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) High buprenorphine-related mortality is persistent in Finland.

Kriikku P, Häkkinen M, Ojanperä I.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Jayawardhana J, Abraham AJ, Perri M.

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

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

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

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

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

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

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

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

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

Comments: Pediatricians, opioids, and naloxone.

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

Wang A, Kesselheim AS.

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

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

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

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

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

Comments: Yes.

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

Harduar Morano L, Steege AL, Luckhaupt SE.

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

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

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

Bearnot B, Pearson JF, Rodriguez JA.

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

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

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

Bell J, Belackova V, Lintzeris N.

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

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

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

Madah-Amiri D, Gjersing L, Clausen T.

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

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

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

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

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

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

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

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

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

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

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

Carroll JJ, Rich JD, Green TC.

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

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

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

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

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

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

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

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

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

Comments: Not enough.

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

Skolnick P.

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

Comments: Nasal naloxone works well at the higher concentrations.

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

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

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

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

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

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

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

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

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

May T, Bennett T, Holloway K.

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

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

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

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

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

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

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

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

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

Comments: Pharmacy, nursing, and physician collaboration.

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

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

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

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

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

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

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

Comments: Yes.

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

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

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

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

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

May T, Bennett T, Holloway K.

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

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

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

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

Forensic Sci Int. 2018 Jul 19;290:219-226. doi: 10.1016/j.forsciint.2018.07.009. [Epub ahead of print]

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

4)Development and implementation of procedures for outpatient naloxoneprescribing at a large academic medical center.

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

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

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

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

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

Res Social Adm Pharm. 2018 Jul 7. pii: S1551-7411(18)30287-0. doi: 10.1016/j.sapharm.2018.07.006. Comment: Fascinating curriculum, including naloxone training, for high school students.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Russolillo A, Moniruzzaman A, Somers JM.

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

Comment: Methadone prevents death.

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

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

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

Comment: Nice.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Strand MA, Eukel H, Burck S.

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

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

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

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

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

Comment: Short training helps.

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

Hines J, Deja E, Black EP.

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

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

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

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

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

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

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

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

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

Comment: Geocoding work is always intriguing.

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

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

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

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

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

Haggerty LC, Gatewood SS, Goode JKR.

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

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

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

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

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

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

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

Cicero TJ, Kasper ZA, Ellis MS.

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

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

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

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

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

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

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

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

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

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

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

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

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

Comment: Increasing use.

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

Fraser S, Farrugia A, Dwyer R.

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

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

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

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

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

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

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

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

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

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

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

Wakeman SE, Barnett ML.

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

Comment: Nice article! Good read.

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

Saloner B, Stoller KB, Alexander GC.

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

Comment: Yes, please.

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

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

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

Comment: Fentanyl review.

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

Rubin R.

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

Comment: Review of addressing OUD in the emergency department.

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

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

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

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

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

Paul L.

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

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

Kansagra SM, Cohen MK.

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

26 naloxone papers:

1) Naloxone prescriptions from the emergency department: An initiative in evolution.

Verdier M, Routsolias JC, Aks SE.

Am J Emerg Med. 2018 May 22. pii: S0735-6757(18)30422-4. doi: 10.1016/j.ajem.2018.05.044. [Epub ahead of print] No abstract available.

Comments: 18% got filled. More likely to get filled if sent with other Rx’s.

2) “Once I’d done it once it was like writing your name”: Lived experience of take-home naloxone administration by people who inject drugs.

McAuley A, Munro A, Taylor A.

Int J Drug Policy. 2018 May 23;58:46-54. doi: 10.1016/j.drugpo.2018.05.002. [Epub ahead of print]

Comments: Qualitative study with 8 PWID who have administered naloxone.

3) Characterizing peer roles in an overdose crisis: Preferences for peer workers in overdose response programs in emergency shelters.

Bardwell G, Kerr T, Boyd J, McNeil R.

Drug Alcohol Depend. 2018 Jun 26;190:6-8. doi: 10.1016/j.drugalcdep.2018.05.023. [Epub ahead of print]

Comments: Peers are hugely important in service provision.

4) Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report.

Ouyang S, Moore T.

Ment Health Clin. 2018 Mar 23;7(6):287-289. doi: 10.9740/mhc.2017.11.287. eCollection 2017 Nov.

Comments: There are hundreds to thousands of successful lay reversals in the US daily.

5) At-a-glance – Lessons learned from launching the Manitoba Take-Home Naloxone Program.

Bozat-Emre S, Marshall SG, Zhong C, Reimer J.

Health Promot Chronic Dis Prev Can. 2018 Jun;38(6):252-255. doi: 10.24095/hpcdp.38.6.06. English, French.

Comments: Standard programmatic data, noting that the program gives valuable information about street opioids.

6) Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review.

Behar E, Bagnulo R, Coffin PO.

Prev Med. 2018 Jun 15;114:79-87. doi: 10.1016/j.ypmed.2018.06.005. [Epub ahead of print] Review.

Comments: Systematic review of literature on naloxone prescribing from primary care.

7) Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone.

Kestler A, Giesler A, Buxton J, Meckling G, Lee M, Hunte G, Wilkins J, Marks D, Scheuermeyer F.

CJEM. 2018 May 23:1-9. doi: 10.1017/cem.2018.368. [Epub ahead of print]

Comments: Those refusing naloxone felt they weren’t at risk of overdose or that the ED wasn’t the place to get the prescription. Those accepting felt they could help others.

8) Naloxone Use Among Emergency Department Patients with Opioid Overdose.

Marco CA, Trautman W, Cook A, Mann D, Rasp J, Perkins O, Ballester M.

J Emerg Med. 2018 May 16. pii: S0736-4679(18)30360-3. doi: 10.1016/j.jemermed.2018.04.022. [Epub ahead of print]

Comments: Ohio study of overdoses in the ED. Lots of repeated visits. Only 31% had home access to naloxone. Among those who had naloxone, 33% reported less opioid usage, 4% reported more, and 63% reported no change.

9) 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.

Comments: Peer programs!

10) Knowledge of naloxone and take-home naloxone programs among a sample of people who inject drugs in Australia: Variations across capital cities.

Dietze PM, Stare M, Cogger S, Nambiar D, Olsen A, Burns L, Lenton S.

Drug Alcohol Rev. 2018 May;37(4):457-463. doi: 10.1111/dar.12644. Epub 2017 Dec 21.

Comments: Half of PWID were aware of take-home naloxone. Good start, ways to go.

11) Facilitators and Barriers to Naloxone Kit Use Among Opioid-Dependent Patients Enrolled in Medication Assisted Therapy Clinics in North Carolina.

Khatiwoda P, Proeschold-Bell RJ, Meade CS, Park LP, Proescholdbell S.

N C Med J. 2018 May-Jun;79(3):149-155. doi: 10.18043/ncm.79.3.149.

Comments: Smaller kits more likely to be carried.

12)Feasibility of Bystander Administration of Public-Access Naloxone for Opioid Overdose.

Goldberg SA, Dworkis DA, Liao VT, Eyre AJ, Albert J, Fawcett MM, Narovec CM, DiClemente J, Weiner SG.

Prehosp Emerg Care. 2018 May 3:1-7. doi: 10.1080/10903127.2018.1461284. [Epub ahead of print]

Comments: Public access naloxone stations is an idea that’s been batted about for decades without much in terms of implementation.

13)Pharmacokinetic properties of intranasal and injectable formulations of naloxone for community use: a systematic review.

Ryan SA, Dunne RB.

Pain Manag. 2018 Apr 23. doi: 10.2217/pmt-2017-0060. [Epub ahead of print]

Comments: Intranasal works well.

14) [Temporary approval for intranasal naloxone: Setting up in a French addiction center].

Barré T, Vorspan F, Fortias M, Veyrier M, Cavagna P, Azuar J, Nicolas L, Naccache F, Barreteau H, Bellivier F, Bloch V.

Therapie. 2018 Mar 29. pii: S0040-5957(18)30060-X. doi: 10.1016/j.therap.2018.03.003. [Epub ahead of print] French.

Comments: Pilot naloxone prescribing in France.

15) Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among HeroinUsers in the United Kingdom.

Langham S, Wright A, Kenworthy J, Grieve R, Dunlop WCN.

Value Health. 2018 Apr;21(4):407-415. doi: 10.1016/j.jval.2017.07.014. Epub 2018 Feb 4.

Comments: Remarkably similar outcomes as the 2012 naloxone model in the United States.

16) Distribution of take-home opioid antagonist kits during a synthetic opioid epidemic in British Columbia, Canada: a modelling study.

Irvine MA, Buxton JA, Otterstatter M, Balshaw R, Gustafson R, Tyndall M, Kendall P, Kerr T, Gilbert M, Coombs D.

Lancet Public Health. 2018 Apr 17. pii: S2468-2667(18)30044-6. doi: 10.1016/S2468-2667(18)30044-6. [Epub ahead of print]

Comments: Authors conclude that rapid expansion of naloxone access helped to reverse the increasing trend of opioid overdose deaths during the fentanyl crisis.

17) Prescribing naloxone for opioid overdose intervention.

Dunne RB.

Pain Manag. 2018 Apr 18. doi: 10.2217/pmt-2017-0065. [Epub ahead of print]

Comments: A review, although it is incorrect that screening for patients at risk of opioid overdose is required. The majority of US states allow for third party prescribing to those who might witness an opioid overdose. Moreover, the use of “overdose” when speaking to patients prescribed opioids can sabotage efforts to get naloxone to where the opioids are.

18) The feasibility of employing a home healthcare model for education and treatment of opioid overdoseusing a naloxone auto-injector in a private practice pain medicine clinic.

Dragovich A, Brason F, Beltran T, McCoart A, Plunkett AR.

Curr Med Res Opin. 2018 Apr 18:1-11. doi: 10.1080/03007995.2018.1466698. [Epub ahead of print]

Comments: Home health approach to training on overdose response.

19) Emergency physician resistance to a take-home naloxone program led by community harm reductionists.

Barbour K, McQuade M, Somasundaram S, Chakravarthy B.

Am J Emerg Med. 2018 Mar 17. pii: S0735-6757(18)30228-6. doi: 10.1016/j.ajem.2018.03.036. [Epub ahead of print] No abstract available.

Comments: A study of providing naloxone in an emergency department, in which the attending physician refused to prescribe naloxone to 37% of the patients who wanted it. Really unclear why someone would refuse to provide a naloxone prescription to a patient who wanted one. And few of the patients filled the prescription – again consistent with what we know about naloxone and any other preventive intervention like flu shots: it has to be free and convenient.

20) Pharmacokinetics and -dynamics of intramuscular and intranasal naloxone: an explorative study in healthy volunteers.

Skulberg AK, Tylleskar I, Nilsen T, Skarra S, Salvesen Ø, Sand T, Loftsson T, Dale O.

Eur J Clin Pharmacol. 2018 Mar 22. doi: 10.1007/s00228-018-2443-3. [Epub ahead of print]

Comments: Intranasal naloxone was 0.75 as bioavailable as intramuscular.

21) Implementation and evaluation of an opioid overdose education and naloxone distribution (OEND) program at a Veterans Affairs Medical Center.

Pauly JB, Vartan CM, Brooks AT.

