1) Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016.

Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M.

Natl Vital Stat Rep. 2018 Dec;67(9):1-14.

Comment: Nice summary of the data demonstrating the shift from prescribed opioids to heroin to fentanyl, with rising methamphetamine and persistent cocaine presence.

2) Enhanced Intranasal Absorption of Naltrexone by Dodecyl Maltopyranoside: Implications for the Treatment of Opioid Overdose.

Krieter P, Gyaw S, Chiang CN, Crystal R, Skolnick P.

J Clin Pharmacol. 2019 Jan 30. doi: 10.1002/jcph.1384. [Epub ahead of print]

Comment: Fascinating that the half-life of naltrexone is only 2.2 hours when administered intranasally … would be great to see that for managing alcohol use.

3) Emergency department physicians’ and pharmacists’ perspectives on take-home naloxone.

Holland TJ, Penm J, Dinh M, Aran S, Chaar B.

Drug Alcohol Rev. 2019 Jan 29. doi: 10.1111/dar.12894. [Epub ahead of print]

Comment: Qualitative assessment of opinions.

4) Take-home naloxone: a life saver in opioid overdose.

The Lancet.

Lancet. 2019 Jan 26;393(10169):296. doi: 10.1016/S0140-6736(19)30153-9. No abstract available. 

Comment: Editorial supporting take-home naloxone.

5) Feasibility and Acceptability of a Checklist and Learning Collaborative to Promote Quality and Safety in the Perinatal Care of Women with Opioid Use Disorders.

Goodman D, Zagaria AB, Flanagan V, Deselle FS, Hitchings AR, Maloney R, Small TA, Vergo AV, Bruce ML.

J Midwifery Womens Health. 2019 Jan;64(1):104-111. doi: 10.1111/jmwh.12943.

Comment: Some good changes – more naloxone provided, more counseling regarding breastfeeding, and more nicotine-replacement therapy initiated.

6) Correlates of seeking emergency medical help in the event of an overdose in British Columbia, Canada: Findings from the Take Home Naloxone program.

Karamouzian M, Kuo M, Crabtree A, Buxton JA.

Int J Drug Policy. 2019 Jan 25. pii: S0955-3959(19)30014-3. doi: 10.1016/j.drugpo.2019.01.006. [Epub ahead of print]

Comment: Great analysis of naloxone programmatic data. 55.7% of lay naloxone administrations were followed by a call for emergency medical services, again demonstrating that we do not have data showing a reduction in calling 911 when naloxone is administered. 

7) Seizures in tramadol overdoses reported in the ToxIC registry: predisposing factors and the role of naloxone.

Murray BP, Carpenter JE, Dunkley CA, Moran TP, Alfaifi M, Alsukaiti WS, Kazzi Z.

Clin Toxicol (Phila). 2019 Jan 24:1-5. doi: 10.1080/15563650.2018.1547826. [Epub ahead of print]

Comment: Tramadol is a weird drug. This analysis found that when it caused an opioid-like overdose, seizures were less likely, and that naloxone use was not associate with tramadol seizures.

8) “You Never Know What You’re Getting”: Opioid Users’ Perceptions of Fentanyl in Southwest Pennsylvania.

McLean K, Monnat SM, Rigg K, Sterner GE 3rd, Verdery A.

Subst Use Misuse. 2019 Jan 24:1-12. doi: 10.1080/10826084.2018.1552303. [Epub ahead of print]

Comment: Fentanyl use patterns are evolving – it seems to be here to stay this time.

9) Development of a Cascade of Care for responding to the opioid epidemic.

Williams AR, Nunes EV, Bisaga A, Levin FR, Olfson M.

Am J Drug Alcohol Abuse. 2019 Jan 24:1-10. doi: 10.1080/00952990.2018.1546862. [Epub ahead of print]

Comment: Nice to see this development.

10) Blockade of the human ether a-go-go related gene (hERG) potassium channel by fentanyl.

Tschirhart JN, Li W, Guo J, Zhang S.

Mol Pharmacol. 2019 Jan 21. pii: mol.118.114751. doi: 10.1124/mol.118.114751. [Epub ahead of print]

Comment: First, you gotta love the naming culture for these genes. Now the human ether a-go-go gene potassium channel effects could prolong the QT interval, which could result in ventricular arrhythmias and, ultimately, cardiac arrest. Is this playing a role in fentanyl-related deaths? Not sure. 

11) Changing risk and presentation of overdose associated with consumption of street drugs at a supervised injection site in Vancouver, Canada.

Notta D, Black B, Chu T, Joe R, Lysyshyn M.

Drug Alcohol Depend. 2019 Jan 15;196:46-50. doi: 10.1016/j.drugalcdep.2018.12.016. [Epub ahead of print]

Comment: Great use of these data. As fentanyl entered the heroin supply in Vancouver, the rate of “heroin” overdoses rose 4.8 fold. This is interesting, as fentanyl knowingly used at the Sydney injection facility was 4 times more likely than heroin to result in overdose – honestly I would have expected an even more substantial increase in “heroin” overdose events in the context of heroin contaminated with fentanyl. Notably, there was a several fold increase in overdose events for all drugs being injected in Vancouver over the period studied. They also saw an increase in rigidity (a potential complication of fentanyl) from 10.4% of “heroin” overdoses in 2010/11 to 18.9% in 2017.

12) High Prevalence of Self-Reported Exposure to Adulterated Drugs Among People Who Experienced an Opioid Overdose in Canada: A Cohort Study.

Prangnell A, Fairgrieve C, Nosova E, DeBeck K, Milloy MJ, Hayashi K.

Subst Use Misuse. 2019 Jan 20:1-6. doi: 10.1080/10826084.2018.1555257. [Epub ahead of print]

Comment: Two-thirds of people who overdosed believed their drugs had been adulterated. While the current drug supply is very dynamic, I suspect this finding would hold for overdoses in areas not heavily affected by fentanyl; that is, this is a common perception among people who have overdosed, explained by the actor-observer bias.

13) Associations between implementation of Project Lazarus and opioid analgesic dispensing and buprenorphine utilization in North Carolina, 2009-2014.

Alexandridis AA, Dasgupta N, McCort AD, Ringwalt CL, Rosamond WD, Chelminski PR, Marshall SW.

Inj Epidemiol. 2019 Jan 21;6(1):2. doi: 10.1186/s40621-018-0179-2.

Comment: Limited effects.

14) What should clinicians do as fentanyl replaces heroin?

Bisaga A.

Addiction. 2019 Jan 20. doi: 10.1111/add.14522. [Epub ahead of print] No abstract available. 

Comment: Be creative, be innovative, don’t be shy.

15) Twenty years of the methadone treatment protocol in Ireland: reflections on the role of general practice.

Delargy I, Crowley D, Van Hout MC.

Harm Reduct J. 2019 Jan 17;16(1):5. doi: 10.1186/s12954-018-0272-4. Review.

Comment: 20 years and 10,000 patients later.

16) Overdose Deaths Involving Fentanyl and Fentanyl Analogs – New York City, 2000-2017.

Colon-Berezin C, Nolan ML, Blachman-Forshay J, Paone D.

MMWR Morb Mortal Wkly Rep. 2019 Jan 18;68(2):37-40. doi: 10.15585/mmwr.mm6802a3.

Comment: It’s always tricky to use toxicology results in overdose mortality surveillance because there are many substances found on toxicology which may not have contributed to the death (e.g. something the patient takes medically that was at a low or appropriately therapeutic level and doesn’t interact with likely causal drugs, or something that is a by-product of decomposition). In this circumstance, however, it made sense.

17) Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion.

Saloner B, Levin J, Chang HY, Jones C, Alexander GC.

JAMA Netw Open. 2018 Aug 3;1(4):e181588. doi: 10.1001/jamanetworkopen.2018.1588.

Comment: Buprenorphine treatment increased and opioid pain reliever prescriptions did not. That makes solid sense.

18) Pharmacokinetics of a novel, approved, 1.4 mg intranasal naloxone formulation for reversal of opioid overdose- a randomised controlled trial.

Skulberg AK, Åsberg A, Khiabani HZ, Røstad H, Tylleskar I, Dale O.

Addiction. 2019 Jan 14. doi: 10.1111/add.14552. [Epub ahead of print]

Comment: Intranasal 1.4mg was ~50% bioavailable, which is half as good as intramuscular, and the pharmacokinetics were similar to 0.8mg intramuscular, although the time to peak effect was about 5 minutes slower.

19) Overdose mortality rates in Croatia and factors associated with self-reported drug overdose among persons who inject drugs in three Croatian cities.

Handanagic S, Bozicevic I, Sekerija M, Rutherford GW, Begovac J.

Int J Drug Policy. 2019 Jan 11;64:95-102. doi: 10.1016/j.drugpo.2018.11.017. [Epub ahead of print]

Comment: Polydrug injection.

20) Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention.

Nolan ML, Shamasunder S, Colon-Berezin C, Kunins HV, Paone D.

J Urban Health. 2019 Jan 11. doi: 10.1007/s11524-018-00343-z. [Epub ahead of print]

Comment: These data suggest that fentanyl is responsible for a good amount of the increase in cocaine deaths in NYC. Was that intentionally consumed or contaminating cocaine? Given that the demographics of cocaine related deaths have historically been fairly distinct from opioid deaths in NYC, I wonder if comparing demographics would help to elucidate which is the case.

21) Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health.

Lovrecic B, Lovrecic M, Gabrovec B, Carli M, Pacini M, Maremmani AGI, Maremmani I.

Int J Environ Res Public Health. 2019 Jan 9;16(2). pii: E177. doi: 10.3390/ijerph16020177. Review.

Comment: Yup, we’re in a mess.

22) Primary Care for Persons Who Inject Drugs.

Visconti AJ, Sell J, Greenblatt AD.

Am Fam Physician. 2019 Jan 15;99(2):109-116.

Comment: Love this topic, which drove me into medicine in the first place. Excellent to see physicians, scientists, and academic publications take on this need.

23) Reversal of Pediatric Opioid Toxicity with Take-Home Naloxone: a Case Report.

Lebin JA, Chen BC, Valento MJ.

J Med Toxicol. 2019 Jan 10. doi: 10.1007/s13181-018-0695-z. [Epub ahead of print]

Comment: This may be the first journal report of pediatric reversal with take-home naloxone, but it’s not the first story … it’s been happening in the community for decades.

