1) Clinical Presentation and the Outcome of Therapy in a Cohort of Patients with Methadone Toxicity in Iran.

Eizadi-Mood N, Yaraghi A, Sharifian Z, Feizi A, Hedaiaty M, Sabzghabaee AM.

Mater Sociomed. 2015 Aug;27(4):276-9. doi: 10.5455/msm.2015.27.276-279.

Comments: Some interesting data on methadone toxicity in Iran. Length of stay was 33 hours (median). 90.3% survived. There were several complications. GCS on admission predicted survival. Useful data for economic modeling …

2) Overdose prevention for prisoners in New York: a novel program and collaboration.

Zucker H, Annucci AJ, Stancliff S, Catania H.

Harm Reduct J. 2015 Nov 5;12(1):51. doi: 10.1186/s12954-015-0084-8.

PMID: 26541987 Free Article

Comments: Early report describing the establishment of a prison naloxone program in NY. Some of the most important work happening in this area…

3) Response to “Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review”.

Winstanley EL, Clark A, Wilder CM.

J Addict Med. 2015 Dec;9(6):503-4. doi: 10.1097/ADM.0000000000000160. No abstract available.

Comments: Can’t access. Meh.

4) Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review: Re: Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014 May-June;8(3): 153-163.

Orkin AM, Bingham K, Buick JE, Klaiman M, Leece P, Kouyoumdjian F.

J Addict Med. 2015 Dec;9(6):502-3. doi: 10.1097/ADM.0000000000000161. No abstract available.

Comments: Also can’t access.

5) Implementation of an inpatient opioid overdose prevention program.

Clark A, Winstanley EL, Martsolf DS, Rosen M.

Addict Behav. 2015 Oct 8;53:141-145. doi: 10.1016/j.addbeh.2015.10.006. [Epub ahead of print] No abstract available.

Comments: Authors report on development of an electronic book on overdose prevention for use in addiction treatment settings.

6) Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods.

Ashrafioun L, Gamble S, Herrmann M, Baciewicz G.

Subst Abus. 2015 Oct 29:0. [Epub ahead of print]

Comments: Those trained in intranasal naloxone were more confident than those trained in injectable. That is odd, as studies suggest that injectable is easier than intranasal.

7) Methadone related deaths compared to all prescription related deaths.

Lev R, Petro S, Lee A, Lee O, Lucas J, Castillo EM, Egnatios J, Vilke GM.

Forensic Sci Int. 2015 Oct 22;257:347-352. doi: 10.1016/j.forsciint.2015.09.021. [Epub ahead of print]

Comments: The lack of data from methadone maintenance programs makes it quite challenging to interpret some of the methadone-related mortality data.

8) Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users.

McAuley A, Aucott L, Matheson C.

Int J Drug Policy. 2015 Oct 1. pii: S0955-3959(15)00306-0. doi: 10.1016/j.drugpo.2015.09.011. [Epub ahead of print]

Comments: 9% of kits were likely to be used for overdose rescue. That looks like a rather low number, but it’s over a 3-month period. I suspect the annual rate is closer to 20% +/- 5%.

9) Legal changes to increase access to naloxone for opioid overdose reversal in the United States.

Davis CS, Carr D.

Drug Alcohol Depend. 2015 Oct 22. pii: S0376-8716(15)01695-6. doi: 10.1016/j.drugalcdep.2015.10.013. [Epub ahead of print]

Comments: Great paper, title says it all.

10) Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J.

PLoS One. 2015 Oct 23;10(10):e0140995. doi: 10.1371/journal.pone.0140995. eCollection 2015.

Comments: I like this study. The physiology of “overdose” is totally fascinating and nowhere near as simple as it seems.

11) Hair testing in postmortem diagnosis of substance abuse: An unusual case of slow-release oral morphine abuse in an adolescent.

Baillif-Couniou V, Kintz P, Sastre C, Pok PP, Chèze M, Pépin G, Leonetti G, Pelissier-Alicot AL.

J Forensic Leg Med. 2015 Sep 4;36:172-176. doi: 10.1016/j.jflm.2015.08.014. [Epub ahead of print]

Comments: Morphine overdose in an adolescent in France. It’s news there because they don’t see people dying of prescription opioids like in the U.S.

12) Effects of acute and repeated administration of oxycodone and naloxone-precipitated withdrawal on Intracranial Self-Stimulation (ICSS) in rats.

Wiebelhaus JM, Walentiny DM, Beardsley PM.

J Pharmacol Exp Ther. 2015 Oct 21. pii: jpet.115.228940. [Epub ahead of print]

Comments: Oxycodone works like other opioids.

13) Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting.

Tucker D, Hayashi K, Milloy MJ, Nolan S, Dong H, Kerr T, Wood E.

