully the first bit of data with much more to come.

9) 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 19:0. [Epub ahead of print]

Comment: New Mexico study of 164 chronic pain patients on opioids who were provided naloxone. There were no overdoses.

10) Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status.

Friedman MS, Manini AF.

J Med Toxicol. 2016 Apr 15. [Epub ahead of print]

Comment: Fascinating abstract – I don’t have full access. They set up “naloxone criteria” of (1) respiratory rate <12, miotic pupils, or drug paraphernalia, and (2) altered mental status by AVPU or GCS and then looked to see if those criteria predicted a beneficial effect of naloxone. They did – with an OR of 7 and 83% sensitivity. Miotic pupils were the best predictor of a response to naloxone. Authors also found that naloxone was underutilized – in only 44.2% of cases where it may have been beneficial. This is a fascinating area, as we don’t yet understand the reasons why naloxone is or is not administered in emergency services.

11) The toxicology of heroin-related death: estimating survival times.

Darke S, Duflou J.

Addiction. 2016 Apr 15. doi: 10.1111/add.13429. [Epub ahead of print]

Comment: 6-MAM, the best way to confirm heroin as a cause of overdose death, is only present if the death occurs in under 30 minutes. In this study, 6-MAM was present in 43% of heroin overdose cases, suggesting that most people took longer to expire.

12) Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.

Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG.

Am J Public Health. 2016 Apr 14:e1-e4. [Epub ahead of print]

Comment: Distribution program increased self-efficacy.

13) Findings and lessons learnt from implementing Australia’s first health service based take-home naloxone program.

Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze P, Lenton S, Kearley J, van Beek I.

Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12400. [Epub ahead of print]

Comment: First data on an Australian naloxone program. 83 people given naloxone. Among the 42% completing follow-up, 30 overdoses were successfully reversed and participants still felt informed and able to use naloxone.

14) OVERDOSED ON OPIOIDS: A deadly opioid epidemic sweeping the country has lawmakers working hard to find solutions.

Hoback J.

State Legis. 2016 Apr;42(4):9-13. No abstract available.

Comment: On a quick glance, seems a bit inflammatory.

15) Safety concerns with long-term opioid use.

Harned M, Sloan P.

Expert Opin Drug Saf. 2016 Apr 26:1-8. [Epub ahead of print]

Comment: Prospective trials are needed to evaluate longterm opioid therapy for chronic pain.

16) Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA Jr, Wilson D, McDonald R, Rotrosen J, Gourevitch MN, Gordon M, Fishman M, Chen DT, Bonnie RJ, Cornish JW, Murphy SM, O’Brien CP.

N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

Comment: Pretty good data on extended-release naltrexone and low overdose risk. Unfortunately, overdose wasn’t specifically asked about, but instead was treated as any other adverse events in a clinical trial and had to be reported by the participants.

17) Overdose Deaths in West Virginia.

Yablonsky TA, Thompson GL.

W V Med J. 2016 Mar-Apr;112(2):16-7. No abstract available.

Comment: Can’t access, but there are a lot.

18) [Accidental ingestion of methadone by children and suggestions for better prevention].

Hein H, Püschel K, Schaper A, Iwersen-Bergmann S.

Arch Kriminol. 2016 Jan-Feb;237(1-2):38-46. German.

Comment: Lockboxes.

19) FASTER RESPONSE. Hospitals backing increased use of opioid antidote.

Asplund J.

Hosp Health Netw. 2016 Jan;90(1):20, 22, 2.

Comment: This is apparently about police and naloxone.

20) Increases in Drug and Opioid Overdose Deaths–United States, 2000-2014.

Rudd RA, Aleshire N, Zibbell JE, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1378-82. doi: 10.15585/mmwr.mm6450a3.

Comment: Really well done. Discusses opioids in a sophisticated and honest manner. Impressive work from the CDC.

21) Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.

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

Ann Intern Med. 2016 Jan 5;164(1):1-9. doi: 10.7326/M15-0038. Epub 2015 Dec 29.

Comment: Patients who have an overdose usually continue to receive opioids. If opioids stop, they have a lower risk of recurrent overdose.

22) Prescription opioid related deaths in New York City: a 2 year retrospective analysis prior to the introduction of the New York State I-STOP law.

Sgarlato A, deRoux SJ.