Subst Abus. 2018 Mar 22:1-17. doi: 10.1080/08897077.2018.1449174. [Epub ahead of print]

Comments: 30% of veterans referred for naloxone completed education and most were at low risk for opioid overdose.

22) Naloxone reversal of clonidine toxicity: dose, dose, dose.

Seger DL, Loden JK.

Clin Toxicol (Phila). 2018 Mar 16:1-7. doi: 10.1080/15563650.2018.1450986. [Epub ahead of print]

Comments: 10mg of naloxone in pediatric patients worked very well. Fascinating.

23) Effects of naloxone distribution to likely bystanders: Results of an agent-based model.

Keane C, Egan JE, Hawk M.

Int J Drug Policy. 2018 Mar 7;55:61-69. doi: 10.1016/j.drugpo.2018.02.008. [Epub ahead of print]

Comments: I have a fair amount of experience with models (created several Markov and decision tree-based models) and, while I’ve never constructed an agent-based model, the absence of a table of parameters for this paper is highly concerning to me. I cannot evaluate if this paper has value.

24) Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities.

Zhang X, Marchand C, Sullivan B, Klass EM, Wagner KD.

Addict Behav. 2018 Mar 5. pii: S0306-4603(18)30109-6. doi: 10.1016/j.addbeh.2018.03.004. [Epub ahead of print]

Comments: EMTs can be trained to administer naloxone.

25) Naloxone formulation for overdose reversal preference among patients receiving opioids for pain management.

Dunn KE, Barrett FS, Bigelow GE.

Addict Behav. 2018 Mar 28. pii: S0306-4603(18)30131-X. doi: 10.1016/j.addbeh.2018.03.011. [Epub ahead of print]

Comments: They prefer non-injectable. No surprise there.

26) Utilizing risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) scores to prioritize offer of rescue naloxone in an outpatient veteran population: A telephone-based project.

Yates D, Frey T, Montgomery JC.

Subst Abus. 2018 Mar 26:1-12. doi: 10.1080/08897077.2018.1449171. [Epub ahead of print]

Comments: 63.4% of those contacted accepted the naloxone prescription.

Plus 6 papers on naloxone and Good Samaritan laws:

27) Naloxone laws facilitate the establishment of overdose education and naloxone distribution programs in the United States.

Lambdin BH, Davis CS, Wheeler E, Tueller S, Kral AH.

Drug Alcohol Depend. 2018 May 12. pii: S0376-8716(18)30238-2. doi: 10.1016/j.drugalcdep.2018.04.004. [Epub ahead of print]

Comments: As title says.

28) Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid.

Gertner AK, Domino ME, Davis CS.

Drug Alcohol Depend. 2018 Jun 22;190:37-41. doi: 10.1016/j.drugalcdep.2018.05.014. [Epub ahead of print]

Comments: Naloxone access laws are associated with increased outpatient prescriptions.

29) Opioid-overdose laws association with opioid use and overdose mortality.

McClellan C, Lambdin BH, Ali MM, Mutter R, Davis CS, Wheeler E, Pemberton M, Kral AH.

Addict Behav. 2018 Mar 19. pii: S0306-4603(18)30138-2. doi: 10.1016/j.addbeh.2018.03.014. [Epub ahead of print]

Comments: Laws supporting naloxone programming were associated with less opioid overdose mortality and no increase in non-medical opioid use.

30) Assessing the effectiveness of New York’s 911 Good Samaritan Law-Evidence from a natural experiment.

Nguyen H, Parker BR.

Int J Drug Policy. 2018 Jun 29;58:149-156. doi: 10.1016/j.drugpo.2018.05.013. [Epub ahead of print]

Comments: Interesting comparison between New York and New Jersey, although this could have been influenced by market forces as well.

31) Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties.

Watson DP, Ray B, Robison L, Huynh P, Sightes E, Walker S, Brucker K, Duwve J.

Harm Reduct J. 2018 Apr 6;15(1):18. doi: 10.1186/s12954-018-0226-x.

Comments: Knowing someone who overdosed predicts getting naloxone. If people know about Good Sam protections they are more likely to call emergency medical services after the overdose.

32) State naloxone access laws are associated with an increase in the number of naloxone prescriptions dispensed in retail pharmacies.

Xu J, Davis CS, Cruz M, Lurie P.

Drug Alcohol Depend. 2018 Aug 1;189:37-41. doi: 10.1016/j.drugalcdep.2018.04.020. Epub 2018 May 29.

Comments: See title.

And 6 papers on pharmacies and naloxone/opioids:

33) Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016.

Meyerson BE, Agley JD, Davis A, Jayawardene W, Hoss A, Shannon DJ, Ryder PT, Ritchie K, Gassman R.

Drug Alcohol Depend. 2018 Apr 26;188:187-192. doi: 10.1016/j.drugalcdep.2018.03.032. [Epub ahead of print]

Comments:  Bigger pharmacies and chains stocked naloxone more.

34) Reviewing state-mandated training requirements for naloxone-dispensing pharmacists.

Roberts AW, Carpenter DM, Smith A, Look KA.

Res Social Adm Pharm. 2018 Apr 5. pii: S1551-7411(17)30915-4. doi: 10.1016/j.sapharm.2018.04.002. [Epub ahead of print]

Comments: The state requirements are silly. Why do we always create barriers to providers taking care of people with substance use disorders and related issues?

35) Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice.

Gilmartin-Thomas JF, Bell JS, Liew D, Arnold CA, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson SJ, Giummarra MJ, Gowan J, Katz B, Lubman DI, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil J.

Res Social Adm Pharm. 2018 Mar 19. pii: S1551-7411(17)30669-1. doi: 10.1016/j.sapharm.2018.03.060. [Epub ahead of print]

Comments: How pharmacists can help.

36) Establishment of a pharmacist-led service for patients at high risk for opioid overdose.

Tewell R, Edgerton L, Kyle E.

Am J Health Syst Pharm. 2018 Mar 15;75(6):376-383. doi: 10.2146/ajhp170294.

Comments: Pharmacists are good at getting naloxone to people who may need it.

37) Naloxone for Opioid Overdose and the Role of the Pharmacist.

Toderika Y, Williams S.

Consult Pharm. 2018 Feb 1;33(2):98-104. doi: 10.4140/TCP.n.2018.98.

Comments: As above!

38) Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions.

Meyerson BE, Davis A, Agley JD, Shannon DJ, Lawrence CA, Ryder PT, Ritchie K, Gassman R.

Int J Drug Policy. 2018 Mar 17;56:46-53. doi: 10.1016/j.drugpo.2018.02.024. [Epub ahead of print]

Comments: Communities with high rates of opioid overdose death were less likely to have pharmacies that dispensed syringes to PWID.

9 papers on fentanyl:

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

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

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

Comments: Reviewing emerging presence of fentanyl in Poland.

40) Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD.

Park JN, Weir BW, Allen ST, Chaulk P, Sherman SG.

Harm Reduct J. 2018 Jul 5;15(1):34. doi: 10.1186/s12954-018-0240-z.

Comments: While this is an interesting effort, I’m not convinced that “perceived fentanyl presence” as a risk factor for overdose is particularly useful.

41) Fentanyl self-testing outside supervised injection settings to prevent opioid overdose: Do we know enough to promote it?

McGowan CR, Harris M, Platt L, Hope V, Rhodes T.

Int J Drug Policy. 2018 May 11;58:31-36. doi: 10.1016/j.drugpo.2018.04.017. [Epub ahead of print]

Comments: Not really, but we are desparate.

42)Community-Based Response to Fentanyl Overdose Outbreak, San Francisco, 2015.

Rowe C, Wheeler E, Stephen Jones T, Yeh C, Coffin PO.

J Urban Health. 2018 May 3. doi: 10.1007/s11524-018-0250-x. [Epub ahead of print]

Comments: Another role for naloxone distribution programs is as an early warning system of changes in the opioid market. In this case, a locality was alerted to fentanyl entering the supply by an increase in naloxone reversals, with no associated deaths. Of note, this clearly overlaps with the “naloxone” section above.

43) Characteristics of opioid-maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini-review.

Kimergård A, Dunne J, Bøgen A, Hindersson P, Breindahl T.

Drug Test Anal. 2018 Apr 19. doi: 10.1002/dta.2397. [Epub ahead of print]

Comments: Testing for fentanyl can be tricky in clinical practice.

44) Efficacious Vaccine against Heroin Contaminated with Fentanyl.

Hwang CS, Smith LC, Natori Y, Ellis B, Zhou B, Janda KD.

ACS Chem Neurosci. 2018 Mar 23. doi: 10.1021/acschemneuro.8b00079. [Epub ahead of print]

Comments: Interesting idea.

45) Fentanyl related overdose in Indianapolis: Estimating trends using multilevel Bayesian models.

Phalen P, Ray B, Watson DP, Huynh P, Greene MS.

Addict Behav. 2018 Mar 20. pii: S0306-4603(18)30121-7. doi: 10.1016/j.addbeh.2018.03.010. [Epub ahead of print]

Comments: Fentanyl deaths became predominant.

46) How Did We Get Here? Heroin and Fentanyl Trafficking Trends: A Law Enforcement Perspective.

Dismukes LC.

N C Med J. 2018 May-Jun;79(3):181-184. doi: 10.18043/ncm.79.3.181.

Comments: Describes a focus on the dark net.

47) Amount of naloxone used to reverse opioid overdoses outside of medical practice in a city with increasing illicitly manufactured fentanyl in illicit drug supply.

Bell A, Bennett AS, Jones TS, Doe-Simkins M, Williams LD.

Subst Abus. 2018 Mar 20:1-12. doi: 10.1080/08897077.2018.1449053. [Epub ahead of print]

Comments: There was no change in the dose or amount of lay-administered naloxone required to reverse overdoses in the community, regardless of a rapid increase in fentanyl-related overdoses.

13 papers on medications for opioid use disorder:

48) Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis.

Ma J, Bao YP, Wang RJ, Su MF, Liu MX, Li JQ, Degenhardt L, Farrell M, Blow FC, Ilgen M, Shi J, Lu L.

Mol Psychiatry. 2018 Jun 22. doi: 10.1038/s41380-018-0094-5. [Epub ahead of print]

Comments: Our medications for opioid use disorder – methadone, buprenorphine, and extended-release naltrexone – reduce mortality, particularly if used for over a year.

49) Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.

Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, Bagley SM, Liebschutz JM, Walley AY.

Ann Intern Med. 2018 Jun 19. doi: 10.7326/M17-3107. [Epub ahead of print]

Comments: Another fascinating analysis out of a powerful dataset. After overdose, 11% enrolled in methadone for a median of 5 months, 17% buprenorphine for 4 months, and naltrexone for 1 month. Methadone and buprenorphine were associated with similar reductions in mortality (adjusted hazard ratio 0.47 and 0.41, respectively). Naltrexone was not associated with a mortality benefit, although the AHR was 1.44, suggesting a possible increase in mortality.

50) Developing an opioid use disorder treatment cascade: A review of quality measures.

Williams AR, Nunes EV, Bisaga A, Pincus HA, Johnson KA, Campbell AN, Remien RH, Crystal S, Friedmann PD, Levin FR, Olfson M.