24) Drug Overdose Deaths Among Women Aged 30-64 Years – United States, 1999-2017.

VanHouten JP, Rudd RA, Ballesteros MF, Mack KA.

MMWR Morb Mortal Wkly Rep. 2019 Jan 11;68(1):1-5. doi: 10.15585/mmwr.mm6801a1.

Comment: Increased overdose mortality across the board among women.

25) Increasing Naloxone Access and Use to Prevent Opioid Overdose Death and Disability.

White ND.

Am J Lifestyle Med. 2018 Oct 20;13(1):33-35. doi: 10.1177/1559827618803874. eCollection 2019 Jan-Feb. Review.

Comment: Legislation and pronouncements have only done so much.

26) Opioid overdose detection using smartphones.

Nandakumar R, Gollakota S, Sunshine JE.

Sci Transl Med. 2019 Jan 9;11(474). pii: eaau8914. doi: 10.1126/scitranslmed.aau8914.

Comment: This is a fascinating topic. We can saturate the world with naloxone, but it still won’t prevent overdose events from becoming fatal among people who are isolated from others (e.g. marginally housed, living in hotel rooms). In San Francisco, about one-third of deaths occurred in single-room occupancy hotel units – a number that is unlikely to be significantly affected by responder interventions. To have non-invasive tools that can detect concerning vital signs could be hugely beneficial if implemented well.

27) Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study.

Lugoboni F, Zamboni L, Cibin M, Tamburin S; Gruppo InterSERT di Collaborazione Scientifica (GICS).

Eur Addict Res. 2019;25(1):10-19. doi: 10.1159/000496112. Epub 2019 Jan 9.

Comment: People who inject drugs frequently try to inject other drugs.

28) Predictive Factors of Treatment Outcomes for Hospital Care in Children with Acute Methadone Poisoning.

Atighi Y, Eizadi-Mood N, Mansourian M, Zamani A, Saffaei A, Sabzghabaee AM.

J Res Pharm Pract. 2018 Oct-Dec;7(4):200-204. doi: 10.4103/jrpp.JRPP_16_141.

Comment: Accidental opioid poisoning amoung children at home is always tragic. While our first effort has to be avoiding such events, an earlier manuscript today showed that having naloxone at home can help mitigate when they do occur.

29) Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study.

Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BDL.

Harm Reduct J. 2019 Jan 8;16(1):3. doi: 10.1186/s12954-018-0276-0.

Comment: People use them and often implement some overdose prevention or management strategies when results are positive.

30) Legally Lethal Kratom: A Herbal Supplement with Overdose Potential.

Palasamudram Shekar S, Rojas EE, D’Angelo CC, Gillenwater SR, Martinez Galvis NP.

J Psychoactive Drugs. 2019 Jan 8:1-3. doi: 10.1080/02791072.2018.1562591. [Epub ahead of print]

Comment: Kratom’s another “weird” drug with some opioid properties. Took 10 days to recover – wow!

31) The importance of buprenorphine research in the opioid crisis.

Pendergrass SA, Crist RC, Jones LK, Hoch JR, Berrettini WH.

Mol Psychiatry. 2019 Jan 7. doi: 10.1038/s41380-018-0329-5. [Epub ahead of print]

Comment: Yep. Although I’d say implementation is more important.

32) Implementation of a collaborative model for opioid overdose prevention on campus.

Hill LG, Holleran Steiker LK, Mazin L, Kinzly ML.

J Am Coll Health. 2019 Jan 7:1-4. doi: 10.1080/07448481.2018.1549049. [Epub ahead of print]

Comment: Further expansion of naloxone.

33) Divergence In Recent Trends In Deaths From Intentional And Unintentional Poisoning.

Hempstead K, Phillips J.

Health Aff (Millwood). 2019 Jan;38(1):29-35. doi: 10.1377/hlthaff.2018.05186.

Comment: Notwithstanding a huge increase in unintentional opioid deaths and a shift in the causal opioids, poisoning suicide deaths have not changed during this period, again suggesting that suicide and unintentional overdose are distinct processes.

34) Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities.

Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M.

Health Aff (Millwood). 2019 Jan;38(1):14-23. doi: 10.1377/hlthaff.2018.05162.

Comment: Uh … yeah. Please.

35) Changes in Pharmacists’ Perceptions After a Training in Opioid Misuse and Accidental Overdose Prevention.

Eukel HN, Skoy E, Werremeyer A, Burck S, Strand M.

J Contin Educ Health Prof. 2019 Jan 3. doi: 10.1097/CEH.0000000000000233. [Epub ahead of print]

Comment: More training pharmacists.

36) Commentary on Stam et al. (2019): Drugs, death and statistics.

Darke S.

Addiction. 2019 Jan 6. doi: 10.1111/add.14520. [Epub ahead of print] No abstract available. 

Comment: As usual, the author has insightful comments on overdose research and surveillance. Heroin deaths are often miscoded as morphine (or codeine?) deaths and stimulant deaths are often missed because the immediate medical cause of a cerebral hemorrhage or cardiac arrest is sufficient for the cause of death field.

37) On-site identification of psychoactive drugs by portable Raman spectroscopy during drug-checking service in electronic music events.

Gerace E, Seganti F, Luciano C, Lombardo T, Di Corcia D, Teifel H, Vincenti M, Salomone A.

Drug Alcohol Rev. 2019 Jan;38(1):50-56. doi: 10.1111/dar.12887. Epub 2019 Jan 6.

Comment: Portable drug detection is very exciting.

38) An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada.

Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K.

Subst Abuse Treat Prev Policy. 2018 Nov 27;13(1):41. doi: 10.1186/s13011-018-0180-3.

Comment: No age differences.

39) Utilizing Buprenorphine in the Emergency Department after Overdose.

Johns SE, Bowman M, Moeller FG.

Trends Pharmacol Sci. 2018 Dec;39(12):998-1000. doi: 10.1016/j.tips.2018.10.002. Review.

Comment: Good idea, when patients want it.

40) Pharmacological Research as a Key Component in Mitigating the Opioid Overdose Crisis.

Baumann MH, Kopajtic TA, Madras BK.

Trends Pharmacol Sci. 2018 Dec;39(12):995-998. doi: 10.1016/j.tips.2018.09.006. Review.

Comment: Review with focus on what new medications could provide.

41) At-a-glance – What can paramedic data tell us about the opioid crisis in Canada?

Do MT, Furlong G, Rietschlin M, Leyenaar M, Nolan M, Poirier P, Field B, Thompson W.

Health Promot Chronic Dis Prev Can. 2018 Sep;38(9):339-342. doi: 10.24095/hpcdp.38.9.06. English, French. 

Comment: It’s tricky to track opioid overdose with paramedic calls for several reasons (e.g. diagnosis codes are preliminary in this triage service, using naloxone administration as a marker misses a lot of events that aren’t “typical” heroin overdoses, the impact of naloxone programming is unclear, etc). Nonetheless, if you can access the data in a useful way, exploring this data source is irresistible.

42) Review of Case Narratives from Fatal Overdoses Associated with Injectable Naltrexone for Opioid Dependence.

Saucier R, Wolfe D, Dasgupta N.

Drug Saf. 2018 Oct;41(10):981-988. doi: 10.1007/s40264-018-0653-3. Erratum in: Drug Saf. 2018 May 24. 

Comment: It is concerning that in overdose deaths the manufacturer placed the blame on opioid use disorder and did not consider elevated risk for overdose after treatment discontinuation. I would agree that a registry is in order.

1) Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History.

Abbasi AB, Salisbury-Afshar E, Jovanov D, Berberet C, Arunkumar P, Aks SE, Layden JE, Pho MT.

J Urban Health. 2019 Jan 3. doi: 10.1007/s11524-018-00329-x. [Epub ahead of print]

Comment: We’ve been losing people to overdose for much longer than the overprescribing issue. Hopefully the type of work this paper represents will help support a longterm emphasis on overdose prevention. About 1 in 3 decedents had not received any opioid prescription in the past 6 years. These individuals were more likely to be racial/ethnic minorities and urban, and less likely to have contact with the healthcare system or receive buprenorphine treatment.

2) Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017.

Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G.

MMWR Morb Mortal Wkly Rep. 2018 Jan 4;67(5152):1419-1427. doi: 10.15585/mmwr.mm675152e1.

Comment: Yup, things kept getting worse through 2017. Most people suspect that 2017 was a peak, that 2018 will be a (statistical) plateau, and that numbers may start to improve but we have a long way to go.

3) Wound Botulism Outbreak Among Persons Who Use Black Tar Heroin – San Diego County, California, 2017-2018.

Peak CM, Rosen H, Kamali A, Poe A, Shahkarami M, Kimura AC, Jain S, McDonald E.

MMWR Morb Mortal Wkly Rep. 2019 Jan 4;67(5152):1415-1418. doi: 10.15585/mmwr.mm675152a3.

Comment: Wound botulism cases tend to come in clusters, suggesting that it is batches of black tar heroin contaminated with botulism (rather than, for example, injection practices exposing people to environmental botulism). This manuscript came up because of what the similarity in symptoms between botulism and several other conditions, including intoxication and poisoning.

4) Testing hair for fentanyl exposure: a method to inform harm reduction behavior among individuals who use heroin.

Palamar JJ, Salomone A, Bigiarini R, Vincenti M, Acosta P, Tofighi B.

Am J Drug Alcohol Abuse. 2019 Jan 2:1-7. doi: 10.1080/00952990.2018.1550652. [Epub ahead of print]

Comment: Interesting results.

5) The value of harm reduction for injection drug use: A clinical and public health ethics analysis.

Vearrier L.

Dis Mon. 2018 Dec 29. pii: S0011-5029(18)30161-5. doi: 10.1016/j.disamonth.2018.12.002. [Epub ahead of print]

Comment: “From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.”

6) Quality Assessment of Expired Naloxone Products from First-Responders’ Supplies.

Pruyn S, Frey J, Baker B, Brodeur M, Graichen C, Long H, Zheng H, Dailey MW.

Prehosp Emerg Care. 2018 Dec 30:1-7. doi: 10.1080/10903127.2018.1563257. [Epub ahead of print]

Comment: Naloxone lasts for 30 years. This is quite reassuring!

7) Urban-rural variation in the socioeconomic determinants of opioid overdose.