Forensic Sci Med Pathol. 2015 Sep;11(3):388-94. doi: 10.1007/s12024-015-9699-z. Epub 2015 Aug 2.

Comment: 36.7% of decedents had a valid opioid prescription; benzos were involved in 68.4% of cases with alprazolam the most common (35.1%).

23) Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohort.

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

Addict Behav. 2015 Nov;50:78-83. doi: 10.1016/j.addbeh.2015.06.030. Epub 2015 Jun 14.

Comment: Heavy drinking was associated with overdose (OR 1.6).

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. Opioid OverdosePrevention Programs Providing Naloxoneto Laypersons – United States, 2014.

Wheeler E, Jones TS, Gilbert MK, Davidson PJ.

MMWR Morb Mortal Wkly Rep. 2015 Jun 19;64(23):631-5.

Comment: The long-awaited sequel to 2010’s blockbuster naloxone MMWR report! 152,283 laypersons trained and 26,463 overdose reversals reported to naloxone programs through 2014.

2. Heroin-related overdose: The unexplored influences of markets, marketing and source-types in the United States.

Mars SG, Fessel JN, Bourgois P, Montero F, Karandinos G, Ciccarone D.

Soc Sci Med. 2015 Jun 30;140:44-53. doi: 10.1016/j.socscimed.2015.06.032. [Epub ahead of print]

Comment: Interesting use of qualitative data exploring the role of heroin markets on overdose risk, suggesting that factors such as open-air versus behind-closed-door markets can affect risk.

3. Risk factors for concurrent use of benzodiazepines and opioids among individuals under community corrections supervision.

Cropsey KL, Stevens EN, Valera P, Brendan Clark C, Bulls HW, Nair P, Lane PS.

Drug Alcohol Depend. 2015 Jul 10. pii: S0376-8716(15)00352-X. doi: 10.1016/j.drugalcdep.2015.06.038. [Epub ahead of print]

Comment: There’s a movement toward not prescribing opioids with benzodiazepines at all. This makes some sense from an overdose prevention perspective, however the impact of such a policy is unknown. Those who require both opioids and benzodiazepines generally have far more complex and substantial mental health challenges. Just removing one or the other of the agents may results in worsening mental health or even increased rates of self-harm. Or not. Nobody knows.

4. Drugquality assessment practices and communication of drugalerts among people who use drugs.

Soukup-Baljak Y, Greer AM, Amlani A, Sampson O, Buxton JA.

Int J Drug Policy. 2015 Jul 2. pii: S0955-3959(15)00200-5. doi: 10.1016/j.drugpo.2015.06.006. [Epub ahead of print]

Comment: This is interesting, particularly in an era of frequent high-potency batches of heroin or even pure fentanyl derivatives. Subjects recommend using words like “dangerous” or “lethal” instead of “potent” which can be misconstrued as desirable. They also emphasized timeliness. As one of the first studies to really look at this issue, this paper is well worth the read.

5. Opioid OverdoseDeaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities.

Visconti AJ, Santos GM, Lemos NP, Burke C, Coffin PO.

J Urban Health. 2015 Jun 16. [Epub ahead of print]

Comment: Epidemiology of opioid overdose mortality in San Francisco – the first since Pete Davidson’s seminal geocoding paper in 2003 that led SF to refocus overdose prevention efforts to the hardest hit neighborhoods. This paper documents that heroin overdose is now remarkably rare in San Francisco, although for me it raises more questions than it answers.

6. Ethanol Reversal of Tolerance to the Respiratory Depressant Effects of Morphine.

Hill R, Lyndon A, Withey S, Roberts J, Kershaw Y, MacLachlan J, Lingford-Hughes A, Kelly E, Bailey C, Hickman M, Henderson G.

Neuropsychopharmacology. 2015 Jul 14. doi: 10.1038/npp.2015.201. [Epub ahead of print]

Comment: Okay, this is a very cool mouse study. They gave morphine to mice until they developed tolerance. The tolerance to respiratory depression effects of morphine were reversed by ethanol. Methadone and buprenorphine seemed to protect mice from this reversal of tolerance effect. Very cool. This is why I do these reviews.