J Subst Abuse Treat. 2018 Aug;91:57-68. doi: 10.1016/j.jsat.2018.06.001. Epub 2018 Jun 2. Erratum in: J Subst Abuse Treat. 2018 Sep;92:99.

Comments: There’s a lot of work going on now to determine the markers of successful care for patients with opioid use disorder. It’s an exciting time in which we are hopefully seeing a transformation in which substance use disorders are treated as chronic diseases, rather than somebody else’s problem.

51) Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016.

Socías ME, Wood E, Kerr T, Nolan S, Hayashi K, Nosova E, Montaner J, Milloy MJ.

Drug Alcohol Depend. 2018 Aug 1;189:90-95. doi: 10.1016/j.drugalcdep.2018.04.026. Epub 2018 May 29.

Comments: Generated 4 stages of OUD care: linkage to care, linkage to methadone/buprenorphine, retention on medications, and stability – and evaluated changes from 2006 to 2016. They found that all parameters improved, but retention on medications was lower than goal (about a third of patients).

52) Opioid Use Disorders: Perioperative Management of a Special Population.

Ward EN, Quaye AN, Wilens TE.

Anesth Analg. 2018 May 25. doi: 10.1213/ANE.0000000000003477. [Epub ahead of print]

Comments: Great topic. So much mismanagement, particularly of patients on buprenorphine as it is too often stopped leading to chaos in the hospital. The general rule is to continue buprenorphine!!! Use ancillary pain medications. Dose the bup 3-4 times a day. Use hydromorphone or fentanyl if necessary.

53) National Institute on Drug Abuse International Program: improving opioid use disorder treatment through international research training.

Gust SW, McCormally J.

Curr Opin Psychiatry. 2018 Jul;31(4):287-293. doi: 10.1097/YCO.0000000000000426.

Comments: International research on OUD treatment and overdose prevention.

54) Stigma associated with medication treatment for young adults with opioid use disorder: a case series.

Hadland SE, Park TW, Bagley SM.

Addict Sci Clin Pract. 2018 May 7;13(1):15. doi: 10.1186/s13722-018-0116-2.

Comments: Case reports of patients being denied proper medical care. Grrr. If you had type 2 diabetes and were kicked off your insulin due to the ignorance of supposed “providers”, you’d make millions in court. Honestly, I can’t wait to see those cases emerge for people with opioid use disorder. Sadly, that is often the best way to change practice in the overly litigious United States.

55) Buprenorphine Therapy for Opioid Use Disorder.

Zoorob R, Kowalchuk A, Mejia de Grubb M.

Am Fam Physician. 2018 Mar 1;97(5):313-320.

Comments: A review of above.

56) Methadone maintenance treatment: A 15-year retrospective study in Split-Dalmatia County, Croatia.

Sutlovic D, Kljucevic Z, Sliskovic L, Susnjar H, Viskovic I, Definis-Gojanovic M.

Ther Drug Monit. 2018 Apr 11. doi: 10.1097/FTD.0000000000000519. [Epub ahead of print]

Comments: Programmatic data review.

57) Pharmacogenetics of Opioid Use Disorder Treatment.

Crist RC, Clarke TK, Berrettini WH.

CNS Drugs. 2018 Apr;32(4):305-320. doi: 10.1007/s40263-018-0513-9.

Comments: Metabolism, clearance, treatment outcomes for OUD meds.

58) Effectiveness of Tapering from Methadone or Buprenorphine Maintenance Treatment Compared to Traditional Maintenance Treatment for People with Opiate Addiction: Systematic Review [Internet].

Dalsbø TK, Steiro A, Strømme H, Reinar LM.

Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2017 Mar 2.

Comments: Insufficient data, although it’s clear from clinical practice that treatment should be provided as long as the patient will accept it, ideally at least a year.

59) The effect of Housing First on adherence to methadone maintenance treatment.

Parpouchi M, Moniruzzaman A, Rezansoff SN, Russolillo A, Somers JM.

Int J Drug Policy. 2018 Mar 30;56:73-80. doi: 10.1016/j.drugpo.2018.03.012. [Epub ahead of print]

Comments: No effect on adherence to OUD treatment with methadone.

60) Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment.

Havens JR, Walsh SL, Korthuis PT, Fiellin DA.

Curr HIV/AIDS Rep. 2018 Aug;15(4):315-323. doi: 10.1007/s11904-018-0402-3. Review.

Comments: 3% of primary care providers can provide buprenorphine. Can we please throw out the waiver requirement?

7 more emergency medical care papers (there’s overlap here, obviously):

61) Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment.

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

Clin Toxicol (Phila). 2018 Jun 6:1-7. doi: 10.1080/15563650.2018.1478093. [Epub ahead of print]

Comments: Not withstanding the remarkably offensive title, in effect describing people who use drugs as fish, the study shows no risk to releasing patients after initial paramedic treatment for opioid overdose.

62) Substance use and homelessness among emergency department patients.

Doran KM, Rahai N, McCormack RP, Milian J, Shelley D, Rotrosen J, Gelberg L.

Drug Alcohol Depend. 2018 May 22;188:328-333. doi: 10.1016/j.drugalcdep.2018.04.021. [Epub ahead of print]

Comments: Patients in emergency departments who are homeless have higher rates of problematic substance use.

63) Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.

Sanello A, Gausche-Hill M, Mulkerin W, Sporer KA, Brown JF, Koenig KL, Rudnick EM, Salvucci AA, Gilbert GH.

West J Emerg Med. 2018 May;19(3):527-541. doi: 10.5811/westjem.2018.1.36559. Epub 2018 Mar 8. Review.

Comments: Criteria for naloxone were – respiratory rate under 12, pinpoint pupils, presence of drug paraphernalia, and altered mental status. Interesting and may account for why we didn’t see as much naloxone given for prescription opioid overdose events during that era.

64) Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose.

Scheuermeyer FX, DeWitt C, Christenson J, Grunau B, Kestler A, Grafstein E, Buxton J, Barbic D, Milanovic S, Torkjari R, Sahota I, Innes G.

Ann Emerg Med. 2018 Mar 9. pii: S0196-0644(18)30082-9. doi: 10.1016/j.annemergmed.2018.01.054. [Epub ahead of print]

Comments: Brief observation is fine. Similar to the above “catch and release” paper.

65) Rate of patients at elevated risk of opioid overdose visiting the emergency department.

Pedigo JR, Seifert CF.

Am J Emerg Med. 2018 Mar 22. pii: S0735-6757(18)30247-X. doi: 10.1016/j.ajem.2018.03.055. [Epub ahead of print]

Comments: More opioid overdose ED visits.

66) A Descriptive Analysis of Care Provided by Law Enforcement Prior to EMS Arrival in the United States.

Klassen AB, Core SB, Lohse CM, Sztajnkrycer MD.

Prehosp Disaster Med. 2018 Apr;33(2):165-170. doi: 10.1017/S1049023X18000213. Epub 2018 Mar 13.

Comments: Overall police provide the initial care in 2% of cases and 13% of drug overdoses – in Norway (rates probably much higher in other countries like the U.S.).

67) Ambulance-attended opioid overdoses: an examination into overdose locations and the role of a safe injection facility.

Madah-Amiri D, Skulberg AK, Braarud AC, Dale O, Heyerdahl F, Lobmaier P, Clausen T.

Subst Abus. 2018 Jun 27:1-17. doi: 10.1080/08897077.2018.1485130. [Epub ahead of print]

Comments: Fascinating look at overdose ambulance calls – where they happen, if they are transported, overdose severity. Useful for a deeper understanding of the epidemiology of serious overdose.

7 surveillance-esque papers:

68) Standard Death Certificates Versus Enhanced Surveillance to Identify Heroin Overdose-Related Deaths.

Horon IL, Singal P, Fowler DR, Sharfstein JM.

Am J Public Health. 2018 Apr 19:e1-e5. doi: 10.2105/AJPH.2018.304385. [Epub ahead of print]

Comments: I love these type of projects. Basically re-litigating the cause of death from the medical examiner’s conclusion. This may sound bad, but the decision the medical examiner makes should be extremely conservative – based only upon what they are quite sure is true. By re-evaluating the data, we can identify a great many more probable heroin overdose events.

69) Accurate identification of opioid overdose deaths using coronial data.

Roxburgh A, Pilgrim JL, Hall WD, Burns L, Degenhardt L.

Forensic Sci Int. 2018 Mar 26;287:40-46. doi: 10.1016/j.forsciint.2018.03.032. [Epub ahead of print]

Comments: One quarter of “morphine” deaths were re-attributed to heroin on review of the clinical record. This passes my sniff test.

70) Mapping Drug Overdose Demographic and Socioeconomic Characteristics in the Community.

Rooney BL, Voter MT, Eberlein CM, Schossow AJ, Fischer CL.

WMJ. 2018 Mar;117(1):18-23.

Comments: Interesting chart review project of overdoses showing up in an emergency department in Wisconsin.

71) Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses – United States, July 2016-September 2017.

Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite-Powell A, Coletta MA.

MMWR Morb Mortal Wkly Rep. 2018 Mar 9;67(9):279-285. doi: 10.15585/mmwr.mm6709e1.

Comments: Up and up.

72) Prevalence of gabapentin in drug overdose postmortem toxicology testing results.

Slavova S, Miller A, Bunn TL, White JR, Kirschke D, Light T, Christy D, Thompson G, Winecker R.

Drug Alcohol Depend. 2018 May 1;186:80-85. doi: 10.1016/j.drugalcdep.2018.01.018. Epub 2018 Mar 10.

Comments: I remain doubtful that this represents a problem with gabapentin.

73) Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants – United States, 2015-2016.

Seth P, Scholl L, Rudd RA, Bacon S.

MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):349-358. doi: 10.15585/mmwr.mm6712a1.

Comments: We really need a major effort on surveillance.

74) Trends in Injector Deaths in Ireland, as Recorded by the National Drug-Related Deaths Index, 1998-2014.

Lynn TM, Lynn E, Keenan E, Lyons S.

J Stud Alcohol Drugs. 2018 Mar;79(2):286-292.

Comments: 90% of deaths were overdose (poisoning) deaths.

And lots (35) more!

75) Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids.

Young JC, Lund JL, Dasgupta N, Jonsson Funk M.

Pharmacoepidemiol Drug Saf. 2018 Jun 11. doi: 10.1002/pds.4572. [Epub ahead of print]

Comments: Wow. Honestly surprising results. One-third of patients started on >=90 morphine equivalent milligrams (MEMs) had no been receiving >=60 MEMs for 7 of the prior 14 days.

76) Prescription opioid use among individuals with serious mental illness.

Spivak S, Cullen B, Eaton W, Nugent K, Spivak A, Fenton A, Rodriguez K, Mojtabai R.

Psychiatry Res. 2018 May 31;267:85-87. doi: 10.1016/j.psychres.2018.05.075. [Epub ahead of print]

Comments: The intersection of mental illness, opioid use, and benzodiazepine use is fascinating and potentially quite complex. This study found that 12.9% of patients at two urban psychiatry clinics were prescribed opioids, and that being prescribed opioids was associated with having used heroin and using benzos; using benzos was associated with suicidal ideation. This doesn’t account for chicken or egg, but is interesting nonetheless.

77) Medical, psychosocial, and treatment predictors of opioid overdose among high risk opioid users.