Pear VA, Ponicki WR, Gaidus A, Keyes KM, Martins SS, Fink DS, Rivera-Aguirre A, Gruenewald PJ, Cerdá M.

Drug Alcohol Depend. 2018 Dec 21;195:66-73. doi: 10.1016/j.drugalcdep.2018.11.024. [Epub ahead of print]

Comment: Economic disadvantage. Important work.

8) Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study.

Clemency BM, Eggleston W, Shaw EW, Cheung M, Pokoj NS, Manka MA, Giordano DJ, Serafin L, Yu H, Lindstrom HA, Hostler D.

Acad Emerg Med. 2019 Jan;26(1):7-15. doi: 10.1111/acem.13567. Epub 2018 Dec 28.

Comment: If patients had normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score at one hour, only 1 out of 538 was felt to benefit from additional naloxone.

9) Incidence of mortality due to rebound toxicity after ‘treat and release’ practices in prehospital opioid overdose care: a systematic review.

Greene JA, Deveau BJ, Dol JS, Butler MB.

Emerg Med J. 2018 Dec 22. pii: emermed-2018-207534. doi: 10.1136/emermed-2018-207534. [Epub ahead of print]

Comment: Release is quite safe, although data for long-acting opioid toxicity is minimal.

10) Assessment of medication for opioid use disorder as delivered within the Vermont hub and spoke system.

Rawson R, Cousins SJ, McCann M, Pearce R, Van Donsel A.

J Subst Abuse Treat. 2019 Feb;97:84-90. doi: 10.1016/j.jsat.2018.11.003. Epub 2018 Nov 19.

Comment: It works.

11) Documenting need for naloxone distribution in the Los Angeles County jail system.

Davidson PJ, Wagner KD, Tokar PL, Scholar S.

Addict Behav. 2018 Dec 12;92:20-23. doi: 10.1016/j.addbeh.2018.12.017. [Epub ahead of print]

Comment: About 2 in 5 inmates wanted training.

12) Investigating the Social Ecological Contexts of Opioid Use Disorder and Poisoning Hospitalizations in Pennsylvania.

Mair C, Sumetsky N, Burke JG, Gaidus A.

J Stud Alcohol Drugs. 2018 Nov;79(6):899-908.

Comment: Places with more manual labor had more opioid overdoses and denser populations had more heroin overdose.

13) Prescription-, Illicit-, and Self-Harm Opioid Overdose Cases Treated in Hospital.

Conner KR, Wiegand TJ, Kaukeinen K, Gorodetsky R, Schult R, Heavey SC.

J Stud Alcohol Drugs. 2018 Nov;79(6):893-898.

Comment: Interesting approach to the analysis.

14) Drug, Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives – Washington, 1999-2015.

Joshi S, Weiser T, Warren-Mears V.

MMWR Morb Mortal Wkly Rep. 2018 Dec 21;67(50):1384-1387. doi: 10.15585/mmwr.mm6750a2.

Comment: Fascinating – lack of correct racial/ethnic identification by medical examiners led to a 40% underestimate of overdose mortality among American Indians and Alaska Natives.

15) Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017-2018.

Samuels EA, McDonald JV, McCormick M, Koziol J, Friedman C, Alexander-Scott N.

Am J Public Health. 2019 Feb;109(2):263-266. doi: 10.2105/AJPH.2018.304847. Epub 2018 Dec 20.

Comment: Really amazing things have happened in Rhode Island.

16) State variation in opioid treatment policies and opioid-related hospital readmissions.

Blanchard J, Weiss AJ, Barrett ML, McDermott KW, Heslin KC.

BMC Health Serv Res. 2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8.

Comment: We are still early in understanding the utility of healthcare utilization data for opioid issues.

17) Shifting characteristics of nonmedical prescription tranquilizer users in the United States, 2005-2014.

Palamar JJ, Han BH, Martins SS.

Drug Alcohol Depend. 2018 Dec 8;195:1-5. doi: 10.1016/j.drugalcdep.2018.11.015. [Epub ahead of print]

Comment: There are real issues with trend analysis in the NSDUH, which largely missed increased use of opioids over the past 20 years.

18) Stakeholder perspectives on implementing fentanyl drug checking: Results from a multi-site study.

Glick JL, Christensen T, Nyeong Park J, McKenzie M, Green TC, Sherman SG.

Drug Alcohol Depend. 2019 Jan 1;194:527-532. doi: 10.1016/j.drugalcdep.2018.10.017. Epub 2018 Nov 13.

Comment: Most stakeholders think this is a good idea.

19) Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder.

Bagley SM, Cabral H, Saia K, Brown A, Lloyd-Travaglini C, Walley AY, Rose-Jacobs R.

Addict Sci Clin Pract. 2018 Dec 14;13(1):26. doi: 10.1186/s13722-018-0126-0.

Comment: Great to see overdose research reach into the population of pregnant women.

20) Evaluating the Impact of Prescribed Versus Nonprescribed Benzodiazepine Use in Methadone Maintenance Therapy: Results from a Population-based Retrospective Cohort Study.

Eibl JK, Wilton AS, Franklyn AM, Kurdyak P, Marsh DC.

J Addict Med. 2018 Dec 12. doi: 10.1097/ADM.0000000000000476. [Epub ahead of print]

Comment: Benzodiazapines for patients in methadone treatment … is a really complicated issue.

21) Pharmacotherapy for opioid addiction in community corrections.

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

Int Rev Psychiatry. 2018 Dec 6:1-19. doi: 10.1080/09540261.2018.1524373. [Epub ahead of print]

Comment: Yes!

22) A Smarter War on Drugs.

Koh HK, Kerlikowske RG, Botticelli MP.

JAMA. 2018 Dec 11;320(22):2301-2302. doi: 10.1001/jama.2018.18397. No abstract available. 

Comment: The title seems an oxymoron, but there’s some good material inside.

23) Naloxone distribution, trauma, and supporting community-based overdose responders.

Shearer D, Fleming T, Fowler A, Boyd J, McNeil R.

Int J Drug Policy. 2018 Dec 5. pii: S0955-3959(18)30292-5. doi: 10.1016/j.drugpo.2018.11.008. [Epub ahead of print] No abstract available. 

Comment: This theme makes me think of that 1999 Nicolas Cage movie – Bringing Out the Dead. Caring for people who overdose can be traumatic, for sure.

24) Operation Naloxone: Overdose prevention service learning for student pharmacists.

Hill LG, Sanchez JP, Laguado SA, Lawson KA.

Curr Pharm Teach Learn. 2018 Oct;10(10):1348-1353. doi: 10.1016/j.cptl.2018.07.010. Epub 2018 Jul 24.

Comment: Training pharmacy students!

25) Commentary on Madah-Amiri et al. (2019): Beyond saturation.

Bennett AS, Elliott L, Wolfson-Stofko B.

Addiction. 2019 Jan;114(1):101-102. doi: 10.1111/add.14499. Epub 2018 Dec 5. No abstract available. 

Comment: Utilize people who sell drugs as naloxone distributors.

26) Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol.

Gisev N, Pearson SA, Dobbins T, Currow DC, Blyth F, Larney S, Dunlop A, Mattick RP, Wilson A, Degenhardt L.

BMJ Open. 2018 Dec 4;8(12):e025840. doi: 10.1136/bmjopen-2018-025840.

Comment: Protocol paper on a huge study in New South Wales following all residents prescribed an opioid – oh the power of database linkage.

27) Remission from chronic opioid use-Studying environmental and socio-economic factors on recovery (RECOVER): Study design and participant characteristics.

Ling W, Nadipelli VR, Ronquest NA, Albright VA, Aldridge AP, Learned SM, Mehra V, Heidbreder C.

Contemp Clin Trials. 2019 Jan;76:93-103. doi: 10.1016/j.cct.2018.11.015. Epub 2018 Nov 30.

Comment: Cohort of patients followed after participation in an injectable buprenorphine program. Less than a quarter had ever overdosed, suggesting a relatively low-risk population. 

28) Opioid-Related Harms: Simplistic Solutions to the Crisis Ineffective and Cause Collateral Damage.

Gallagher R.

Health Serv Insights. 2018 Nov 25;11:1178632918813321. doi: 10.1177/1178632918813321. eCollection 2018.

Comment: Yes.

29) Prevention and Treatment of Opioid Misuse and Addiction: A Review.

Volkow ND, Jones EB, Einstein EB, Wargo EM.

JAMA Psychiatry. 2018 Dec 5. doi: 10.1001/jamapsychiatry.2018.3126. [Epub ahead of print]

Comment: A nice companion to the article listed above.

30) Illicit fentanyls in the opioid street market: desired or imposed?

Mars SG, Rosenblum D, Ciccarone D.

Addiction. 2018 Dec 4. doi: 10.1111/add.14474. [Epub ahead of print]

Comment: The authors argue imposed, by market forces. 

31) Postmortem Hyperthermia: Two Case Reports and a Review of the Literature.

Angélique F, Guillaume G, Nicolas G, Jean Sébastien R, Laurent M.

Am J Forensic Med Pathol. 2018 Dec;39(4):364-366. doi: 10.1097/PAF.0000000000000431. Review.

Comment: Fascinating cases of rapid onset rigor mortis and temperature elevation related to toxic exposure to MDMA and to methadone with possible neuroleptic malignant syndrome.

32) Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates.

Pietrusza LM, Puskar KR, Ren D, Mitchell AM.

J Addict Nurs. 2018 Jul/Sep;29(3):188-195. doi: 10.1097/JAN.0000000000000235.

Comment: One-third filled the prescription. Distribution models remain the essential linchpin for naloxone programming.

33) Naloxone Academic Detailing: Role of Community Outreach Teaching.

Abd-Elsayed A, Albert CA, Fischer M, Anderson B.

Curr Pain Headache Rep. 2018 Aug 27;22(11):72. doi: 10.1007/s11916-018-0730-4. Review.

Comment: Another paper showing that academic detailing is effective at increasing naloxone prescribing.

1) Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States.

Khan SQ, Berrington de Gonzalez A, Best AF, Chen Y, Haozous EA, Rodriquez EJ, Spillane S, Thomas DA, Withrow D, Freedman ND, Shiels MS.

JAMA Pediatr. 2018 Oct 1:e183317. doi: 10.1001/jamapediatrics.2018.3317. [Epub ahead of print]

Comment: U.S. is not looking so good due to drug overdose deaths.