Addict Behav. 2015 Oct 9;52:103-107. doi: 10.1016/j.addbeh.2015.10.002. [Epub ahead of print]

Comments: Benzo use is associated with lots of risk factors for negative health outcomes, including blood-borne virus transmission, among drug users.

14) Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid overdose-an important opportunity for saving lives.

Dailey M.

Addiction. 2015 Nov;110(11):1775-6. doi: 10.1111/add.13093. No abstract available.

Comments: Nice commentary, pointing out the opportunities for intervention among those who contact the medical system with an overdose.

15) Flumazenil, naloxone and the ‘coma cocktail’.

Sivilotti ML.

Br J Clin Pharmacol. 2015 Aug 7. doi: 10.1111/bcp.12731. [Epub ahead of print] Review.

Comments: Fascinating differences between benzo and opioid-induced respiratory depression. Benzos cause apnea usually because the upper airway is blocked or collapses – so respiratory support is the need – and the antidote can lead to seizures. Opioids are different and naloxone much safer.

16) Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies.

Cheatle MD, Webster LR.

Pain Med. 2015 Oct;16 Suppl 1:S22-6. doi: 10.1111/pme.12910. Review.

Comments: Opioids might be dangerous with sleep disorders.

17) More than just someone to inject drugs with: Injecting within primary injection partnerships.

Morris MD, Bates A, Andrew E, Hahn J, Page K, Maher L.

Drug Alcohol Depend. 2015 Nov 1;156:275-81. doi: 10.1016/j.drugalcdep.2015.09.025. Epub 2015 Sep 30.

Comments: Injection partnerships can have divergent benefits and risks.

18) A True Antidote.

Berlin J.

Tex Med. 2015 Oct 1;111(10):41-7.

Comments: Naloxone in Texas!

19) The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs.

Lake S, Hayashi K, Buxton J, Milloy MJ, Dong H, Wood E, Montaner J, Kerr T.

Drug Alcohol Depend. 2015 Nov 1;156:297-303. doi: 10.1016/j.drugalcdep.2015.09.026. Epub 2015 Sep 30.

Comments: Interesting analysis – injecting prescription opioids didn’t by itself increase overdose risk. Injecting of both prescription opioids and heroin did, however. So there is probably some protection offered by the known doses and constituents in prescription opioids.

20) Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature.

Martins SS, Sampson L, Cerdá M, Galea S.

Am J Public Health. 2015 Nov;105(11):e29-49. doi: 10.2105/AJPH.2015.302843.

Comments: Nice summary of global data looking at some basic overdose results. Mean/median rate of witnessed overdose in a drug user’s lifetime = 73/70%. Lifetime prevalence of experienced overdose was mean of 45.4% and median of 47%. Population-based overdose mortality rates varied from 0.4-46.6 / 100,000 person years (note, this is population based).

21) An Overdose Antidote Goes Mainstream.

Humphreys K.

Health Aff (Millwood). 2015 Oct 1;34(10):1624-7. doi: 10.1377/hlthaff.2015.0934.

Comments: Review of naloxone based on summer 2015 FDA meeting.

22) Is immunotherapy an opportunity for effective treatment of drug addiction?

Zalewska-Kaszubska J.

Vaccine. 2015 Oct 2. pii: S0264-410X(15)01369-9. doi: 10.1016/j.vaccine.2015.09.079. [Epub ahead of print] Review.

Comments: Really interesting idea – use antibodies against drugs, like cocaine, to manage overdose on those drugs. Excellent.

23) Involvement of Opioid Receptors in the Lipid Rescue of Bupivacaine-Induced Cardiotoxicity.

Partownavid P, Sharma S, Li J, Umar S, Rahman S, Eghbali M.

Anesth Analg. 2015 Aug;121(2):340-7. doi: 10.1213/ANE.0000000000000788.

Comments: Opioid receptors are required for rescuing people from the cardiac toxicity of bupivacaine overdose.

24) New drugs of abuse.

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

Pharmacotherapy. 2015 Feb;35(2):189-97. doi: 10.1002/phar.1522. Epub 2014 Dec 4. Review.

Comments: Desomorphine. Blech.

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

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

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

Comments: Not much.

26) Access to harm reduction and HIV-related treatment services inside Indian prisons: experiences of formerly incarcerated injecting drug users.

Chakrapani V, Kamei R, Kipgen H, Kh JK.

Int J Prison Health. 2013;9(2):82-91. doi: 10.1108/17449201311326952.

Comments: Access is … no there.

27) Low Expression of D2R and Wntless Correlates With High Motivation for Heroin.

Tacelosky DM, Alexander DN, Morse M, Hajnal A, Berg A, Levenson R, Grigson PS.