Schiavon S, Hodgin K, Sellers A, Word M, Galbraith JW, Dantzler J, Cropsey KL.

Addict Behav. 2018 May 30. pii: S0306-4603(18)30575-6. doi: 10.1016/j.addbeh.2018.05.029. [Epub ahead of print]

Comments: Some unusual associations with overdose: HCV infection, witnessing an overdose, or more buprenorphine treatment episodes.

78) Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine.

Lorvick J, Browne EN, Lambdin BH, Comfort M.

Addict Behav. 2018 Oct;85:94-99. doi: 10.1016/j.addbeh.2018.05.013. Epub 2018 May 24.

Comments: Polydrug use is associated with lots of health problems and risk behaviors.

79) Not just heroin: Extensive polysubstance use among US high school seniors who currently use heroin.

Palamar JJ, Le A, Mateu-Gelabert P.

Drug Alcohol Depend. 2018 Jul 1;188:377-384. doi: 10.1016/j.drugalcdep.2018.05.001. Epub 2018 Jun 4.

Comments: Interesting analysis. Alcohol use is less likely as heroin use increases, but benzodiazepine use is.

80) Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base.

Ranapurwala SI, Naumann RB, Austin AE, Dasgupta N, Marshall SW.

Pharmacoepidemiol Drug Saf. 2018 Jun 3. doi: 10.1002/pds.4564. [Epub ahead of print] Review.

Comments: Concerns with studies used to justify the CDC opioid prescribing guidelines.

81) Quantity fluctuations of illicitly used opioids and overdose risk.

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

Int J Drug Policy. 2018 May 25;58:64-70. doi: 10.1016/j.drugpo.2018.05.004. [Epub ahead of print]

Comments: An interesting analysis of data from a randomized trial of overdose prevention, finding that variations in the amount of opioids used over time was associated with subsequent overdose.

82) Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review.

Fink DS, Schleimer JP, Sarvet A, Grover KK, Delcher C, Castillo-Carniglia A, Kim JH, Rivera-Aguirre AE, Henry SG, Martins SS, Cerdá M.

Ann Intern Med. 2018 May 8. doi: 10.7326/M17-3074. [Epub ahead of print]

Comments: First, can we please call these what they are: Controlled Substance Monitoring Programs (CSMPs)? Please? Second, as the review concludes data are insufficient.

83) Risk factors for opioid overdose among hospitalized patients.

Vu Q, Beselman A, Monolakis J, Wang A, Rastegar D.

J Clin Pharm Ther. 2018 May 23. doi: 10.1111/jcpt.12701. [Epub ahead of print]

Comments: For patients in the hospital, risk of overdose was associated with older age, being in the ICU, getting other depressants, and impaired kidneys.

84) Trends in non-medical prescription opioids and heroin co-use among adults, 2003-2014.

Mital S, Windle M, Cooper HLF, Crawford ND.

Addict Behav. 2018 May 16. pii: S0306-4603(18)30468-4. doi: 10.1016/j.addbeh.2018.05.005. [Epub ahead of print]

Comments: Pulling trends from the National Survey on Drug Use and Health is tough work. Authors found increasing co-use of these opioids.

85) Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency.

Mars SG, Ondocsin J, Ciccarone D.

Harm Reduct J. 2018 May 16;15(1):26. doi: 10.1186/s12954-018-0232-z.

Comments: Such important work! Not just tester shots. Also “slow shots”, trying the drug through other routes of administration first, watching someone else use first, etc.

86) Post-stroke Intranasal (+)-Naloxone Delivery Reduces Microglial Activation and Improves Behavioral Recovery from Ischemic Injury.

Anttila JE, Albert K, Wires ES, Mätlik K, Loram LC, Watkins LR, Rice KC, Wang Y, Harvey BK, Airavaara M.

eNeuro. 2018 Apr 18;5(2). pii: ENEURO.0395-17.2018. doi: 10.1523/ENEURO.0395-17.2018. eCollection 2018 Mar-Apr.

Comments: I’m so intrigued by this. Clinically, I have sometimes seen a slight reaction to naloxone when given for a non-opioid arrest event – have always wondered what was going on.

87) Young adults’ opioid use trajectories: From nonmedical prescription opioid use to heroin, druginjection, drug treatment and overdose.

Guarino H, Mateu-Gelabert P, Teubl J, Goodbody E.

Addict Behav. 2018 May 1. pii: S0306-4603(18)30362-9. doi: 10.1016/j.addbeh.2018.04.017. [Epub ahead of print]

Comments: Use started with Rx opioids, 83% transitioned to heroin and 64% to heroin injection, generally within 4 years of initial nonmedical use. First overdose occurred on average <1 year after starting heroin.

88) Harm Reduction Strategies for the Opiod [sic] Crisis.

Castillo T.

N C Med J. 2018 May-Jun;79(3):192-194. doi: 10.18043/ncm.79.3.192.

Comments: What’s happening in North Carolina.

89) Perceptions of Health-Related Community Reentry Challenges among Incarcerated Drug Users in Azerbaijan, Kyrgyzstan, and Ukraine.

Rozanova J, Morozova O, Azbel L, Bachireddy C, Izenberg JM, Kiriazova T, Dvoryak S, Altice FL.

J Urban Health. 2018 May 4. doi: 10.1007/s11524-018-0256-4. [Epub ahead of print]

Comments: Prisoners did not prioritize getting on methadone for opioid use disorder prior to release. Presumably this is related to both access and competing priorities.

90) Physician Prescribing of Opioids to Patients at Increased Risk of Overdose From Benzodiazepine Use in the United States.

Ladapo JA, Larochelle MR, Chen A, Villalon MM, Vassar S, Huang DYC, Mafi JN.

JAMA Psychiatry. 2018 Apr 12. doi: 10.1001/jamapsychiatry.2018.0544. [Epub ahead of print]

Comments: Although new opioid prescriptions have been declining, including among patients taking benzodiazepines, getting started on opioids is still more likely for patients already using benzodiazepines compared to those not using benzos. Authors conclude that other factors appear to be contributing to overdose, rather than prescribing practices.

91)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.

Comments: Yes, please! All medical students should get buprenorphine waivered in order to complete pre-clinical training.

92)The long-term impact of post traumatic stress disorder on recovery from heroin dependence.

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

J Subst Abuse Treat. 2018 Jun;89:60-66. doi: 10.1016/j.jsat.2018.04.001. Epub 2018 Apr 4.

Comments: Patients with PTSD and opioid use disorder did just as well as those without PTSD with regard to recovery, but had higher rates of major depression, attempted suicide, trauma, and poor occupational function.

93)Re-racialization of Addiction and the Redistribution of Blame in the White Opioid Epidemic.

Mendoza S, Rivera AS, Hansen HB.

Med Anthropol Q. 2018 Apr 27. doi: 10.1111/maq.12449. [Epub ahead of print]

Comments: Such complicated issues. Overall, the narrative of white opioid users opened an opportunity for us to treat ALL people with substance use disorders with respect.

94)The U.S. opioid epidemic: One disease, diverging tales.

McBain R, Rose AJ, LaRochelle MR.

Prev Med. 2018 Apr 20. pii: S0091-7435(18)30134-8. doi: 10.1016/j.ypmed.2018.04.023. [Epub ahead of print] No abstract available.

Comments: Interesting discussion of opioid health outcomes in older versus younger adults.

95) Survey Assessing Medical Student and Physician Knowledge and Attitudes Regarding the Opioid Crisis.

Chouinard S, Prasad A, Brown R.

WMJ. 2018 Mar;117(1):34-37.

Comments: A lot of education is needed.

96) Delayed Cerebral Edema Leading to Cerebral Hernia in a Patient With Heroin Overdose.

Amjad W, Qureshi WT, Farooq AU.

Am J Ther. 2018 Apr 11. doi: 10.1097/MJT.0000000000000761. [Epub ahead of print] No abstract available.

Comments: I have no way to access.

97) Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City.

Hunter K, Park JN, Allen ST, Chaulk P, Frost T, Weir BW, Sherman SG.

Int J Drug Policy. 2018 Apr 13;57:25-31. doi: 10.1016/j.drugpo.2018.03.026. [Epub ahead of print]

Comments: Injecting in public spaces was associated with overdose, arrest, and receptive syringe sharing.

98) Implementation of Online Opioid Prevention, Recognition and Response Trainings for Laypeople: Year 1 Survey Results.

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

Subst Use Misuse. 2018 Apr 11:1-6. doi: 10.1080/10826084.2018.1451891. [Epub ahead of print]

Comments: Online training in naloxone is certainly sufficient.

99) 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.

Comments: Review of issues related to opioid crisis.

100) Blocking interleukin-4 enhances efficacy of vaccines for treatment of opioid abuse and prevention of opioid overdose.

Laudenbach M, Baruffaldi F, Robinson C, Carter P, Seelig D, Baehr C, Pravetoni M.

Sci Rep. 2018 Apr 3;8(1):5508. doi: 10.1038/s41598-018-23777-6.

Comments: Given the diversity of opioids, I remain skeptical that a vaccine specific to an individual opioid would be particularly beneficial.

101) Fatal and non-fatal overdose among opiate users in South Wales: A qualitative study of peer responses.

Holloway K, Hills R, May T.

Int J Drug Policy. 2018 Mar 29;56:56-63. doi: 10.1016/j.drugpo.2018.03.007. [Epub ahead of print]

Comments: Hm. These results seem a bit odd and may be specific to South Wales. Overdose isn’t that hard to identify…

102) An electronic intervention to improve safety for pain patients co-prescribed chronic opioids and benzodiazepines.

Zaman T, Rife TL, Batki SL, Pennington DL.

Subst Abus. 2018 Mar 29:1-8. doi: 10.1080/08897077.2018.1455163. [Epub ahead of print]

Comments: The VA has done some remarkable work, always with attention to the needs of its patients.

103) Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists.

Peglow SL, Binswanger IA.

Med Clin North Am. 2018 Jul;102(4):621-634. doi: 10.1016/j.mcna.2018.02.005. Review.

Comments: Review of overdose prevention plans.

104) 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.

Comments: Methods for a postmarketing study that has not yet been conducted.

105) The President’s Commission on Combating Drug Addiction and the Opioid Crisis: Origins and Recommendations.

Madras BK.

Clin Pharmacol Ther. 2018 Mar 23. doi: 10.1002/cpt.1050. [Epub ahead of print]

Comments: As title says.

106) Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA.

Poowanawittayakom N, Dutta A, Stock S, Touray S, Ellison RT 3rd, Levitz SM.

Emerg Infect Dis. 2018 Apr;24(4). doi: 10.3201/eid2404.171807.

Comments: As title says. Hopefully an inspiration for infectious disease providers to engage in addiction medicine.

107) Beyond the walls: Risk factors for overdose mortality following release from the Philadelphia Department of Prisons.

Pizzicato LN, Drake R, Domer-Shank R, Johnson CC, Viner KM.

Drug Alcohol Depend. 2018 Aug 1;189:108-115. doi: 10.1016/j.drugalcdep.2018.04.034. Epub 2018 Jun 5.

Comments: In Pennsylvania, former inmates released from state prison. 3% died and one-third were due to overdose. Whites were at higher risk than Blacks and Latinos and serious mental illness predicted overdose death.