2) An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada.

Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K.

Subst Abuse Treat Prev Policy. 2018 Nov 27;13(1):41. doi: 10.1186/s13011-018-0180-3.

Comment:  This study compares young to older cohorts of people in Vancouver who use prescription opioids non-medically, although the two cohorts may have some qualitative differences that make them challenging to compare. 

3) Evaluating opioid overdose using the National Violent Death Reporting System, 2016.

Clinton HA, Hunter AA, Logan SB, Lapidus GD.

Drug Alcohol Depend. 2018 Nov 15;194:371-376. doi: 10.1016/j.drugalcdep.2018.11.002. [Epub ahead of print]

Comment:  People who die of prescription opioid overdose tend to be relatively older and include more women, compared to deaths from illicit opioid toxicity.

4) How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken by lay first-responders during overdose emergencies.

Neale J, Brown C, Campbell ANC, Jones JD, Metz VE, Strang J, Comer SD.

Addiction. 2018 Nov 26. doi: 10.1111/add.14510. [Epub ahead of print]

Comment:  Very.

5) Development and evaluation of a pilot overdose education and naloxone distribution program for hospitalized general medical patients.

Jakubowski A, Pappas A, Isaacsohn L, Castillo F, Masyukova M, Silvera R, Holaday L, Rausch E, Farooq S, Veltri KT, Cunningham CO, Bachhuber MA.

Subst Abus. 2018 Nov 26:1-5. doi: 10.1080/08897077.2018.1518836. [Epub ahead of print]

Comment:  Providing naloxone in inpatient settings works well and reaches many individuals who don’t access naloxone from distribution programs.

6) Generational trends and patterns in readmission within a statewide cohort of clients receiving heroin use disorder treatment in Maryland, 2007-2013.

Rezai-Zadeh KP, Engstrom RN, Sharma A, Chen Y, Chu J, Cox RP, Lee MT.

J Subst Abuse Treat. 2019 Jan;96:82-91. doi: 10.1016/j.jsat.2018.10.010. Epub 2018 Nov 2.

Comment:  Autors suggest that millennials are frequently readmitted for treatment of heroin use disorder and generally resistant to treatment.

7) Fentanyl exposure among patients seeking opioid treatment.

Ochalek TA, Parker MA, Higgins ST, Sigmon SC.

J Subst Abuse Treat. 2019 Jan;96:23-25. doi: 10.1016/j.jsat.2018.10.007. Epub 2018 Oct 17.

Comment:  People coming in for opioid use disorder treatment are frequently positive for both heroin and fentanyl.

8) Using Network and Spatial Data to Better Target Overdose Prevention Strategies in Rural Appalachia.

Rudolph AE, Young AM, Havens JR.

J Urban Health. 2018 Nov 21. doi: 10.1007/s11524-018-00328-y. [Epub ahead of print]

Comment:  Great to see network data applied to overdose in a manner that moves both fields forward. 

9) Reversal and prevention of the respiratory-depressant effects of heroin by the novel µ opioid receptor antagonist methocinnamox in rhesus monkeys.

Gerak LR, Maguire DR, Woods JH, Husbands SM, Disney A, France CP.

J Pharmacol Exp Ther. 2018 Nov 21. pii: jpet.118.253286. doi: 10.1124/jpet.118.253286. [Epub ahead of print]

Comment:  Opioid antagonist that lasts many days – I’m not clear that this is an improvement over the short-term antagonism of naloxone. Would it be ethical to administer a long-term opioid antagonist in an emergency situation without the consent of a patient? Would it be safe given possible subsequent drug use behaviors?

10) Utilizing Buprenorphine in the Emergency Department after Overdose.

Johns SE, Bowman M, Moeller FG.

Trends Pharmacol Sci. 2018 Dec;39(12):998-1000. doi: 10.1016/j.tips.2018.10.002.

Comment:  Lots of work going on in this domain.

11) Pharmacological Research as a Key Component in Mitigating the Opioid Overdose Crisis.

Baumann MH, Kopajtic TA, Madras BK.

Trends Pharmacol Sci. 2018 Dec;39(12):995-998. doi: 10.1016/j.tips.2018.09.006.

Comment:  Still not sure we need new opioid antagonists.

12) Prevalent misconceptions about opioid use disorders in the United States produce failed policy and public health responses.

Heimer R, Hawk K, Vermund SH.

Clin Infect Dis. 2018 Nov 17. doi: 10.1093/cid/ciy977. [Epub ahead of print]

Comment:  A nice review of recent history.

13) Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia.

Stam NC, Gerostamoulos D, Smith K, Pilgrim JL, Drummer OH.

Clin Toxicol (Phila). 2018 Nov 17:1-6. doi: 10.1080/15563650.2018.1529319. [Epub ahead of print]

Comment:  Authors correctly note that most fatal overdose events are unwitnessed and that the availability of naloxone would only be expected to improve the outcome of events that are witnessed (17% of cases in this study – and about half of those involved a witness who may not have been able to effectively respond). This is consistent with prior modeling of naloxone and the anticipated modest effect on mortality.

14) Assessing pharmacy student experience with, knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction.

Mahon LR, Hawthorne AN, Lee J, Blue H, Palombi L.

Harm Reduct J. 2018 Nov 16;15(1):57. doi: 10.1186/s12954-018-0262-6.

Comment:  Survey of incoming first-year pharmacy students shows excellent opportunities for education.

15) The Emergency Department as an Opportunity for Naloxone Distribution.

Gunn AH, Smothers ZPW, Schramm-Sapyta N, Freiermuth CE, MacEachern M, Muzyk AJ.

West J Emerg Med. 2018 Nov;19(6):1036-1042. doi: 10.5811/westjem.2018.8.38829. Epub 2018 Sep 10. Review.

Comment:  Systematic review of 5 studies of naloxone distribution from EDs showing that uptake is very challenging.

16) [The American opioid overdose crisis: A threat for France?]

Vodovar D, Langrand J, Tournier N, Mégarbane B.

Rev Med Interne. 2018 Nov 11. pii: S0248-8663(18)31164-0. doi: 10.1016/j.revmed.2018.10.389. [Epub ahead of print] French. 

Comment:  Situation “worrying”, but nothing like the U.S. crisis.

17) A Public Health Strategy for the Opioid Crisis.

Saloner B, McGinty EE, Beletsky L, Bluthenthal R, Beyrer C, Botticelli M, Sherman SG.

Public Health Rep. 2018 Nov/Dec;133(1_suppl):24S-34S. doi: 10.1177/0033354918793627.

Comment:  Nice review of strategies. 

18) Blocking drug activation as a therapeutic strategy to attenuate acute toxicity and physiological effects of heroin.

Zhang T, Zheng X, Kim K, Zheng F, Zhan CG.

Sci Rep. 2018 Nov 13;8(1):16762. doi: 10.1038/s41598-018-35196-8.

Comment:  Using antagonists for heroin use disorder treatment. Always risky, sometimes has a benefit.

19) Provision of Naloxone Without a Prescription by California Pharmacists 2 Years After Legislation Implementation.

Puzantian T, Gasper JJ.

JAMA. 2018 Nov 13;320(18):1933-1934. doi: 10.1001/jama.2018.12291. No abstract available. 

Comment:  Limited.

20) Historical Review: Opiate Addiction and Opioid Receptors.

Wang S.

Cell Transplant. 2018 Nov 13:963689718811060. doi: 10.1177/0963689718811060. [Epub ahead of print]

Comment:  Neurobiology of opioid use disorder.

21) Postmortem Toxicology of New Synthetic Opioids.

Concheiro M, Chesser R, Pardi J, Cooper G.

Front Pharmacol. 2018 Oct 26;9:1210. doi: 10.3389/fphar.2018.01210. eCollection 2018. Review.

Comment:  Determining which drugs are responsible for death is always challenging, particularly as new symthetic drugs enter the market.

22) Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries.

Peters JL, Durand WM, Monteiro KA, Dumenco L, George P.

J Am Board Fam Med. 2018 Nov-Dec;31(6):881-896. doi: 10.3122/jabfm.2018.06.180152.

Comment: The link between the U.S. shift from welfare to disability for support of those in need and the opioid crisis is well established. In this study, disability recipients accounted for 11.7% of hospitalizations for opioid overdose. Of note, most opioid overdose events don’t result in hospitalization, so this proportion may be more representative of complicated overdose events rather than overdose events outright.

23) Vaccination reduces fentanyl distribution to the brain and fentanyl-induced toxicity in mice and rats: a potential role for a prophylactic vaccine against fentanyl-induced overdose.

Raleigh MD, Baruffaldi F, Peterson SJ, Le Naour M, Harmon TM, Vigliaturo JR, Pentel PR, Pravetoni M.

J Pharmacol Exp Ther. 2018 Nov 8. pii: jpet.118.253674. doi: 10.1124/jpet.118.253674. [Epub ahead of print]

Comment: A fentanyl vaccine. Interesting.

24) Routine opioid outcome monitoring in community pharmacy: Pilot implementation study protocol.

Nielsen S, Kowalski M, Wood P, Larney S, Bruno R, Shanahan M, Lenton S, Dietze P, Green T, Murnion B, Ritter A.

Res Social Adm Pharm. 2018 Oct 22. pii: S1551-7411(18)30285-7. doi: 10.1016/j.sapharm.2018.10.024. [Epub ahead of print]

Comment: Study protocol for intervention for pharmacists working on overdose and naloxone.

25) Non-fatal opioid-related overdoses among adolescents in Massachusetts 2012-2014.

Chatterjee A, Larochelle MR, Xuan Z, Wang N, Bernson D, Silverstein M, Hadland SE, Land T, Samet JH, Walley AY, Bagley SM.

Drug Alcohol Depend. 2018 Oct 25;194:28-31. doi: 10.1016/j.drugalcdep.2018.09.020. [Epub ahead of print]

Comment: Great study from a fantastic dataset proving critical to developing comprehensive public health responses to the overdose crisis. Adolescents were less likely than adults to be prescribed opioids or to receive medications for opioid use disorder before or after the overdose event – only 8% of adolescents got medications after the overdose, compared to 29% of adults. Interestingly, the majority of adolescent overdose events were among females.

26) Trends and correlates of perceived access to heroin among young adults in the United States, 2002-2016.