7. OverdoseEducation and Naloxonefor Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.

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

J Gen Intern Med. 2015 Jun 9. [Epub ahead of print]

Comment: Interesting initial look at prescriber concerns regarding prescribing naloxone from primary care practices. Issues are knowledge about lay use, uncertainty about who to prescribe to, logistical barriers, fears about offending patients, fears about risky use, and discomfort with their own opioid prescribing practices.

8. Methadoneoverdosecausing acute cerebellitis and multi-organ damage.

Rando J, Szari S, Kumar G, Lingadevaru H.

Am J Emerg Med. 2015 Jun 18. pii: S0735-6757(15)00509-4. doi: 10.1016/j.ajem.2015.06.032. [Epub ahead of print] No abstract available.

Comment: A very sad case in which a 14 year old boy accessed his mother’s methadone (apparently prescribed for pain) and had severe disease of the cerebellum as a result. When we speak of opioid overdose, we are generally talking about respiratory depression, but there are some complications that can be unique to particular opioids.

9. Vital Signs: Demographic and Substance Use Trends Among HeroinUsers – United States, 2002-2013.

Jones CM, Logan J, Gladden RM, Bohm MK.

MMWR Morb Mortal Wkly Rep. 2015 Jul 10;64(26):719-25.

Comment: Just after 2010 there was a big uptick in heroin use and overdose mortality. Again, this suggests that the increases in heroin use and sequelae were not simply the inevitable consequence of increased opioid dependence, but resulted from – or were substantially contributed to by – restrictions on prescription opioids. It is essential to recognize this in order to minimize the harms of the new/emerging paradigm of opioid prescribing.

10. High uptake of naloxone-based overdoseprevention training among previously incarcerated syringe-exchange program participants.

Barocas JA, Baker L, Hull SJ, Stokes S, Westergaard RP.

Drug Alcohol Depend. 2015 Jun 24. pii: S0376-8716(15)00322-1. doi: 10.1016/j.drugalcdep.2015.06.023. [Epub ahead of print]

Comment: People who have been incarcerated are more likely to access naloxone programs. This is consistent with the aims of naloxone programming.

11. Messaging to Increase Public Support for NaloxoneDistribution Policies in the United States: Results from a Randomized Survey Experiment.

Bachhuber MA, McGinty EE, Kennedy-Hendricks A, Niederdeppe J, Barry CL.

PLoS One. 2015 Jul 1;10(7):e0130050. doi: 10.1371/journal.pone.0130050. eCollection 2015.

Comment: Useful study testing different approaches to providing information about naloxone programming. The finding that adding sympathetic narratives to factual information roughly doubles support for the programs is consistent with recent experience in which personal exposure to the tragedy of opioid overdose has led many people in positions of power to advocate for naloxone programming.

12. Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdoseamong psychologically distressed people who inject drugs?

Betts KS, McIlwraith F, Dietze P, Whittaker E, Burns L, Cogger S, Alati R.

Drug Alcohol Depend. 2015 Jun 22. pii: S0376-8716(15)00319-1. doi: 10.1016/j.drugalcdep.2015.06.020. [Epub ahead of print]

Comment: This is fascinating. Polysubstance use research is an underdeveloped (and surprisingly challenging) avenue of research. The finding that those with less psychological distress are protected by a combination of agonist maintenance and prescription drug use is of particular interest…

13. Duration of opioid receptor blockade determines biotherapeutic response.

McLaughlin PJ, Zagon IS.

Biochem Pharmacol. 2015 Jun 25. pii: S0006-2952(15)00332-9. doi: 10.1016/j.bcp.2015.06.016. [Epub ahead of print]

Comment: This isn’t really about overdose or even substance use, but it’s about naloxone and naltrexone – opioid blockers – and it’s intriguing. There are some other potential therapeutic roles for opioid blockade, related to complications of diabetes, autoimmune disorders, and cancer.

14. Chiral analysis of methorphan in opiate-overdoserelated deaths by using capillary electrophoresis.

Bertaso A, Musile G, Gottardo R, Seri C, Tagliaro F.

J Chromatogr B Analyt Technol Biomed Life Sci. 2015 Jul 19;1000:130-135. doi: 10.1016/j.jchromb.2015.07.024.

Comment: Methorphan, a codeine analog and related to dextromethorphan, is being added to heroin sometimes. This paper describes how to test for it.