108) Criminal justice continuum for opioid users at risk of overdose.

Brinkley-Rubinstein L, Zaller N, Martino S, Cloud DH, McCauley E, Heise A, Seal D.

Addict Behav. 2018 Feb 24. pii: S0306-4603(18)30089-3. doi: 10.1016/j.addbeh.2018.02.024. [Epub ahead of print]

Comments: Criminal justice settings need to take substance use disorders seriously, providing services that can greatly improve health and post-release survival.

109) “Taking away the chaos”: a health needs assessment for people who inject drugs in public places in Glasgow, Scotland.

Tweed EJ, Rodgers M, Priyadarshi S, Crighton E.

BMC Public Health. 2018 Jul 4;18(1):829. doi: 10.1186/s12889-018-5718-9.

Comments: Support for safer consumptions spaces in Scotland.

Onward!

1) Simulation of the Effects of Co-Locating Naloxone with Automated External Defibrillators.

Salerno JE, Weiss LS, Salcido DD.

Prehosp Emerg Care. 2018 Mar 1:1-6. doi: 10.1080/10903127.2018.1439128. [Epub ahead of print]

Comments: Not a lot of correlation between AED and naloxone need.

2) Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: An observational analysis.

Baldwin N, Gray R, Goel A, Wood E, Buxton JA, Rieb LM.

Drug Alcohol Depend. 2018 Feb 20;185:322-327. doi: 10.1016/j.drugalcdep.2017.12.032. [Epub ahead of print]

Comments: More fentanyl around is associated with more deaths.

3) National Systematic Legal Review of State Policies on Emergency Medical Services Licensure Levels’ Authority to Administer Opioid Antagonists.

Kinsman JM, Robinson K.

Prehosp Emerg Care. 2018 Feb 27:1-5. doi: 10.1080/10903127.2018.1439129. [Epub ahead of print]

Comments: 49 of 52 US jurisdictions now authorize all levels of emergency responders to administer naloxone.

4) Opioid Overdose Education for Individuals Prescribed Opioids for Pain Management: Randomized Comparison of Two Computer-Based Interventions.

Huhn AS, Garcia-Romeu AP, Dunn KE.

Front Psychiatry. 2018 Feb 12;9:34. doi: 10.3389/fpsyt.2018.00034. eCollection 2018.

Comments: Online naloxone education.

5) Observational study of dermatological manifestations in patients admitted to a tertiary poison center in Iran

Talaie H, Nasiri S, Gheisari M, Dadkhahfar S, Ahmadi S.

Turk J Med Sci. 2018 Feb 23;48(1):136-141. doi: 10.3906/sag-1707-141.

Comments: Interesting study. Dry skin associated with methadone toxicity. Lead exposure leads to shin hyperpigmentation.

6) Dispensing Naloxone Without a Prescription: Survey Evaluation of Ohio Pharmacists.

Thompson EL, Rao PSS, Hayes C, Purtill C.

J Pharm Pract. 2018 Jan 1:897190018759225. doi: 10.1177/0897190018759225. [Epub ahead of print]

Comments: Lots of pharmacists not aware.

7) Does training people to administer take-home naloxone increase their knowledge? Evidence from Australian programs.

Dietze PM, Draper B, Olsen A, Chronister KJ, van Beek I, Lintzeris N, Dwyer R, Nelson M, Lenton S.

Drug Alcohol Rev. 2018 Feb 22. doi: 10.1111/dar.12680. [Epub ahead of print]

Comments: Yes.

8) Outcomes of compulsory detention compared to community-based voluntary methadone maintenance treatment in Vietnam.

Vuong T, Ritter A, Shanahan M, Ali R, Nguyen N, Pham K, Vuong TTA, Le GM.

J Subst Abuse Treat. 2018 Apr;87:9-15. doi: 10.1016/j.jsat.2018.01.011. Epub 2018 Jan 16.

Comments: Voluntary methadone better than forced treatment. Not much of a surprise here.

9) Socioeconomic and geographical disparities in prescription and illicit opioid related overdose deaths in Orange County, California from 2010-2014.

Marshall JR, Gassner SF, Anderson CL, Cooper RJ, Lotfipour S, Chakravarthy B.

Subst Abus. 2018 Feb 21:1-25. doi: 10.1080/08897077.2018.1442899. [Epub ahead of print]

Comments: If you know Orange County, you know it is fascinating to see a report on overdose deaths in Orange County.

10) The Syndemic of Opioid Misuse, Overdose, HCV, and HIV: Structural-Level Causes and Interventions.

Perlman DC, Jordan AE.

Curr HIV/AIDS Rep. 2018 Feb 19. doi: 10.1007/s11904-018-0390-3. [Epub ahead of print] Review.

Comments: A look at the multiple issues.

11) Risk of fentanyl-involved overdose among those with past year incarceration: Findings from a recent outbreak in 2014 and 2015.

Brinkley-Rubinstein L, Macmadu A, Marshall BDL, Heise A, Ranapurwala SI, Rich JD, Green TC.

Drug Alcohol Depend. 2018 Feb 9;185:189-191. doi: 10.1016/j.drugalcdep.2017.12.014. [Epub ahead of print]

Comments: Interesting that risk of death extended past 90 days after release, whereas traditionally the highest risk is in the first week or two.

12) Past-Year Nonmedical Use of Prescription Drugs among Women on Probation and Parole: A Cross-Sectional Study.

Hall MT, Ball D, Sears J, Higgins GE, Logan TK, Golder S.

Subst Abus. 2018 Feb 16:1-23. doi: 10.1080/08897077.2018.1442382. [Epub ahead of print]

Comments: Strong associations between opioid use and trauma history.

13) Characteristics of adherence to methadone maintenance treatment over a 15-year period among homeless adults experiencing mental illness.

Parpouchi M, Moniruzzaman A, Rezansoff SN, Russolillo A, Somers JM.

Addict Behav Rep. 2017 Sep 23;6:106-111. doi: 10.1016/j.abrep.2017.09.001. eCollection 2017 Dec.

Comments: Poor adherence to methadone among homeless – we need innovative solutions!

14) Impacts of an opioid overdose prevention intervention delivered subsequent to acute care.

Banta-Green CJ, Coffin PO, Merrill JO, Sears JM, Dunn C, Floyd AS, Whiteside LK, Yanez ND, Donovan DM.

Inj Prev. 2018 Feb 7. pii: injuryprev-2017-042676. doi: 10.1136/injuryprev-2017-042676. [Epub ahead of print]

Comments: This study didn’t find a significant impact of delivering a brief education-based overdose prevention intervention among a population with extensive morbidity. No surprise to have a study with a negative finding – it expands our knowledge of what can make a difference.

15) Pharmaceutical opioid overdose deaths and the presence of witnesses.

Ogeil RP, Dwyer J, Bugeja L, Heilbronn C, Lubman DI, Lloyd B.

Int J Drug Policy. 2018 Feb 9;55:8-13. doi: 10.1016/j.drugpo.2017.12.020. [Epub ahead of print]

Comments: Witnessed overdoses don’t have to result in death.

16) Overcoming medication stigma in peer recovery: a new paradigm.

Krawczyk N, Negron T, Nieto M, Agus D, Fingerhood MI.

Subst Abus. 2018 Feb 12:0. doi: 10.1080/08897077.2018.1439798. [Epub ahead of print]

Comments: Yeah – this is a real, and very sad, problem. Imagine a diabetes support group that stigmatized / didn’t allow anyone who took medications for their diabetes.

17) The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland.

Latkin CA, Edwards C, Davey-Rothwell MA, Yang C, Tobin KE.

Subst Abus. 2018 Feb 12:0. doi: 10.1080/08897077.2018.1439801. [Epub ahead of print]

Comments: Public drug use.

18) Retention of student pharmacists’ knowledge and skills regarding overdose management with naloxone.

Jacobson AN, Bratberg JP, Monk M candidate, Ferrentino J candidate.

Subst Abus. 2018 Feb 12:0. doi: 10.1080/08897077.2018.1439797. [Epub ahead of print]

Comments: Pharmacist student education on overdose and naloxone.

19) An opioid overdose curriculum for medical residents: Impact on naloxone prescribing, knowledge, and attitudes.

Taylor JL, Rapoport AB, Rowley CF, Mukamal KJ, Stead W.

Subst Abus. 2018 Feb 12:0. doi: 10.1080/08897077.2018.1439800. [Epub ahead of print]

Comments: Resident education increased prescribing.

20) From Peers to Lay Bystanders: Findings from a Decade of Naloxone Distribution in Pittsburgh, PA.

Bennett AS, Bell A, Doe-Simkins M, Elliott L, Pouget E, Davis C.

J Psychoactive Drugs. 2018 Feb 9:1-7. doi: 10.1080/02791072.2018.1430409. [Epub ahead of print]

Comments: People who use opioids are more likely than others to come for a naloxone refill. Consistent with prior studies.

21) Commentary on McDonald et al. (2018): Intranasal naloxone-from the laboratory to the real world.

Nielsen S, Larney S, Farrell M.

Addiction. 2018 Mar;113(3):494-495. doi: 10.1111/add.14087. No abstract available.

Comments: Comments on intranasal naloxone.

22) High willingness to use rapid fentanyl test strips among young adults who use drugs.

Krieger MS, Yedinak JL, Buxton JA, Lysyshyn M, Bernstein E, Rich JD, Green TC, Hadland SE, Marshall BDL.

Harm Reduct J. 2018 Feb 8;15(1):7. doi: 10.1186/s12954-018-0213-2.

Comments: Fentanyl test strips are in high demand.

23) Low-energy Bluetooth for detecting real-world penetrance of bystander naloxone kits: a pilot study.

Lai JT, Chapman BP, Boyle KL, Boyer EW, Chai PR.

Proc Annu Hawaii Int Conf Syst Sci. 2018 Jan 3;2018:3253-3258.

Comments: Hmm. People who got naloxone carried it off the hospital campus – that’s as far as the detector could detect.

24) Expected and actual fentanyl exposure among persons seeking opioid withdrawal management.

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

J Subst Abuse Treat. 2018 Mar;86:65-69. doi: 10.1016/j.jsat.2018.01.005. Epub 2018 Jan 4.

Comments: Fentanyl exposure goes further than people who use drugs realize?

25) Opioid recovery initiation: Pilot test of a peer outreach and modified Recovery Management Checkup intervention for out-of-treatment opioid users.

Scott CK, Grella CE, Nicholson L, Dennis ML.

J Subst Abuse Treat. 2018 Mar;86:30-35. doi: 10.1016/j.jsat.2017.12.007. Epub 2017 Dec 19.

Comments: Authors report that there’s a high-risk subgroup of people who carry naloxone who don’t engage in treatment.

26) Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness.

Robertson AG, Easter MM, Lin HJ, Frisman LK, Swanson JW, Swartz MS.

J Subst Abuse Treat. 2018 Mar;86:17-25. doi: 10.1016/j.jsat.2017.12.003. Epub 2017 Dec 12.

Comments: Big reductions in crisis-driven service utilization.

27) 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.