Behav Neurosci. 2015 Oct 26. [Epub ahead of print]

Comments: Holding drug exposure constant, reducing dopamine D2 receptors or that other thing (Wntless) results in more opioid craving.

28) The misuse and abuse of prescription medications: part 1 current trends.

Allread V, Paul S.

MD Advis. 2014 Fall;7(4):12-20. Review.

Comments: Can’t access. Review for New Jersey and rest of US regarding prescription opioids and heroin use.

1) The Whole Is Just the Sum of Its Parts: Limited Polydrug Use Among the “Big Three” Expensive Drugs in the United States.

Caulkins JP, Everingham S, Kilmer B, Midgette G.

Curr Drug Abuse Rev. 2013 Dec 5. [Epub ahead of print]

Comments: Somewhat surprising data suggesting relatively separate markets for heroin, cocaine and methamphetamine.

2) 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. 2013 Dec 3. doi: 10.1111/dar.12095. [Epub ahead of print]

Comments: A systematic review concluding that the data for naltrexone implants for opioid dependence are insufficient for use outside of clinical trials.

3)  Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009.

Bohnert AS, Ilgen MA, Trafton JA, Kerns RD, Eisenberg A, Ganoczy D, Blow FC.

Clin J Pain. 2013 Nov 25. [Epub ahead of print]

Comments: What happened with opioid analgesic overdose deaths in the United States also happened in among veterans receiving care in the Veterans’ Administration.

4) The Dueling Obligations of Opioid Stewardship.

Coffin P, Banta-Green C.

Ann Intern Med. 2013 Dec 10. doi: 10.7326/M13-2781. [Epub ahead of print] No abstract available.

Comments: Commentary on the reliance on opioids and minimizing the potential harms of stewardship efforts.

5) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2013 Nov 25. [Epub ahead of print] No abstract available.

Comments: This is really a news report in CMAJ about Canada’s BC naloxone program.

6) Preventing deaths from rising opioid overdose in the US – the promise of naloxoneantidote in community-based naloxone take-home programs.

Straus MM, Ghitza UE, Tai B.

Subst Abuse Rehabil. 2013 Sep 2;2013(4). doi: 10.2147/SAR.S47463.

Comments: Good review of major initiatives to respond to increasing rates of opioid overdose mortality in the United States, including take-back programs, prescription drug monitoring programs, and naloxone distribution.

7) Drug-induced deaths – United States, 1999-2010.

Mack KA; National Center for Injury Prevention and Control, CDC.

MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-3.

Comments: Review of drug-related deaths of the past decade.

8) From oxycodone to heroin: Two cases of transitioning opioid use in young Australians.

Dertadian GC, Maher L.

Drug Alcohol Rev. 2013 Nov 21. doi: 10.1111/dar.12093. [Epub ahead of print]

Comments: Interesting case reports of transitions from oral prescription opioid consumption to illicit opioid injection. Unable to access for details.

9) Common causes of poisoning: etiology, diagnosis and treatment.

Müller D, Desel H.

Dtsch Arztebl Int. 2013 Oct;110(41):690-9; quiz 700. doi: 10.3238/arztebl.2013.0690. Epub 2013 Oct 11.

Comments: Interesting analysis of all acute poisonings in the German poison control center over 26 years.

10) Opiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A Study on Gender Differences.

Origer A, Lopes da Costa S, Baumann M.

Eur Addict Res. 2013 Oct 31;20(2):87-93. [Epub ahead of print]

Comments: Interesting gender-based analysis suggesting that women may be at higher risk earlier in their drug use careers.

11) Safe methadone induction and stabilization: report of an expert panel.

Baxter LE Sr, Campbell A, Deshields M, Levounis P, Martin JA, McNicholas L, Payte JT, Salsitz EA, Taylor T, Wilford BB.

J Addict Med. 2013 Nov-Dec;7(6):377-86. doi: 10.1097/01.ADM.0000435321.39251.d7.

Comments: Guidelines addressing methadone starting dose, dose escalation, and concomitant medications/drugs.

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

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

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

Comments: No overdoses.

13) [Distribution of naloxone to prevent death from heroin overdose. Study of opioid dependent patients’ attitudes to be part of the antidote program].

Håkansson A, Vedin A, Wallin C, Kral AH.

Lakartidningen. 2013 Jul 17-Aug 6;110(29-31):1340-2. Swedish. No abstract available.

Comments: Unable to access, but it would be fascinating to see the Swedish response to lay naloxone.

14) Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran.

Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A.

Clin Toxicol (Phila). 2013 Sep-Oct;51(8):777-82. doi: 10.3109/15563650.2013.830732. Epub 2013 Aug 23.

Comments:

15) Project Lazarus: an innovative community response to prescription drug overdose.

Brason FW 2nd, Roe C, Dasgupta N.