15. Naloxone-does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose.

Neale J, Strang J.

Addiction. 2015 Jun 27. doi: 10.1111/add.13027. [Epub ahead of print]

Comment: Medical professionals are generally cautious in administering naloxone these days because we know it makes patients miserable. Low doses and, if in a monitored setting, only using it when oxygen saturation begins to decline helps to minimize the untoward effects. In this study naloxone had a bad rap but respondents often didn’t know that it had been administered because it was done cautiously.

16. Technology: Barriers to misuse.

Dolgin E.

Nature. 2015 Jun 25;522(7557):S60-1. doi: 10.1038/522S60a. No abstract available.

Comment: There’s a serious problem with the term “abuse-deterrent formulations.” These are formulations of opioids that are more difficult to inject – or in some cases insufflate. They should really be referred to as “injection-deterrent formulations.” They don’t prevent somebody from developing an opioid habit. This article instead reads more like a press release for “abuse-deterrent formulations.”

17. Incidence and predictors of non-fatal drug overdoseafter release from prison among people who inject drugs in Queensland, Australia.

Winter RJ, Stoové M, Degenhardt L, Hellard ME, Spelman T, Jenkinson R, McCarthy DR, Kinner SA.

Drug Alcohol Depend. 2015 Aug 1;153:43-9. doi: 10.1016/j.drugalcdep.2015.06.011. Epub 2015 Jun 16.

Comment: People overdose after they leave prison.

18. The Supply of Physicians Waivered to Prescribe Buprenorphinefor Opioid Use Disorders in the United States: A State-Level Analysis.

Knudsen HK.

J Stud Alcohol Drugs. 2015 Jul;76(4):644-54.

Comment: The average U.S. state has 8 physicians per 100,000 residents able to prescribe buprenorphine for opioid dependence. This rate is even worse in many states, from a low of 1.9 in Nebraska to a high of 27.9 in Vermont. Appalachia – probably the region with the most urgent need – has a rate of 3 to 11 / 100,000 residents. We really need to do something about this waiver situation.

19. Druguse patterns predict risk of non-fatal overdoseamong street-involved youth in a Canadian setting.

Mitra G, Wood E, Nguyen P, Kerr T, DeBeck K.

Drug Alcohol Depend. 2015 Aug 1;153:135-9. doi: 10.1016/j.drugalcdep.2015.05.035. Epub 2015 May 28.

Comment: This is a sample of street-involved youth – 17.1% injected heroin. Any opioid use was associated with overdose, but interestingly prescription opioid use was a stronger predictor than heroin. That’s surprising. The relatively low overall rate of overdose – 7.67/100,000 person years is not surprising given the distribution of substance use.

20. The Epidemic of Prescription Opioid Abuse, the Subsequent Rising Prevalence of HeroinUse, and the Federal Response.

Kanouse AB, Compton P.

J Pain Palliat Care Pharmacother. 2015 Jun;29(2):102-14. doi: 10.3109/15360288.2015.1037521.

Comment: This leaves some holes in the story, such as the role of reduced access to prescription opioids has had in rising heroin use. Another issue is the suggestion in the text that police getting naloxone has led to 10,000 lay reversals. These were lay person – aka drug user – reversals. It’s frustrating to see this misinformation being spread in the literature.

21. Association between non-fatal opioid overdoseand encounters with healthcare and criminal justice systems: Identifying opportunities for intervention.

Wagner KD, Liu L, Davidson PJ, Cuevas-Mota J, Armenta RF, Garfein RS.

Drug Alcohol Depend. 2015 Aug 1;153:215-20. doi: 10.1016/j.drugalcdep.2015.05.026. Epub 2015 May 27.

Comment: Criminal justice and hospital-related opportunities for naloxone distribution.

22. Harm Reduction: Front Line Public Health.

Stancliff S, Phillips BW, Maghsoudi N, Joseph H.

J Addict Dis. 2015 Jun 16:0. [Epub ahead of print]

Comment: Excellent harm reduction review.

23. Intranasal naloxoneadministration by police first responders is associated with decreased opioid overdosedeaths.

Rando J, Broering D, Olson JE, Marco C, Evans SB.