Comments: Authors report variation in naloxone dosing and utilization. I’m not certain that’s a bad thing. There is certainly some variation by provider, but there’s also a lot of variation by situation. Yes, opioid overdose can be simply managed, but if you have the clinical expertise, there’s no reason not to manage it in a more sophisticated, individualized manner.

28) Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts.

Formica SW, Apsler R, Wilkins L, Ruiz S, Reilly B, Walley AY.

Int J Drug Policy. 2018 Jan 23;54:43-50. doi: 10.1016/j.drugpo.2018.01.001. [Epub ahead of print]

Comments: Descriptive paper on types of linkage programs after an overdose.

29) Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention “Renaissance”.

Gilbert L, Hunt T, Primbetova S, Terlikbayeva A, Chang M, Wu E, McCrimmon T, El-Bassel N.

Int J Drug Policy. 2018 Jan 27;54:105-113. doi: 10.1016/j.drugpo.2018.01.004. [Epub ahead of print]

Comments: Pre-post suggested a reduction in overdose events with naloxone receipt.

30) Factors associated with sedative use and misuse among heroin users.

Moses TEH, Lundahl LH, Greenwald MK.

Drug Alcohol Depend. 2018 Feb 2;185:10-16. doi: 10.1016/j.drugalcdep.2017.11.035. [Epub ahead of print]

Comments: Interesting that use of prescribed sedatives was not associated with more problems, but non-medical use was. I wonder what that means in the era when we are rapidly removing benzodiazepines from the medication profiles of any patients who use opioids… is that misguided?

31) Naloxone for Opioid Overdose and the Role of the Pharmacist.

Toderika Y, Williams S.

Consult Pharm. 2018 Feb 1;33(2):98-104. doi: 10.4140/TCP.n.2018.98.

Comments: Pharmacists’ role.

32) Intravenous fentanyl use among people who inject drugs in Australia.

Geddes L, Iversen J, Memedovic S, Maher L.

Drug Alcohol Rev. 2018 Feb 6. doi: 10.1111/dar.12668. [Epub ahead of print]

Comments: People who inject fentanyl were 2.16 times more likely to report past-year overdose.

33) A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release.

Brinkley-Rubinstein L, McKenzie M, Macmadu A, Larney S, Zaller N, Dauria E, Rich J.

Drug Alcohol Depend. 2018 Mar 1;184:57-63. doi: 10.1016/j.drugalcdep.2017.11.023. Epub 2018 Jan 31. Erratum in: Drug Alcohol Depend. 2018 Mar 6;186:9.

Comments: All of the findings suggest that continued methadone was superior to detoxing off methadone while in corrections, but the study was almost certainly underpowered to detect a significant difference. The as-treated analysis showed a substantial benefit to continued methadone, but it’s really the intent-to-treat that matters.

34) Injectable Extended-Release Naltrexone to Treat Opioid Use Disorder.

Ndegwa S, Pant S, Pohar S, Mierzwinski-Urban M.

CADTH Issues in Emerging Health Technologies. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016-. 163.

Comments: We still have a lot to learn.

35) Extended-release injectable naltrexone for opioid use disorder: a systematic review.

Jarvis BP, Holtyn AF, Subramaniam S, Tompkins DA, Oga EA, Bigelow GE, Silverman K.

Addiction. 2018 Feb 3. doi: 10.1111/add.14180. [Epub ahead of print] Review.

Comments: Authors determine that lots of people who want to start don’t and those who do often stop treatment early – and there are limited data on efficacy.

36) Why It’s Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy.

Wakeman SE.

AMA J Ethics. 2017 Sep 1;19(9):922-930. doi: 10.1001/journalofethics.2017.19.9.stas1-1709.

Comments: No different from other healthcare.

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

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

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

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

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

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

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

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

3) Drug involvement in fatal overdoses.

Ruhm CJ.

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

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

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

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

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

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

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

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

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

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

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

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

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

Comment: Demographics from the poison center.

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

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

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

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

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

Hedegaard H, Warner M, Miniño AM.

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

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

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

Rzasa Lynn R, Galinkin JL.

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

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

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

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

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

Comment: Advanced toxicology identified findings consistent with heroin exposure.

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

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

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

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

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

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

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

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

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

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

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

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

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

Wallace B, Barber K, Pauly BB.

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

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

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

Farahmand P, Modesto-Lowe V, Chaplin MM.

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

Comment: A good idea, as the authors argue.

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

Davidson PJ, Lopez AM, Kral AH.

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

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

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

Peprah K, Frey N.

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

Comment: Limited to absent data.

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

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

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

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

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

McCarty D, Priest KC, Korthuis PT.

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

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

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

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

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

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

21) Opioid, Overdose.

Schiller EY, Mechanic OJ.

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

Comment: A basic description.

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

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

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

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

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

Dasgupta N, Beletsky L, Ciccarone D.

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

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

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

Martin A, Mitchell A.

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

Comment: Great!

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

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

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

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

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

Palmer LE, Gautier A.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Marotta PL, McCullagh CA.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ghaddar A, Abbas Z, Haddad R.

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

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

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

Richmond NJ.

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

Comment: Can’t access and no abstract.

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

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

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

Comment: Important target for overdose prevention.

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

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

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

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

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

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

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

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

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

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

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

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

41) Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse.

Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.

PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.

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

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

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

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

43) Elderly Man in Respiratory Arrest.

Mackle T, Rhine D.

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

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

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

Shanks KG, Behonick GS.

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

Comment: Go low.

45) Naloxone Access and Use for Suspected Opioid Overdoses.

[No authors listed]

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

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

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

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

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

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

Consumption spaces

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

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

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

Comment: There were fewer people on the streets oversedated.

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

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

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

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

OxyContin reformulation

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

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

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

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

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

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

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

Comment: More on the unintended consequence of OxyContin reformulation.

Fentanyl papers

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

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

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

Comment: Per title.

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

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

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

Comment: New standard for untargeted drug identification.

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

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

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

Comment: Lots of fentanyl exposure.

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

Mars SG, Ondocsin J, Ciccarone D.

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

Comment: Critical ethnography.

55) Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin.

Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.

Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30. Review.

Comment: Way more complicated than just pain meds.

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

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

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

Comment: Another paper on identifying fentanyl analogs.

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

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

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

Comment: And another!

There’s some sophisticated work here – innovative epidemiology, interventions, and reviews of overdose. We’ve come a long way from the 1990s, but clearly not quickly enough for the dynamic urgency of this issue.

1) Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse.

Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.

PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.

Comments: Interesting approach and data.

2) Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin.

Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.

Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30.

Comments: Yeah … this is really complicated.

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

Plescia CJ, Manu P.

Am J Ther. 2017 Nov 14. doi: 10.1097/MJT.0000000000000692. [Epub ahead of print]

Comments: This is an iatrogenic methadone and benzodiazepine overdose during simultaneous alcohol and opioid detoxification.

4) Revisiting Naloxone: A different take on overdose guidelines from Lee County, Fla.

Hamel MG.

JEMS. 2016 Nov;41(11):46-8. No abstract available.

Comments: No abstract. Can’t access.

5) Naloxone Conundrum: Reduce risk in managing the opioid overdose patient.

Wirth SR.

JEMS. 2016 Nov;41(11):14-5. No abstract available.

Comments: Same journal, again no abstract, and can’t access.

6) Evaluation of the Southern Harm Reduction Coalition for HIV Prevention: Advocacy Accomplishments.

Story CR; Members of the Southern Harm Reduction Coalition, Kao WK, Currin J, Brown C, Charles V.

Health Promot Pract. 2017 Nov 1:1524839917742850. doi: 10.1177/1524839917742850. [Epub ahead of print]

Comments: Paper on the advocacy efforts for harm reduction.

7) Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus.

Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M.

Expert Opin Pharmacother. 2017 Dec;18(18):1987-1999. doi: 10.1080/14656566.2017.1409722. Epub 2017 Dec 3.

Comments: We have good medications. Use them.

8) Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review.

Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O’Reilly C, Grusing S, Daya M.

Ann Intern Med. 2017 Dec 19;167(12):867-875. doi: 10.7326/M17-2224. Epub 2017 Nov 28.

Comments: As with many systematic reviews, there are insufficient data to really answer the questions. Open access.

9) Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution.

Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM.

Pain Med. 2017 Jun 15. doi: 10.1093/pm/pnx140. [Epub ahead of print]

Comments: This is a unique survey at Mayo Clinic in Minnesota. Kudos to the authors. Most providers weren’t comfortable with the care they provided. Few (2%) routinely prescribed naloxone. Many weren’t registered with the PDMP. We’re kind of in a mess.

10) Payer Policy Behavior Towards Opioid Pharmacotherapy Treatment in Ohio.

Molfenter T, Sherbeck C, Starr S, Kim JS, Zehner M, Quanbeck A, Jacobson N, McCarty D.

J Addict Med. 2017 Nov 15. doi: 10.1097/ADM.0000000000000369. [Epub ahead of print]

Comments: Everyone pays for opioids for pain but treating opioid use disorder is not paid for unless paired with behavioral therapy and duration of treatment is limited. These are not evidence-based decisions. There are strong data that buprenorphine treatment are effective with or without behavioral therapy. And stopping treatment is always associated with increased mortality. How about we put a limit on the duration of insulin for diabetes?

11) Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington.

Glick SN, Burt R, Kummer K, Tinsley J, Banta-Green CJ, Golden MR.

Drug Alcohol Depend. 2017 Nov 16;182:86-92. doi: 10.1016/j.drugalcdep.2017.10.011. [Epub ahead of print]

Comments: The opioid epidemic is also a stimulant issue.

12) Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue.

Huxley-Reicher Z, Maldjian L, Winkelstein E, Siegler A, Paone D, Tuazon E, Nolan ML, Jordan A, MacDonald R, Kunins HV.

Addict Behav. 2017 Nov 16. pii: S0306-4603(17)30437-9. doi: 10.1016/j.addbeh.2017.11.029. [Epub ahead of print]

Comments: Great results from an innovative program to reach those at risk for overdose. Impressive work from NYC!

13) PHArmacists’ perspective oN the Take hOme naloxone prograM (The PHANTOM Study).

Edwards J, Bates D, Edwards B, Ghosh S, Yarema M.

Can Pharm J (Ott). 2017 Jul 7;150(4):259-268. doi: 10.1177/1715163517711960. eCollection 2017 Jul-Aug.

Comments: Pharmacists in Alberta highly supportive of screening patients and providing naloxone.

14) 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.

Comments: Training in naloxone prior to release was associated with improved knowledge.

15) Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999-2014: An Age-Period-Cohort Analysis.

Huang X, Keyes KM, Li G.

Am J Public Health. 2018 Jan;108(1):131-136. doi: 10.2105/AJPH.2017.304142. Epub 2017 Nov 21.

Comments: Fascinating results. Two cohorts are involved. Baby boomers 1947 through 1964 have elevated rates of prescription opioid as well as heroin overdose death. A second cohort, born 1979-1992, is at elevated risk of heroin overdose death. I can’t access full article unfortunately.

16) ‘I have it just in case’ – Naloxone access and changes in opioid use behaviours.

Heavey SC, Chang YP, Vest BM, Collins RL, Wieczorek W, Homish GG.