Salas-Wright CP, Oh S, Vaughn MG, Muroff J, Amodeo M, Delva J.

Drug Alcohol Depend. 2018 Dec 1;193:169-176. doi: 10.1016/j.drugalcdep.2018.09.009. Epub 2018 Oct 18.

Comment: Many adolescents think it impossible to obtain heroin – that proportion rose from 31% in 2002 to 41% in 2016.

27) Case Report: 28-year-old Woman With Opioid Use Disorder Delivers Healthy Baby While in Custody: Addressing Forced Detox.

Gray J, Saia K, Walley AY.

J Addict Med. 2018 Oct 30. doi: 10.1097/ADM.0000000000000468. [Epub ahead of print]

Comment: Medications for opioid use disorder are critical, even more so for the vulnerable populations often inappropriately denied such access – including incarcerated persons and pregnant women.

28) Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity.

Toce MS, Chai PR, Burns MM, Boyer EW.

J Med Toxicol. 2018 Dec;14(4):306-322. doi: 10.1007/s13181-018-0685-1. Epub 2018 Oct 30. Review.

Comment: Review of medications used in opioid use disorder, including treatment agents (buprenorphine, methadone) and medications to manage symptoms / alternative therapies such as clonidine, kratom, loperamide, lofexidine, akuamma seeds, kava, and gabapentin.

29) Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.

Samples H, Williams AR, Olfson M, Crystal S.

J Subst Abuse Treat. 2018 Dec;95:9-17. doi: 10.1016/j.jsat.2018.09.001. Epub 2018 Sep 7.

Comment: Those more likely to discontinue were started on a lower dose of buprenorphine, male, younger, Black or Latinx, or had capitated insurance, other substance use disorders, HCV, prior overdose, or prior inpatient care. Besides the lower initial dose of buprenorphine and minority race/ethnicity, the other factors appear consistent well known barriers to treatment.

30) Trends in Overdose-Related Out-of-Hospital Cardiac Arrests in Arizona.

Smith G, Beger S, Vadeboncoeur T, Chikani V, Walter F, Bobrow B.

Resuscitation. 2018 Oct 20. pii: S0300-9572(18)31014-1. doi: 10.1016/j.resuscitation.2018.10.019. [Epub ahead of print]

Comment: Evaluating out-of-hospital cardiac arrests for cardiac versus drug toxicity as the etiology is fascinating and extremely important for national guidelines – including American Heart Association guidelines and training. The proportion of arrests due to drug overdose increased from 4.7% in 2010 to 6.6% in 2015.

31) Use of rapid fentanyl test strips among young adults who use drugs.

Krieger MS, Goedel WC, Buxton JA, Lysyshyn M, Bernstein E, Sherman SG, Rich JD, Hadland SE, Green TC, Marshall BDL.

Int J Drug Policy. 2018 Oct 12. pii: S0955-3959(18)30246-9. doi: 10.1016/j.drugpo.2018.09.009. [Epub ahead of print]

Comment: People used fentanyl test strips and reported improved overdose risk behaviors after getting a positive fentanyl result.

32) Characterizing fentanyl-related overdoses and implications for overdose response: Findings from a rapid ethnographic study in Vancouver, Canada.

Mayer S, Boyd J, Collins A, Kennedy MC, Fairbairn N, McNeil R.

Drug Alcohol Depend. 2018 Dec 1;193:69-74. doi: 10.1016/j.drugalcdep.2018.09.006. Epub 2018 Oct 12.

Comment: At this stage, fentanyl is well-established to result in more rapid overdose and some cases of chest wall rigidity.

33) Safety of a Modified Community Trailer to Manage Patients with Presumed Fentanyl Overdose.

Scheuermeyer FX, Grafstein E, Buxton J, Ahamad K, Lysyshyn M, DeVlaming S, Prinsloo G, Van Veen C, Kestler A, Gustafson R.

J Urban Health. 2018 Oct 15. doi: 10.1007/s11524-018-0321-z. [Epub ahead of print]

Comment: I recall about 20 years ago walking through the Lower East Side of NYC and observing paramedics treat a person for overdose. They then put the man in the ambulance. The man walked out of the side door while the paramedics climbed in the rear. They came out and put the man back in the ambulance. While they walked out of the side door, the man walked out the back of the ambulance. This went in circles for some time, until the man eventually escaped and ran down the street. That is a failure to provide the care that people want.

34) Cost-effectiveness of naloxone kits in secondary schools.

Cipriano LE, Zaric GS.

Drug Alcohol Depend. 2018 Nov 1;192:352-361. doi: 10.1016/j.drugalcdep.2018.08.003. Epub 2018 Sep 17.

Comment: Unlikely to meet any standard of cost-effectiveness.

35) Pharmacists’ knowledge, support, and perceived roles associated with providing naloxone in the community.

Stewart B, Thomas RL, Tutag-Lehr V.

Curr Pharm Teach Learn. 2018 Aug;10(8):1013-1021. doi: 10.1016/j.cptl.2018.05.016. Epub 2018 Jun 7.

Comment: Some pharmacists are very much on top of these issues.

36) Commentary: The opioid overdose epidemic: Evidence-based interventions.

Barglow P.

Am J Addict. 2018 Oct 12. doi: 10.1111/ajad.12823. [Epub ahead of print]

Comment: Authors note that sharp opioid dose restrictions result in increased heroin and fentanyl use. I haven’t read the full paper, but am unclear if they have solid data for this, although it is likely true.

37) Cognitive and socio-cognitive functioning of chronic non-medical prescription opioid users.

Kroll SL, Nikolic E, Bieri F, Soyka M, Baumgartner MR, Quednow BB.

Psychopharmacology (Berl). 2018 Dec;235(12):3451-3464. doi: 10.1007/s00213-018-5060-z. Epub 2018 Oct 11.

Comment: Morphine hair concentrations were related to deficits in recognizing emotion from faces, bodies, and complex scenes, in a dose-dependent fashion.

38) Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study.

Gano L, Renshaw SE, Hernandez RH, Cronholm PF.

Fam Med. 2018 Oct;50(9):698-701. doi: 10.22454/FamMed.2018.757385.

Comment: 50% of family medicine clerkships addressed providing naloxone – that’s pretty good given the novelty of the intervention for medical systems.

39) The Fentanyl Epidemic and Evolution of Fentanyl Analogs in the United States and the European Union.

Jannetto PJ, Helander A, Garg U, Janis GC, Goldberger B, Ketha H.

Clin Chem. 2018 Oct 10. pii: clinchem.2017.281626. doi: 10.1373/clinchem.2017.281626. [Epub ahead of print] Review.

Comment: This is a global crisis.

40) The Opioid Epidemic and the Role of the Occupational Health Nurse.

Higgins SA, Simons J.

Workplace Health Saf. 2018 Oct 10:2165079918796242. doi: 10.1177/2165079918796242. [Epub ahead of print]

Comment: Occupational health and management of opioid use disorder.

41) Characteristics of Patients With Opioid Use Disorder Associated With Performing Overdose Reversals in the Community: An Opioid Treatment Program Analysis.

Katzman JG, Greenberg NH, Takeda MY, Moya Balasch M.

J Addict Med. 2018 Oct 9. doi: 10.1097/ADM.0000000000000461. [Epub ahead of print]

Comment: Interesting analysis. The first such analysis was a study of naloxone recipients from a naloxone distribution program. That study found that those who had previously witnessed an overdose or used heroin or methamphetamine were most likely to use naloxone to reverse an overdose. This study, among patients seeking treatment for opioid use disorder, finds such an association with having previously witnessed an overdose and testing positive for 2 or more illicit drugs, but also accessing emergency medical care for their own overdose, being younger, and being Latinx.

42) Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States.

Peiper NC, Clarke SD, Vincent LB, Ciccarone D, Kral AH, Zibbell JE.

Int J Drug Policy. 2018 Oct 3. pii: S0955-3959(18)30213-5. doi: 10.1016/j.drugpo.2018.08.007. [Epub ahead of print]

Comment: Second study from this update finding that use of fentanyl test strips was associated with fewer overdose risk behaviors.

43) “Feeling confident and equipped”: Evaluating the acceptability and efficacy of an overdose response and naloxone administration intervention to service industry employees in New York City.

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

Drug Alcohol Depend. 2018 Nov 1;192:362-370. doi: 10.1016/j.drugalcdep.2018.08.001. Epub 2018 Sep 21.

Comment: Training service industry workers in overdose response / naloxone administration.

44) Understanding an emerging treatment population: Protocol for and baseline characteristics of a prospective cohort of people receiving treatment for pharmaceutical opioid dependence.

Nielsen S, Lintzeris N, Murnion B, Degenhardt L, Bruno R, Haber P, Johnson J, Hardy M, Ling S, Saddler C, Dunlop A, Demirkol A, Silsbury C, Phung N, Houseman J, Larance B.

Drug Alcohol Rev. 2018 Nov;37(7):887-896. doi: 10.1111/dar.12859. Epub 2018 Oct 2.

Comment: Most had commenced opioids for pain – and these were older than the others.

45) Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches.

Waye KM, Goyer J, Dettor D, Mahoney L, Samuels EA, Yedinak JL, Marshall BDL.

Addict Behav. 2019 Feb;89:85-91. doi: 10.1016/j.addbeh.2018.09.027. Epub 2018 Sep 25.

Comment: Peer services at the emergency department appears to be highly effective at getting naloxone into the hands of patients and establishing future outreach contact.

46) Commentary. Fentanyl-related death and the underreporting risk.

D’Errico S.

J Forensic Leg Med. 2018 Nov;60:35-37. doi: 10.1016/j.jflm.2018.09.007. Epub 2018 Sep 21.

Comment: More forensic work needed.

46) EMS naloxone administration as non-fatal opioid overdose surveillance: 6-year outcomes in Marion County, Indiana.

Ray BR, Lowder EM, Kivisto AJ, Phalen P, Gil H.

Addiction. 2018 Dec;113(12):2271-2279. doi: 10.1111/add.14426. Epub 2018 Sep 26.

Comment: Of 4726 patients administered naloxone in Marion County, Indiana, 9.4% died in about a year on average. The 13.4% with repeated non-fatal overdose events were twice as likely to die and 3 times as likely to die from a drug-related cause.