N C Med J. 2013 May-Jun;74(3):259-61. No abstract available.

Comments: Unable to access.

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

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

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

Comments: Report from the first 8 months of naloxone trainings in Toronto!

17) The pathogenetic role of adulterants in 5 cases of drug addicts with a fatal outcome.

Barbera N, Busardò FP, Indorato F, Romano G.

Forensic Sci Int. 2013 Apr 10;227(1-3):74-6. doi: 10.1016/j.forsciint.2012.08.041. Epub 2012 Sep 20.

Comments: Fascinating paper on the role of dextromethorphan, built upon evidence that dextromethorphan – an NMDA-recepter antagonist – decreases the expiratory phase of respiration and magnifies the respiratory depression induced by morphine. While adulterants may be more important than we’ve previously realized, how does one translate that to overdose prevention in the field?

18) Deadly heroin or the death of heroin – overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Horvath M, Dunay G, Csonka R, Keller E.

Neuropsychopharmacol Hung. 2013 Dec;15(4):253-9.

Comments: Very exciting to see a review of drug overdose deaths in Budapest, Hungary. The number of deaths is remarkably low, with just 464 deaths in 18 years (299 opioid-related). Surprisingly 58% of the deaths were heroin alone, a finding the authors suggest means that use patterns are distinct in Budapest.

19) [Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

Cui N, Cao XB, Wang CH, Luo W, Pang L, Rou KM, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Oct;34(10):961-3. Chinese.

Comments: Interesting analysis from China with the suggestion that adherence to methadone maintenance reduces overdose mortality.

20) Survey of naloxone legal status in opioid overdose prevention and treatment.

Hewlett L, Wermeling DP.

J Opioid Manag. 2013 Sep-Oct;9(5):369-77. doi: 10.5055/jom.2013.0179.

Comments: Review of naloxone access laws in the United States. There was so much activity in 2013, that this article is already a bit out of date!

21) Mortality among Methadone Maintenance Clients in China: A Six-Year Cohort Study.

Cao X, Wu Z, Li L, Pang L, Rou K, Wang C, Luo W, Yin W, Li J, McGoogan JM; National Methadone Maintenance Treatment Program Working Group.

PLoS One. 2013 Dec 12;8(12):e82476. doi: 10.1371/journal.pone.0082476.

Comments: Overdose was the leading cause of death among methadone patients, four times more likely among those with HIV, and longer time in methadone treatment reduced overdose mortality risk.

22) Associations among Pain, Non-Medical Prescription Opioid Use, and Drug Overdose History.

Bonar EE, Ilgen MA, Walton M, Bohnert AS.

Am J Addict. 2014 Jan;23(1):41-7. doi: 10.1111/j.1521-0391.2013.12055.x. Epub 2013 Jun 14.

Comments: Analysis among substance users at a treatment center of pain, non-medical prescription opioid use, and overdose.

23) Revisiting the role of the urban environment in substance use: the case of analgesicoverdose fatalities.

Cerdá M, Ransome Y, Keyes KM, Koenen KC, Tardiff K, Vlahov D, Galea S.

Am J Public Health. 2013 Dec;103(12):2252-60. doi: 10.2105/AJPH.2013.301347. Epub 2013 Oct 17.

Comments: This is a fascinating analysis that I’ve been waiting to see (AJPH does tend to take a while to publish!). However, what happened in NYC with opioid overdose may or may not be reflective of what happened in other areas of the country. NYC saw a clear increase in overdose on Staten Island, among those using prescription opioids, while heroin deaths were decreasing citywide. Staten Island then had an increase in heroin deaths as many transitioned to heroin and there were no services in place to limit the harms of heroin. In other areas there is less of a clear trend.

24) Opioid overdose mortality in Kansas, 2001-2011: toxicologic evaluation of intent.

Okic M, Cnossen L, Crifasi JA, Long C, Mitchell EK.

J Anal Toxicol. 2013 Nov-Dec;37(9):629-35. doi: 10.1093/jat/bkt085.

Comments: Again demonstrating the limited utility of drug concentration in opioid overdose deaths.

25) Naltrexone in the treatment of opioid-dependent pregnant women: the case for a considered and measured approach to research.

Jones HE, Chisolm MS, Jansson LM, Terplan M.

Addiction. 2013 Feb;108(2):233-47. doi: 10.1111/j.1360-0443.2012.03811.x. Epub 2012 Apr 4. Review.

Comments: The research field of obstetrics is generally way behind the rest of medicine. Because we are so concerned over the health of pregnant women and the well-being of the embryos and fetuses they carry, we tend to rely on decades of experience and new approaches progress glacially. As the authors point out, given the numerous potential downsides of naltrexone for opioid dependence, we are not near the point of recommending this therapy for pregnant women at this time – or even researching it directly.