Int J Drug Policy. 2017 Nov 17;51:27-35. doi: 10.1016/j.drugpo.2017.09.015. [Epub ahead of print]

Comments: This is a qualitative study (N=20) at a residential treatment center (presumably in Buffalo NY where authors are based). Authors report that some respondents reported behaviors related to naloxone that may put them at higher risk. The is the first research to suggest this finding. The examples they provide, however, are not entirely concordant with the purported themes, with the exception of one example in which a respondent reported using something that he thought was fentanyl because there was someone with naloxone present in case it was in fact fentanyl. The other examples include: a person who overdosed three days in a row and was reversed by paramedics each time which is described as “opioid use after naloxone”, and “naloxone behaviors that may increase overdose mortality risk” which include mistaking an overdose for a nod (this doesn’t seem relevant to naloxone) and people who tend to use alone (again, unclear how this is related to naloxone). Finally, conducting this study in a residential treatment center brings extensive biases that affect how people (re)interpret their own history.

17) Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015.

Curtin SC, Tejada-Vera B, Warmer M.

NCHS Data Brief. 2017 Aug;(282):1-8.

Comments: Wow. Increased heroin deaths among kids. This suggests that we are dealing with increased opioid use, not just increased risk with the shift to heroin and emergence of fentanyl.

18) Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.

Lee JD, Nunes EV Jr, Novo P, Bachrach K, Bailey GL, Bhatt S, Farkas S, Fishman M, Gauthier P, Hodgkins CC, King J, Lindblad R, Liu D, Matthews AG, May J, Peavy KM, Ross S, Salazar D, Schkolnik P, Shmueli-Blumberg D, Stablein D, Subramaniam G, Rotrosen J.

Lancet. 2017 Nov 14. pii: S0140-6736(17)32812-X. doi: 10.1016/S0140-6736(17)32812-X. [Epub ahead of print]

Comments: In randomized-controlled trials, we care about the intent-to-treat analysis. The per-protocol analysis is a distant second that doesn’t usually get a place of prominence in the abstract of a major paper, making this abstract unusual. Moreover, describing the intent-to-treat findings as “it is harder to initiate patients” is very unusual. The most important finding from this study is, of course, that those assigned to XR-NTX had higher rates of relapse and more opioid-positive urines – and this should be the conclusion by traditional RCT standards. While the authors are likely correct that this finding is because it is harder (and presumably more dangerous) to induct people onto XR-NTX, from a clinical perspective this makes XR-NTX inferior to buprenorphine. That does not mean it’s not valuable, but it does mean that relying exclusively on it is inconsistent with quality care. I really hope they are following people longer than 24 weeks, given that this is a lifelong disease and, while buprenorphine is usually provided longterm, XR-NTX is rarely provided for more than 6 months. Of note, there are several author COIs related to Alkermes which I consider relevant given the unusual presentation of intent-to-treat results.

19) Is naloxone the best antidote to reverse tramadol-induced neuro-respiratory toxicity in overdose? An experimental investigation in the rat.

Lagard C, Malissin I, Indja W, Risède P, Chevillard L, Mégarbane B.

Clin Toxicol (Phila). 2017 Nov 17:1-7. doi: 10.1080/15563650.2017.1401080. [Epub ahead of print]

Comments: Works, but increases seizure risk.

20) Extracorporeal membrane oxygenation used successfully in a near fatal case of opioid-induced acute respiratory distress syndrome.

Greenberg K, Kohl B.

Am J Emerg Med. 2017 Nov 8. pii: S0735-6757(17)30928-2. doi: 10.1016/j.ajem.2017.11.020. [Epub ahead of print]

Comments: ARDS is a nasty lung disease that is difficult to ventilate, with a high mortality rate.

21) Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas-United States.

Mack KA, Jones CM, Ballesteros MF.

Am J Transplant. 2017 Dec;17(12):3241-3252. doi: 10.1111/ajt.14555.

Comments: Why is this in a transplantation journal? Also, an earlier paper in this review suggests that youth opioid use has picked up since the end of the study period for this article.

22) Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study.

McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, Strang J.

Addiction. 2017 Nov 16. doi: 10.1111/add.14033. [Epub ahead of print]

Comments: 2mg IN similar to 0.4mg IM … as one would expect!

23) Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial.

Molfenter T, Knudsen HK, Brown R, Jacobson N, Horst J, Van Etten M, Kim JS, Haram E, Collier E, Starr S, Toy A, Madden L.

Implement Sci. 2017 Nov 15;12(1):135. doi: 10.1186/s13012-017-0665-x.

Comments: Description of an impending implementation science study to increase provision of addiction treatment for opioid use disorder.

24) Reversal of Opioid-Induced Toxicity.

Ostwal SP, Salins N, Deodhar J.

Indian J Palliat Care. 2017 Oct-Dec;23(4):484-486. doi: 10.4103/IJPC.IJPC_117_17.

Comments: Case report of a person on palliative opioids successfully reversed with naloxone.

25) Epidemiologic incidence of rhabdomyolysis in opioid overdose in ICU of poisoning center in Iran, 2014.

Khoshideh B, Arefi M, Ghorbani M, Akbarpour S, Taghizadeh F.

Epidemiol Health. 2017 Nov 8. doi: 10.4178/epih.e2017050. [Epub ahead of print]

Comments: Rhabdomyolysis is a disease produced by breakdown of muscle cells, resulting in buildup of creatine kinase which is toxic to the kidneys. Usually it occurs when someone is “down” for a prolonged period (i.e. unconscious on the floor), resulting in pressure on muscles. Sometimes we see it with extreme exposure to stimulants, such as cocaine or methamphetamine, with excessive tensing of muscles for prolonged periods. We also see it as a rare side effect of statin exposure, and several other causes.

26) Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose.

Freeman LK, Bourque S, Etches N, Goodison K, O’Gorman C, Rittenbach K, Sikora CA, Yarema M.

Can J Public Health. 2017 Nov 9;108(4):e398-e402. doi: 10.17269/cjph.108.5989.

Comments: 9572 kits distributed and 472 reversals reported in Alberta’s 953 naloxone sites in 2016.

27) Availability of naloxone in Canadian pharmacies: a population-based survey.

Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN.

CMAJ Open. 2017 Nov 8;5(4):E779-E784. doi: 10.9778/cmajo.20170123.

Comments: Half of pharmacies had naloxone available in British Columbia, one-third in Maritimes, a quarter in Ontario and central and northern Canada; 0.9% in Quebec.

28) Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 – 10 States, July-December 2016.

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1197-1202. doi: 10.15585/mmwr.mm6643e1.

Comments: I’m still stuck on “this sucks.”

29) Is systematic training in opioid overdose prevention effective?

Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT; REDAN Group.

PLoS One. 2017 Oct 31;12(10):e0186833. doi: 10.1371/journal.pone.0186833. eCollection 2017.

Comments: 40% of people who inject opioids that received naloxone used it to reverse an overdose.

30) Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial.

Coffin PO, Santos GM, Matheson T, Behar E, Rowe C, Rubin T, Silvis J, Vittinghoff E.

PLoS One. 2017 Oct 19;12(10):e0183354. doi: 10.1371/journal.pone.0183354. eCollection 2017.

Comments: Motivational interviewing-based intervention among naloxone recipients resulted in substantial reduction in occurrence of subsequent overdose events.

31) Drug related deaths in Scotland double in 10 years.

Iacobucci G.

BMJ. 2017 Aug 21;358:j3941. doi: 10.1136/bmj.j3941. No abstract available.

Comments: Ugh. Overdose death is way more complicated than a simple reversal agent. There are clearly economic and social elements to the epidemic we are facing today.

32) Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Moore PQ, Weber J, Cina S, Aks S.

Am J Emerg Med. 2017 Nov;35(11):1706-1708. doi: 10.1016/j.ajem.2017.05.003. Epub 2017 May 8.

Comments: We are still a long way from effectively utilizing clinical data systems.

33) Deadly chemistry.

McLaughlin K.

Science. 2017 Mar 31;355(6332):1364-1366. doi: 10.1126/science.355.6332.1364. No abstract available.

Comments: Fentanyl and analogues.

34) Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD.

Addict Sci Clin Pract. 2017 Feb 28;12(1):7. doi: 10.1186/s13722-017-0072-2.

Comments: Home induction works well, even in low resource settings.

35) A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence.

Chetty M, Kenworthy JJ, Langham S, Walker A, Dunlop WC.

Addict Sci Clin Pract. 2017 Feb 24;12(1):6. doi: 10.1186/s13722-017-0071-3. Review.

Comments: 18 models in total, with widely varying approaches and quality, a tiny number given the impact of opioid use disorder and treatment.

36) Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study.

Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD.

Harm Reduct J. 2017 Feb 20;14(1):13. doi: 10.1186/s12954-017-0139-0.

Comments: >60%

37) The impact of benzodiazepine use in patients enrolled in opioid agonist therapy in Northern and rural Ontario.

Franklyn AM, Eibl JK, Gauthier G, Pellegrini D, Lightfoot NE, Marsh DC.

Harm Reduct J. 2017 Jan 26;14(1):6. doi: 10.1186/s12954-017-0134-5. Erratum in: Harm Reduct J. 2017 Mar 28;14 (1):15.

Comments: Benzodiazepine use complicated opioid use disorder treatment, for sure. One of the questions is why? Is it comorbid use disorder? Is it anxiety? Depression?

38) Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know.

Kerensky T, Walley AY.

Addict Sci Clin Pract. 2017 Jan 7;12(1):4. doi: 10.1186/s13722-016-0068-3. Review.

Comments: Nice review of key issues related to naloxone provision.

1) Using Group Visits to Provide Overdose Education and Distribute Naloxone to High-Risk Primary Care Patients.

Bair MJ.

Pain Med. 2017 Nov 1. doi: 10.1093/pm/pnx279. [Epub ahead of print] No abstract available.

Comment: Described in the title, this is a commentary on a quasi-experimental study in Veterans’ Administration clinics.

2) Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative.

Spelman JF, Peglow S, Schwartz AR, Burgo-Black L, McNamara K, Becker WC.

Pain Med. 2017 Oct 16. doi: 10.1093/pm/pnx243. [Epub ahead of print]

Comment: The paper discussed in the above commentary.

3) Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France.

Roux P, Rojas Castro D, Ndiaye K, Briand Madrid L, Laporte V, Mora M, Maradan G, Morel S, Spire B, Carrieri P.

Subst Abuse Treat Prev Policy. 2017 Nov 2;12(1):46. doi: 10.1186/s13011-017-0131-4.

Comment: If oral therapy did not work, some people would accept supervised IV buprenorphine treatment.

4) Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 – 10 States, July-December 2016.

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1197-1202. doi: 10.15585/mmwr.mm6643e1.

Comment: >10% of deaths involved fentanyl and analogues.

5) Trends in Hospitalization for Opioid Overdose among Rural Compared to Urban Residents of the United States, 2007-2014.

Mosher H, Zhou Y, Thurman AL, Sarrazin MV, Ohl ME.

J Hosp Med. 2017 Nov;12(11):925-929. doi: 10.12788/jhm.2793.

Comment: Can’t access full article, but this seems to compare overdose hospitalizations between urban and rural sites and urban and rural residents.

6) Is systematic training in opioid overdose prevention effective?

Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT; REDAN Group.

PLoS One. 2017 Oct 31;12(10):e0186833. doi: 10.1371/journal.pone.0186833. eCollection 2017.