47) Delay-Dependent Impairments in Memory and Motor Functions After Acute Methadone Overdose in Rats.

Ahmad-Molaei L, Hassanian-Moghaddam H, Farnaghi F, Tomaz C, Haghparast A.

Front Pharmacol. 2018 Sep 10;9:1023. doi: 10.3389/fphar.2018.01023. eCollection 2018.

Comment: Methadone overdose as a cause of delayed neurologic/cognitive disorders.

48) Detection and Quantitation of Trace Fentanyl in Heroin by Surface-Enhanced Raman Spectroscopy.

Haddad A, Comanescu MA, Green O, Kubic TA, Lombardi JR.

Anal Chem. 2018 Nov 6;90(21):12678-12685. doi: 10.1021/acs.analchem.8b02909. Epub 2018 Oct 8.

Comment: More forensics.

49) Buprenorphine treatment formulations: Preferences among persons in opioid withdrawal management.

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

J Subst Abuse Treat. 2018 Nov;94:55-59. doi: 10.1016/j.jsat.2018.08.011. Epub 2018 Aug 28.

Comment: Past overdose was associated with willingness to start buprenorphine – that’s an important result. About half preferred a sublingual formulation, while the others would opt for an injection or buccal implant.

50) Factors associated with methadone maintenance therapy discontinuation among people who inject drugs.

Lo A, Kerr T, Hayashi K, Milloy MJ, Nosova E, Liu Y, Fairbairn N.

J Subst Abuse Treat. 2018 Nov;94:41-46. doi: 10.1016/j.jsat.2018.08.009. Epub 2018 Aug 23.

Comment: Lack of financial support, incarceration, and homelessness were associated with stopping methadone therapy.

51) Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island: Safety, dose, retention, and relapse at 6 months.

Stone AC, Carroll JJ, Rich JD, Green TC.

Drug Alcohol Depend. 2018 Nov 1;192:94-97. doi: 10.1016/j.drugalcdep.2018.07.019. Epub 2018 Aug 25.

Comment: Methadone still works in the context of fentanyl.

52) Acceptability of prison-based take-home naloxone programmes among a cohort of incarcerated men with a history of regular injecting drug use.

Curtis M, Dietze P, Aitken C, Kirwan A, Kinner SA, Butler T, Stoové M.

Harm Reduct J. 2018 Sep 21;15(1):48. doi: 10.1186/s12954-018-0255-5.

Comment: Yes, prisoners will accept naloxone. Just give it to them!!!

53) Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016.

Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS.

Science. 2018 Sep 21;361(6408). pii: eaau1184. doi: 10.1126/science.aau1184.

Comment: Fascinating look at the opioid crisis as just the latest wave in a 38+ year trend of increasing drug overdose mortality.

54) Near-fatal Intoxication with the “New” Synthetic Opioid U-47700: The First Reported Case in the Czech Republic.

Židková M, Horsley R, Hloch O, Hložek T.

J Forensic Sci. 2018 Sep 19. doi: 10.1111/1556-4029.13903. [Epub ahead of print]

Comment: Bummer.

55) The Opioid Crisis in Missouri: A Call to Action for Physicians, Legislators, and Society.

Lewis L, Carpenter CR, Schwarz ES, Jotte RS, Waller C, Winograd R, Williams R, Stenger S, Rehder H, Governick S, Giuffra L.

Mo Med. 2017 Nov-Dec;114(6):440-446.

Comment: Why are there barriers to accessing medications for opioid use disorder treatment?

56) Emerging Evidence for Cannabis’ Role in Opioid Use Disorder.

Wiese B, Wilson-Poe AR.

Cannabis Cannabinoid Res. 2018 Sep 1;3(1):179-189. doi: 10.1089/can.2018.0022. eCollection 2018. Review.

Comment: Cannabis effects seem to be highly dependent upon set and setting (i.e. expected effects and environment). I wonder if there is a way to leverage cannabis toward treatment ends by adding a counseling component to medical cannabis recommendations.

57) Correlations between population-levels of prescription opioid dispensing and related deaths in Ontario (Canada), 2005-2016.

Fischer B, Jones W, Varatharajan T, Malta M, Kurdyak P.

Prev Med. 2018 Nov;116:112-118. doi: 10.1016/j.ypmed.2018.09.001. Epub 2018 Sep 11.

Comment: Yes, there are correlations.

58) Evaluation of a fentanyl drug checking service for clients of a supervised injection facility, Vancouver, Canada.

Karamouzian M, Dohoo C, Forsting S, McNeil R, Kerr T, Lysyshyn M.

Harm Reduct J. 2018 Sep 10;15(1):46. doi: 10.1186/s12954-018-0252-8.

Comment: Another fentanyl test paper.- this one showing that most didn’t want drugs checked.

59) State Unintentional Drug Overdose Reporting Surveillance: Opioid Overdose Deaths and Characteristics in Rhode Island.

Jiang Y, McDonald JV, Goldschmidt A, Koziol J, McCormick M, Viner-Brown S, Alexander-Scott N.

R I Med J (2013). 2018 Sep 4;101(7):25-30.

Comment: Most decedents had substance use disorder diagnoses, multiple drugs attributed to death, and fentanyl as one contributing drug.

60) Acceptability of Naloxone Dispensing Among Pharmacists.

Do V, Behar E, Turner C, Geier M, Coffin P.

J Pharm Pract. 2018 Sep 4:897190018798465. doi: 10.1177/0897190018798465. [Epub ahead of print]

Comment: This paper on pharmacist acceptability of naloxone was done prior to FDA-approval of formulations intended for lay administration. It is likely that a similar study today would show even greater acceptability – and fewer concerns.

61) Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates.

Pietrusza LM, Puskar KR, Ren D, Mitchell AM.

J Addict Nurs. 2018 Jul/Sep;29(3):188-195. doi: 10.1097/JAN.0000000000000235.

Comment: Only 33% of patients picked up the naloxone at the pharmacy. Once again, it is clear that we have to reach outside of the established healthcare system in order to properly care for those patients most in need.

62) Naloxone Effectiveness: A Systematic Review.

Chimbar L, Moleta Y.

J Addict Nurs. 2018 Jul/Sep;29(3):167-171. doi: 10.1097/JAN.0000000000000230.

Comment: Unable to access the full paper and the abstract lacks key details needed to evaluate the quality of the study.

63) Opioid Overdose and Naloxone Kit Distribution: A Quality Assurance Educational Program in the Primary Care Setting.

Lockett TL, Hickman KL, Fils-Guerrier BJ, Lomonaco M, Maye JP, Rossiter AG.

J Addict Nurs. 2018 Jul/Sep;29(3):157-162. doi: 10.1097/JAN.0000000000000231.

Comment: Basic education can improve patient management.

64) Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City.

McKnight C, Des Jarlais DC.

Int J Drug Policy. 2018 Oct;60:82-88. doi: 10.1016/j.drugpo.2018.08.004. Epub 2018 Aug 31.

Comment: Interview study. “PWUD utilized test shots, a consistent drug dealer, fentanyl test strips, naloxone, getting high with or near others and reducing drug use to protect from overdose.”

65) An overview of take-home naloxone programs in Australia.

Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, Lintzeris N, Oh G, Dicka J, Fry CL, Hayllar J, Lenton S.

Drug Alcohol Rev. 2018 May;37(4):440-449. doi: 10.1111/dar.12812.

Comment: Evaluation data of naloxone programs in Australia.

66) Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula.

Ratycz MC, Papadimos TJ, Vanderbilt AA.

Med Educ Online. 2018 Dec;23(1):1466574. doi: 10.1080/10872981.2018.1466574.

Comment: Agreed.

67) America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis.

Ostling PS, Davidson KS, Anyama BO, Helander EM, Wyche MQ, Kaye AD.

Curr Pain Headache Rep. 2018 Apr 4;22(5):32. doi: 10.1007/s11916-018-0685-5. Review.

Comment: Authors note restrictions on opioid prescribing and costs of naloxone as contributing to the crisis and controlled substance monitoring programs and abuse-deterrent opioid formulations as solutions. Hmm. First, we use the term “controlled substance monitoring programs” because the commonly-used “prescription drug monitoring program” is a misnomer – these systems only track controlled substances. If they tracked all prescription drugs, you can be certain they would be limited to healthcare rather than emphasizing law enforcement access as they currently do. We would also probably have something closer to universal healthcare in the country. Second, I’m not convinced that these interventions have much of an impact on the crisis. 

68) Opioid use and harms associated with a sustained-release tapentadol formulation: a postmarketing study protocol.

Peacock A, Larance B, Farrell M, Cairns R, Buckley N, Degenhardt L.

BMJ Open. 2018 Mar 23;8(3):e020006. doi: 10.1136/bmjopen-2017-020006.

Comment: Study protocol (I’ve noticed that Australian investigators seem to be publishing protocols prior to conducting studies).

69) Assessment of potential opioid toxicity and response to naloxone by rapid response teams at an urban Melbourne hospital.

Gunasekaran B, Weil J, Whelan T, Santamaria J, Boughey M.

Intern Med J. 2018 Feb;48(2):198-200. doi: 10.1111/imj.13692.

Comment: Wide variations in naloxone use and dose, consistent with other studies.

70) 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. Review.

Comment: Still more forensics!

71) 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. 2018 May 1;42(4):255-264. doi: 10.1093/jat/bkx111.

Comment: Accidental drug poisonings among children are really tragic. This brings to mind a separate, but fascinating, story that contributed to the 1980s War on Drugs. That story involved a journalist for the Washington Post who won the Pulitzer Prize for a story on child heroin use that led to a huge citywide search for the subject of the story … and was later established to be entirely fraudulent, long after additional anti-drug legislation was passed in response.

72) 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: This study of naloxone among youth in Vancouver was done in the early days of naloxone in Canada. They have since vastly expanded distribution and I suspect the data would look different today.

73) 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: People do better in multiple aspects of life.

74) 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: Totally.

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

Plescia CJ, Manu P.

Am J Ther. 2018 Mar/Apr;25(2):e267-e269. doi: 10.1097/MJT.0000000000000692.

Comment: Methadone overdose has been associated with hypoglycemia on many occasions. 

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

Petterson AG, Madah-Amiri D.

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

Comment: Give naloxone to prisoners prior to release.

77) A Cross-sectional Survey Using Clinical Vignettes to Examine Overdose Risk Assessment and Willingness to Prescribe Naloxone.