Am J Emerg Med. 2015 May 29. pii: S0735-6757(15)00443-X. doi: 10.1016/j.ajem.2015.05.022. [Epub ahead of print]

Comment: Naloxone should be in the hands of first responders. Even more important, however, is that naloxone is in the hands of people who use drugs – who are much more likely to be present at the time of an overdose. If the data from this paper are scientific evidence that naloxone given to first responders is associated with reduced mortality, then we had much stronger evidence for giving it to drug users in the late 20^th century. Neither of those statements is true.

24. Heroinuse, HIV-risk, and criminal behavior in Baltimore: Findings from Clinical Research.

Schwartz RP, Kelly SM, Gryczynski J, Mitchell SG, O’Grady KE, Jaffe JH.

J Addict Dis. 2015 Jun 16:0. [Epub ahead of print]

Comment: Interesting data and experience out of Baltimore with harm reduction interventions.

25. Engaging Law Enforcement in OverdoseReversal Initiatives: Authorization and Liability for NaloxoneAdministration.

Davis CS, Carr D, Southwell JK, Beletsky L.

Am J Public Health. 2015 Aug;105(8):1530-7. doi: 10.2105/AJPH.2015.302638. Epub 2015 Jun 11.

Comment: Review of police and naloxone administration.

26. Prehospital NaloxoneAdministration as a Public Health Surveillance Tool: A Retrospective Validation Study.

Lindstrom HA, Clemency BM, Snyder R, Consiglio JD, May PR, Moscati RM.

Prehosp Disaster Med. 2015 Jun 10:1-5. [Epub ahead of print]

Comment: Interesting paper. Pre-hospital naloxone administrations are more likely for heroin overdose than prescription opioid overdose.

27. Accidental methadoneintoxication masquerading as asthma exacerbation with respiratory arrest in a six-year-old boy.

Swenson O.

Del Med J. 2015 May;87(5):147-9.

Comment: Keep your eyes out for pinpoint pupils.

28. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery.

Lubana SS, Genin DI, Singh N, De La Cruz A.

Am J Case Rep. 2015 Jun 8;16:353-6. doi: 10.12659/AJCR.893880.

Comment: Survival after cardiac arrest in opioid overdose is thought to be quite uncommon.

29. Economic impact of a novel naloxoneautoinjector on third-party payers.

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

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

Comment: This model attempts to estimate the cost to payers of the naloxone autoinjector, accounting for anticipated savings. There are some serious issues with this model that are quite disappointing. As a minor example, authors used “80%” as the likelihood naloxone would be administered. This assumption was based on a qualitative paper estimating the likelihood that naloxone would be administered if a heroin user was carrying it. In this paper it was used as the likelihood that the autoinjector would be used in an overdose if it had been prescribed. For a model such as this, that’s a quite different parameter.

30. A comparison of liver disease mortality with HIV and overdosemortality among Georgia prisoners and releasees: a 2-decade cohort study of prisoners incarcerated in 1991.

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

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

Comment: Another paper from the analysis of mortality among prisoners in the state of Georgia (not the country). Overdose was only a minor contributor, in contrast to many other prison releasee studies.

31. Overdosereversal.

Spencer S.

Am J Nurs. 2015 Jan;115(1):13. doi: 10.1097/01.NAJ.0000459609.86788.ac. No abstract available.

Comment: Letter I’m unable to access.

32. 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. 2015 Apr;49(2):100-10. doi: 10.1177/0023677214554216. Epub 2014 Oct 10.

Comment: Mice can handle remarkably high doses of buprenorphine without adverse effects.

33. An overview of the patterns of prescription opioid use, costs and related harms in Australia.

Blanch B, Pearson SA, Haber PS.

Br J Clin Pharmacol. 2014 Nov;78(5):1159-66. doi: 10.1111/bcp.12446. Review.

Comment: Review of opioid use and death rates in Australia, illustrating something that looks like a very mild version of what’s happened in the U.S.

34. Gender differences in mortality and risk factors in a 13-year cohort study of street-recruited injecting drugusers.

Gjersing L, Bretteville-Jensen AL.

BMC Public Health. 2014 May 10;14:440. doi: 10.1186/1471-2458-14-440.

Comment: Study in Norway of mortality among injectors recruited in 1997 and followed for 13 years, comparing men to women. Overdose was the leading cause of death. Men had a higher mortality rate but women had higher early mortality.

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.