Deanna Wilson J, Berk J, Matson P, Spicyn N, Alvanzo A, Adger H, Feldman L.

J Gen Intern Med. 2018 Nov 7. doi: 10.1007/s11606-018-4733-y. [Epub ahead of print] No abstract available. 

Comment: Survey of resident physicians in Baltimore regarding naloxone prescribing. Authors felt they underestimated overdose risk among patients prescribed opioids – and noted that they didn’t prescribe naloxone to a lot of patients who they felt were at risk for overdose. 

78) Managing the opioid epidemic: back to the basics with resuscitation.

Hung O, Stewart RD, Malpas G, Phipps S, Hung D.

CJEM. 2018 Nov 8:1-2. doi: 10.1017/cem.2018.453. [Epub ahead of print] No abstract available. 

Comment: Authors argue that naloxone should come after establishing rescue breathing and/or chest compressions.

79) Commentary on Rege et al. (2018): Naloxone reports to US poison centers highlight overdose prevention opportunities.

Oliva EM, Bounthavong M.

Addiction. 2018 Dec;113(12):2316-2317. doi: 10.1111/add.14443. Epub 2018 Oct 21. No abstract available. 

Comment: As above.

80) The changing landscape of naloxone availability in the United States, 2011 – 2017.

Freeman PR, Hankosky ER, Lofwall MR, Talbert JC.

Drug Alcohol Depend. 2018 Oct 1;191:361-364. doi: 10.1016/j.drugalcdep.2018.07.017. Epub 2018 Aug 30.

Comment: Big increase in prescribed naloxone since nasal approved by FDA.

81) Peer navigation and take-home naloxone for opioid overdose emergency department patients: Preliminary patient outcomes.

Samuels EA, Bernstein SL, Marshall BDL, Krieger M, Baird J, Mello MJ.

J Subst Abuse Treat. 2018 Nov;94:29-34. doi: 10.1016/j.jsat.2018.07.013. Epub 2018 Aug 1. No abstract available. 

Comment: People who land in the ED with opioid overdose have high rates of mortality in the subsequent year, women and older patients are less likely to be provided with naloxone, and recovery coaches may reduce time to treatment uptake. 

82) Pregnancy and Naltrexone Pharmacotherapy.

Jones CW, Terplan M.

Obstet Gynecol. 2018 Oct;132(4):923-925. doi: 10.1097/AOG.0000000000002864.

Comment: Data do not support naltrexone during pregnancy at this time.

83) Potential Risk Window for Opioid Overdose Related to Treatment with Extended-Release Injectable Naltrexone.

Binswanger IA, Glanz JM.

Drug Saf. 2018 Oct;41(10):979-980. doi: 10.1007/s40264-018-0705-8. No abstract available. 

Comment: There are some data suggesting increased overdose risk in the 1-month after ending injectable naltrexone treatment.

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. 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.

1) Underrepresentation of Heroin Involvement in Unintentional Drug Overdose Deaths in Allegheny County, PA.

Mertz KJ, Janssen JK, Williams KE.

J Forensic Sci. 2014 Jul 16. doi: 10.1111/1556-4029.12541. [Epub ahead of print]

Comments: This manuscript presents critical and very concerning results regarding interpretation of our prescription opioid overdose epidemic. Morphine and codeine are commonly present and without 6-MAM (a third heroin metabolite) present at sufficient levels those deaths are coded as morphine and codeine. On this review of 112 such deaths, 66% met criteria for heroin involvement based on a history of heroin use (which may not be sufficient given the frequent use of other opioids among heroin users), drug paraphernalia or stamp bags, track marks, and detection of 6-MAM (generally at very low levels). Good toxicologists always check for 6-MAM so that shouldn’t be a major issue, but it is conceivable that some of these morphine/codeine cases are in fact heroin – an important caveat as we respond to the epidemic.

2) Legislative strategies other than legalizing illicit opioids may help to reduce overdosefatalities.

Trafton JA, Oliva EM.

Addiction. 2014 Aug;109(8):1243-4. doi: 10.1111/add.12585. No abstract available.

Comments: Authors argue that Good Samaritan and naloxone legislation may be effective strategies to reduce overdose.

3) Prevalence and factors associated with HIV infection among injection drug users atmethadone clinics in Taipei, Taiwan.

Yen YF, Yen MY, Lin T, Li LH, Jiang XR, Chou P, Deng CY.

BMC Public Health. 2014 Jul 4;14(1):682. doi: 10.1186/1471-2458-14-682.

Comments: Again, HIV infection is associated with a history of overdose among persons who inject drugs.

4) Methadone toxicity in a poisoning referral center.

Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi-Mood N, Gheshlaghi F, Farajzadegan Z.

J Res Pharm Pract. 2013 Jul;2(3):130-4. doi: 10.4103/2279-042X.122387.

Comments: an analysis of methadone poisonings in Iran. Among 385 patients, 57.7% of cases were “intentional” and demonstrated high rates of psychiatric disorders (25.8%). Among the full cohort, 40% had opioid use disorders and 25.5% were in a methadone program.

5) Are empty methadone bottles empty? An analytic study.

Dupuy G, Cavalcanti L, Bourgogne E, Brichant-Petitjean C, Gomberoff L, Bloch V, Bellivier F, Lépine JP, Laprévote O, Vorspan F.

Harm Reduct J. 2014 Jul 2;11(1):20. doi: 10.1186/1477-7517-11-20.

Comments: There is residual methadone in take-home containers. Proper disposal or a consideration of alternative deliveries is important to minimize the risk of accidental exposures.

6) Not so fast on naloxone? There’s growing support for non-paramedic use, but keep these cautions in mind.

Goodloe JM.

EMS World. 2014 May;43(5):51-2. No abstract available.

Comments: I’m unable to access this.

7) America embraces treatment for opioid drug overdose.

Alcorn T.

Lancet. 2014 Jun 7;383(9933):1957-8. No abstract available.

Comments: A summary of what’s going on in the United States regarding naloxone.

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

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

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

PMID: 24904666 [PubMed] Free PMC Article

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

2) Brugada Phenocopy in Concomitant Ethanol and Heroin Overdose.

Rambod M, Elhanafi S, Mukherjee D.

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

PMID: 24903622 [PubMed – as supplied by publisher]

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

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

Clark AK, Wilder CM, Winstanley EL.

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

PMID: 24874759 [PubMed – in process]

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

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

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

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

PMID: 24859230 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24854119 [PubMed – in process]

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

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

Wang KH, Fiellin DA, Becker WC.

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

PMID: 24853143 [PubMed – in process]

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

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

Koller AC, Salcido DD, Menegazzi JJ.

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

PMID: 24831102 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24973558 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24821348 [PubMed – in process]

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

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

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

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

PMID: 24811951 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24795288 [PubMed – as supplied by publisher]

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

12) Intranasal naloxone for treatment of opioid overdose.

[No authors listed]

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

PMID: 24662159 [PubMed – indexed for MEDLINE]

Comments: Unable to access.

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

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

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

PMID: 24131165 [PubMed – indexed for MEDLINE]

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

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

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

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

PMID: 23350582 [PubMed – indexed for MEDLINE]

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

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

Stöver HJ, Schäffer D.

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

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

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

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

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

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

PMID: 24938727 [PubMed – as supplied by publisher]

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

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

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

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

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

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

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

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

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

PMID: 24931395 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24925493 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24922133 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24909124 [PubMed – as supplied by publisher]

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

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

Mettner J.

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

PMID: 24868924 [PubMed – indexed for MEDLINE]

Comments: Can’t access.

22) Heroin: life, death, and politics.

Jacobson J.

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

PMID: 24759473 [PubMed – indexed for MEDLINE]

Comments: A news article on naloxone.

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

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

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

PMID: 24589873 [PubMed – indexed for MEDLINE]

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

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

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

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

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

Comments: In-prison methadone maintenance.

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

Nielsen MK, Johansen SS, Linnet K.

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

PMID: 23891033 [PubMed – indexed for MEDLINE]

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

1) Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study.

Doe-Simkins M, Quinn E, Xuan Z, Sorensen-Alawad A, Hackman H, Ozonoff A, Walley AY.

BMC Public Health. 2014 Apr 1;14(1):297. [Epub ahead of print]

Comments: Sometimes naloxone is used by bystanders who have not been formally educated (or “trained”) in administering naloxone. This innovative analysis suggests that the untrained witness does a good job in lay naloxone administration.

2) Easy-to-use overdose antidote earns fast-track approval.

Kuehn BM.

JAMA. 2014 Apr 23-30;311(16):1600. doi: 10.1001/jama.2014.4483. No abstract available.

Comments: The naloxone auto-injector – Evzio – has been approved and is expected to be available this summer.

3) Research gaps on methadone harms and comparative harms: findings from a review of the evidence for an american pain society and college on problems of drug dependence clinical practice guideline.

Weimer MB, Chou R.

J Pain. 2014 Apr;15(4):366-76. doi: 10.1016/j.jpain.2014.01.496.

Comments: Basic summary is that it’s not entirely clear why there was such a surge in methadone-related deaths in the early part of the 2000s. It’s important to remember that the surge came after a surge in oxycontin-related deaths, when many payers shifted their preferred agent from oxycontin to methadone. Mortality data seems to follow the trend of the most prescribed agent.

4) Paramedic-supplied ‘Take Home’ Naloxone: protocol for cluster randomised feasibility study.

Moore C, Lloyd G, Oretti R, Russell I, Snooks H.

BMJ Open. 2014 Mar 20;4(3):e004712. doi: 10.1136/bmjopen-2013-004712.

Comments: Outstanding, innovative design to reach those at very high risk of future overdose events. I anxiously await results.

5) Intranasal naloxone for treatment of opioid overdose.

[No authors listed]

Med Lett Drugs Ther. 2014 Mar 17;56(1438):21-4. No abstract available.

Comments: Can’t access.

6) Long-term opioids and naloxone administration in a district general hospital.

Facey C, Brooks D.

BMJ Support Palliat Care. 2014 Mar;4 Suppl 1:A103. doi: 10.1136/bmjspcare-2014-000654.297.

Comments: All I see is an abstract here that suggests naloxone is being over-administered to patients on long-acting opioids in the inpatient setting. This is hard to assess without more details, including the context of the facility, but I am somewhat skeptical of the authors stark conclusions. The authors state that the only reason to administer naloxone is respiratory depression. There are flaws with this – providers often don’t document respiratory rate or use default parameters and don’t actually measure the rate; oxygenation is often a far better parameter; and there are other reasons to administer naloxone in a monitored setting, such as hypotension which is often caused by opioids and may be somewhat improved with naloxone.

7) Management of opioid addiction with buprenorphine: French history and current management.

Poloméni P, Schwan R.

Int J Gen Med. 2014 Mar 3;7:143-8. doi: 10.2147/IJGM.S53170. eCollection 2014.

Comments: A history and update on opioid use disorder management in France, including summary of the remarkable impact of buprenorphine on overdose mortality in that country.

8) Methadone overdose and cardiac arrhythmia potential: findings from a review of the evidence for an american pain society and college on problems of drug dependence clinical practice guideline.

Chou R, Weimer MB, Dana T.

J Pain. 2014 Apr;15(4):338-65. doi: 10.1016/j.jpain.2014.01.495.

Comments: Methadone has a long history of potential issues with the QT phase of the cardiac cycle (we’ve discussed this before on this blog so I won’t include a nifty cardiac cycle picture again here). One question with the surge in methadone deaths was if it was related to the lengthening of the QT interval. The basic summary is that there’s no data to support that at this time.

9) Methadone safety: a clinical practice guideline from the american pain society and college on problems of drug dependence, in collaboration with the heart rhythm society.

Chou R, Cruciani RA, Fiellin DA, Compton P, Farrar JT, Haigney MC, Inturrisi C, Knight JR, Otis-Green S, Marcus SM, Mehta D, Meyer MC, Portenoy R, Savage S, Strain E, Walsh S, Zeltzer L.

J Pain. 2014 Apr;15(4):321-37. doi: 10.1016/j.jpain.2014.01.494.

Comments: No recommendations were based on high-quality data.

10) Methadone Overdose and Withdrawal in a Tetraplegic Patient: A Case Report.

Connelly P, Wu H.

PM R. 2014 Mar 2. pii: S1934-1482(14)00098-7. doi: 10.1016/j.pmrj.2014.02.012. [Epub ahead of print] No abstract available.

Comments: Methadone is metabolized by enzymes in the liver that are also affected by other common drugs. In this case ciprofloxacin and phenytoin messed up the metabolism and caused overdose, then withdrawal. This is also a reminder that overdose isn’t always evidence of a substance use disorder – it is a risk of ‘risky medications’ not necessarily ‘risky patients.’

11) High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in OverdoseDeaths.

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

JAMA Intern Med. 2014 Mar 3. doi: 10.1001/jamainternmed.2013.12711. [Epub ahead of print]

Comments: Risk factors for death were high dose opioid prescription and using multiple providers – 55% of deaths had one of these risk factors. What’s interesting, however, is the other 45%, who did not have any of these risk factors.

12) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2014 Jan 7;186(1):17. doi: 10.1503/cmaj.109-4663. Epub 2013 Nov 25. No abstract available.

Comments: A news article in the journal regarding naloxone programs.

13) Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.

Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, Di Capua P, Chou R.

Ann Intern Med. 2014 Jan 7;160(1):38-47. doi: 10.7326/0003-4819-160-1-201401070-00732. Review.

Comments: There are lots of guidelines for reducing risk with opioid prescribing but no data.

14) Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers – United States, 2002-2004 and 2008-2010.

Jones CM.

Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi: 10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12.

Comments: Opioid use precedes heroin use, heroin use is going up.

15) “SALOME gave my dignity back”: the role of randomized heroin trials in transforming lives in the Downtown Eastside of Vancouver, Canada.

Jozaghi E.

Int J Qual Stud Health Well-being. 2014 Mar 13;9:23698. doi: 10.3402/qhw.v9.23698. eCollection 2014.

Comments: Personal level experience in heroin treatment programs.

16) ‘Lingering’ opiate deaths? Concentration of opiates in medulla and femoral blood.

Naso-Kaspar CK, Herndon GW, Wyman JF, Felo JA, Lavins ES, Gilson TP.

J Anal Toxicol. 2013 Oct;37(8):507-11. doi: 10.1093/jat/bkt061. Epub 2013 Jul 18.

Comments: Analysis of opiate levels from femoral and cerebral sources suggesting opiates linger in the brain – authors suggest this may explain low blood opioid levels in overdose deaths but I’m not sure that’s a reasonable conclusion.

17) Is opioid substitution treatment beneficial if injecting behaviour continues?

Gjersing L, Bretteville-Jensen AL.

Drug Alcohol Depend. 2013 Nov 1;133(1):121-6. doi:

Comments: Yes.

18) Medication-Assisted Therapies – Tackling the Opioid-Overdose Epidemic.

Volkow ND, Frieden TR, Hyde PS, Cha SS.

N Engl J Med. 2014 Apr 23. [Epub ahead of print]

Comments: A discussion of methadone, buprenorphine and naltrexone as responses to the opioid overdose epidemic.

19) Poisonings requiring admission to the pediatric intensive care unit: A 5-year review.

Even KM, Armsby CC, Bateman ST.

Clin Toxicol (Phila). 2014 Apr 17. [Epub ahead of print]

Comments: An increasing proportion of pediatric poisonings involve opioids.

20) Opioid-related mortality and filled prescriptions for buprenorphine and methadone.

Wikner BN, Ohman I, Seldén T, Druid H, Brandt L, Kieler H.

Drug Alcohol Rev. 2014 Apr 16. doi: 10.1111/dar.12143. [Epub ahead of print]

Comments: Rarely does methadone or buprenorphine prescribed for maintenance result in death. I can’t access the full article so cannot assess quality.

21) Unexpected variation of the codeine/morphine ratio following fatal heroin overdose.

Gambaro V, Argo A, Cippitelli M, Dell’acqua L, Farè F, Froldi R, Guerrini K, Roda G, Rusconi C, Procaccianti P.

J Anal Toxicol. 2014 Jun;38(5):289-94. doi: 10.1093/jat/bku016. Epub 2014 Apr 11.

Comments: Codeine may accumulate in brain tissue more than morphine (heroin’s major metabolites are codeine, morphine, and 6-monoacetylmorphine).

22) Suboxone versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Nov 14.

Comments: They are similar.

23) [No opiates against cannabis hyperemesis syndrome].

Bonnet U, Stratmann U, Isbruch K.

Dtsch Med Wochenschr. 2014 Feb;139(8):375-7. doi: 10.1055/s-0033-1360065. Epub 2014 Feb 11. German.

Comments: An odd case report.

24) Analyzing methadone-related deaths.

Newman RG.

J Addict Med. 2014 Jan-Feb;8(1):73. doi: 10.1097/ADM.0000000000000014. No abstract available.

Comments: A letter responding to “Methadone-related overdose deaths in rural Virginia: 1997 to 2003” – I can’t access.

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

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

Subst Abuse Treat Prev Policy. 2014 Feb 27;9(1):12. [Epub ahead of print]

Comment: Seeking alternative explanations for “overdose”, the authors explored histamine levels in heroin using individuals. They found that heroin users had greater spikes in histamine levels when exposed to IV heroin compared to oral morphine. They hypothesized that this may explain why so many cases of overdose have a sublethal concentration of opioids, but this seems an overreach based on their data.

2) Effective use of naloxone among people who inject drugs in Kyrgyzstan and Tajikistan using pharmacy- and community-based distribution approaches.

Kan M, Gall JA, Latypov A, Gray R, Alisheva D, Rakhmatova K, Sadieva AS.

Int J Drug Policy. 2014 Jan 23. pii: S0955-3959(14)00008-5. doi: 10.1016/j.drugpo.2014.01.005. [Epub ahead of print]

Comment: 47 to 81% of naloxone kits given out in Kyrgyzstan and Tajikistan were used to reverse an overdose – remarkable numbers, from 3 to 5 times higher than seen in western states.

3) Norway tries naloxone in spray form to prevent deaths from drug overdose.

Hansen A.

BMJ. 2014 Feb 20;348:g1686. doi: 10.1136/bmj.g1686. No abstract available.

Comment: Naloxone in Norway.

4) Naloxone induces endoplasmic reticulum stress in PC12 cells.

Seo S, Kwon YS, Yu K, Kim SW, Kwon OY, Kang KH, Kwon K.

Mol Med Rep. 2014 Apr;9(4):1395-9. doi: 10.3892/mmr.2014.1935. Epub 2014 Feb 7.

Comment: I can only see the abstract for this one and the science is outside of my realm – I’m unable to identify anything of apparent clinical relevance.

5) Naloxone for Opioid Overdose Prevention: Pharmacists’ Role in Community-Based Practice Settings.

Bailey AM, Wermeling DP.

Ann Pharmacother. 2014 Feb 12. [Epub ahead of print]

Comment: Very helpful and relevant summary of some pharmacists experience with dispensing naloxone.

6) A case of heroin induced sensorineural hearing loss.

Aulet RM, Flis D, Sillman J.

Case Rep Otolaryngol. 2014;2014:962759. doi: 10.1155/2014/962759. Epub 2014 Jan 6.

Comment: Another case of opioid overdose-related sensorineural hearing loss, which means hearing loss from the cochlea (inner ear). The authors kindly run through some theories, including hypotension (e.g. reduced blood flow to the inner ear), overstimulation of kappa opioid receptors present in the cochlea, or adulteration with an ototoxic substance such as quinine.

7) Overdose prevention in injecting opioid users: The role of substance abuse treatment and training programs.

Sarasa-Renedo A, Espelt A, Folch C, Vecino C, Majó X, Castellano Y, Casabona J, Brugal MT; Redan Study Group.

Gac Sanit. 2014 Jan 10. pii: S0213-9111(13)00227-6. doi: 10.1016/j.gaceta.2013.10.012. [Epub ahead of print]

Comment: Substance use disorder treatment programs are increasingly engaging in overdose prevention efforts – a badly needed development.

8) Commentary on Kerr et al. (2013): advertising high-potency heroin.

Dietze P.

Addiction. 2013 Jul;108(7):1277-8.

Comment: Interesting remarks by the author, suggesting that rather than advertising the high potency heroin, simply noting a spike in deaths and advertising overdose prevention/response strategies may be safer and more relevant to the target population.