Comment: Yes. Improved knowledge and a possible slight decline in regional fatal overdoses.

7) Heroin Contaminated with Fentanyl Dramatically Enhances Brain Hypoxia and Induces Brain Hypothermia.

Solis E Jr, Cameron-Burr KT, Kiyatkin EA.

eNeuro. 2017 Oct 30;4(5). pii: ENEURO.0323-17.2017. doi: 10.1523/ENEURO.0323-17.2017. eCollection 2017 Sep-Oct.

Comment: As the title says.

8) A Survey of Prescribers’ Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program.

Peckham AM, Niculete ME, Steinberg H, Boggs DL.

J Public Health Manag Pract. 2017 Oct 27. doi: 10.1097/PHH.0000000000000668. [Epub ahead of print]

Comment: Providers still need individualized training for this.

9) Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review.

Lewis CR, Vo HT, Fishman M.

Subst Abuse Rehabil. 2017 Oct 11;8:79-95. doi: 10.2147/SAR.S101700. eCollection 2017. Review.

Comment: Progress has been made but we have a long way to go.

10) Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial.

Coffin PO, Santos GM, Matheson T, Behar E, Rowe C, Rubin T, Silvis J, Vittinghoff E.

PLoS One. 2017 Oct 19;12(10):e0183354. doi: 10.1371/journal.pone.0183354. eCollection 2017.

Comment: Talking about overdose regularly can reduce overdose events…

11) Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas – United States.

Mack KA, Jones CM, Ballesteros MF.

MMWR Surveill Summ. 2017 Oct 20;66(19):1-12. doi: 10.15585/mmwr.ss6619a1.

Comment: Not as simple as we’ve been told.

12) The US Opioid Crisis: Current Federal and State Legal Issues.

Soelberg CD, Brown RE Jr, Du Vivier D, Meyer JE, Ramachandran BK.

Anesth Analg. 2017 Nov;125(5):1675-1681. doi: 10.1213/ANE.0000000000002403. Review.

Comment: Legal and policy approaches.

13) Increasing availability of illicit and prescription opioids among people who inject drugs in a Canadian setting, 2010-2014.

Ho J, DeBeck K, Milloy MJ, Dong H, Wood E, Kerr T, Hayashi K.

Am J Drug Alcohol Abuse. 2017 Oct 19:1-10. doi: 10.1080/00952990.2017.1376678. [Epub ahead of print]

Comment: As title says, and in some contrast to the U.S. experience in which prescription opioid availability began to decline after 2010.

14) Imaging Sex Differences in Regional Brain Metabolism during Acute Opioid Withdrawal.

Santoro GC, Carrion J, Dewey SL.

J Alcohol Drug Depend. 2017 Apr;5(2). pii: 262. doi: 10.4172/2329-6488.1000262. Epub 2017 Apr 6.

Comment: Differences between men and women may help to explain different responsiveness to opioid use disorder treatment.

15) Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”.

Salama A, Levin Y, Jha P, Alweis R.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):222-226. doi: 10.1080/20009666.2017.1351290. eCollection 2017 Oct.

Comment: Yikes.

16) Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU.

Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, Jean E.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):202-207. doi: 10.1080/20009666.2017.1356189. eCollection 2017 Oct.

Comment: This was a study of ICU admissions for acute drug poisoning in a single facility in NYC over 6 months from late 2015 to early 2016. The 65 patients accounted for 19% of all ICU admissions during the period; 8 signed out AMA while in the ICU and 5 patients died. The most common drugs positive on serumor urine testing were alcohol (35%), opioids (33%), cocaine (24%), methadone (22%), benzodiazepines (18%), and marijuana (16%). Among the 35% with negative screens, causes of the admission including tylenol, ethylene gycol, isopropyl alcohol, bleach, NSAIDS, and antidepressants. Mean cost of ICU care was $16k.

I don’t see a report on length of stay or on disposition (i.e. did they go home, to skilled nursing, were they vegetative, etc.).

17) Naloxone Counseling for Harm Reduction and Patient Engagement.

Han JK, Hill LG, Koenig ME, Das N.

Fam Med. 2017 Oct;49(9):730-733.

Comment: Family health providers providing naloxone kits.

18) National trends and outcomes of cardiac arrest in opioid overdose.

Sakhuja A, Sztajnkrycer M, Vallabhajosyula S, Cheungpasitporn W, Patch R 3rd, Jentzer J.

Resuscitation. 2017 Oct 14;121:84-89. doi: 10.1016/j.resuscitation.2017.10.010. [Epub ahead of print]

Comment: Interesting. Mortality in the hospital for drug poisoning 1.5%: heroin overdose 4.4% (61.8% if arrived in cardiac arrest), prescription opioid overdose 2.3% (58.3% for cardiac arrest), non-opioid 1.2% (54.7% for cardiac arrest). Authors report increasing rate of cardiac arrest presentations for heroin overdose from 2000-2013, and most presentations are for prescription opioids. Trying to tease this apart is a bit tricky. Does this mean heroin overdoses are getting more dangerous? If the data went to 2015 or 2016 the answer would likely be yes, due to fentanyl, but earlier years didn’t see much of that so I don’t think this is explained by fentanyl. Were more heroin overdoses being managed in the field, either by lay persons or paramedics with more lenient transport policies, and thus not presenting to the hospital unless they had serious complications?

19) Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature.

Butler DC, Shanks K, Behonick GS, Smith D, Presnell SE, Tormos LM.

J Anal Toxicol. 2017 Sep 28:1-6. doi: 10.1093/jat/bkx083. [Epub ahead of print]

Comment: Hard to detect.

20) Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists.

Knipper E, Banta-Green CJ, Jimenez N.

Paediatr Anaesth. 2017 Nov;27(11):1070-1076. doi: 10.1111/pan.13225. Review.

Comment: Discussion of disordered opioid use by pediatric patients.

21) Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses.

Larance B, Degenhardt L, Peacock A, Gisev N, Mattick R, Colledge S, Campbell G.

Drug Alcohol Rev. 2017 Oct 12. doi: 10.1111/dar.12617. [Epub ahead of print]

Comment: Not much harm yet and interest in developing policies and practices to prevent them.

22) Basic and Advanced EMS Providers Are Equally Effective in Naloxone Administration for Opioid Overdose in Northern New England.

Gulec N, Lahey J, Suozzi JC, Sholl M, MacLean CD, Wolfson DL.

Prehosp Emerg Care. 2017 Oct 12:1-7. doi: 10.1080/10903127.2017.1371262. [Epub ahead of print]

Comment: It’s a remarkably safe and straightforward drug.

23) Use of on-site detoxification services co-located with a supervised injection facility.

Gaddis A, Kennedy MC, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T.

J Subst Abuse Treat. 2017 Nov;82:1-6. doi: 10.1016/j.jsat.2017.08.003. Epub 2017 Aug 8.

Comment: Insite has a detox service. 11% of Insite attendees utilized it in a 2 year period. A recent overdose roughly doubled the chances that a participant would access the service (adjusted odds ratio 1.90).

24) Acute eosinophilic pneumonia secondary to heroin inhalation.

Eyüpoğlu D, Ortaç Ersoy E, Rollas K, Topeli A.

Tuberk Toraks. 2017 Jun;65(2):154-156. doi: 10.5578/tt.10438.

Comment: Treated with steroids.

25) Patterns of substance use and mortality risk in a cohort of “hard-to-reach” polysubstance users.

Gjersing L, Bretteville-Jensen AL.

Addiction. 2017 Oct 7. doi: 10.1111/add.14053. [Epub ahead of print]

Comment: 6% reported an overdose in the preceding 30 days. Crude mortality was 2.52/100py, 57% of which was due to overdose. A past-four week overdose quadrupled the risk of death and agonist treatment halved mortality. Using a latent class analysis among those not in agonist treatment, polysubstance injectors and somewhat frequent injectors were the most likely to die.

26) Combatting the opioid epidemic: Baltimore’s experience and lessons learned.

Wen LS, Warren KE.

J Public Health (Oxf). 2017 Jul 19:1-5. doi: 10.1093/pubmed/fdx093. [Epub ahead of print]

Comment: Summary of actions in Baltimore

27) Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers.

Dahlem CHG, King L, Anderson G, Marr A, Waddell JE, Scalera M.

Public Health Nurs. 2017 Oct 6. doi: 10.1111/phn.12365. [Epub ahead of print]

Comment: Description of naloxone use by law enforcement.

28) Opioid crisis at the Jersey Shore-special report.

Dudley LS, Konomos D, Robbins V, Qiu L, Bauter R, Merlin MA.

J Public Health (Oxf). 2017 Aug 31:1-6. doi: 10.1093/pubmed/fdx106. [Epub ahead of print]

Comment: Jersey Shore overdoses seen by advanced EMS. 312 cases. 212 got first naloxone by lay person, police, or other BLS provider. Of those 5.2% died. Of those who got first naloxone dose by paramedics, 19.3% died.

29) A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose.

Griswold MK, Chai PR, Krotulski AJ, Friscia M, Chapman BP, Varma N, Boyer EW, Logan BK, Babu KM.

J Med Toxicol. 2017 Oct 2. doi: 10.1007/s13181-017-0632-6. [Epub ahead of print]

Comment: Oral fluid testing.

30) The Opioid Epidemic: Crisis and Solutions.

Skolnick P.

Annu Rev Pharmacol Toxicol. 2017 Oct 2. doi: 10.1146/annurev-pharmtox-010617-052534. [Epub ahead of print]

Comment: Discussion of need for alternative pharmacotherapies for pain.

31) Take-home naloxone provision cuts opioid overdose deaths.

Thompson J.

Practitioner. 2016 Nov;260(1798):7. No abstract available.

Comment: Letter. Can’t access.

32) Fentanyl and the Evolving Opioid Epidemic: What Strategies Should Policy Makers Consider?

Barry CL.

Psychiatr Serv. 2017 Oct 2:appips201700235. doi: 10.1176/appi.ps.201700235. [Epub ahead of print]

Comment: Several harm reduction approaches discussed.

33) Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015.

Eigner G, Henriksen B, Huynh P, Murphy D, Brubaker C, Sanders J, McMahan D.

Health Serv Res Manag Epidemiol. 2017 Sep 8;4:2333392817727424. doi: 10.1177/2333392817727424. eCollection 2017 Jan-Dec.

Comment: Opioid deaths in Allen County, Indiana.

34) Heroin-Related Compartment Syndrome: An Increasing Problem for Acute Care Surgeons.

Benns M, Miller K, Harbrecht B, Bozeman M, Nash N.

Am Surg. 2017 Sep 1;83(9):962-965.

Comment: Unable to access, but I assume this is in Kentucky. Heroin is now the second most common etiology for compartment syndrome. Compartment syndrome is basically when there is so much swelling in a part of the body that blood can no longer flow to that region.

35) Concurrent Use of Opioids and Benzodiazepines: Evaluation of Prescription Drug Monitoring by a United States Laboratory.

McClure FL, Niles JK, Kaufman HW, Gudin J.

J Addict Med. 2017 Sep 28. doi: 10.1097/ADM.0000000000000354. [Epub ahead of print]

Comment: Among people who were prescribed either an opioid or a benzodiazepine and who were urine tox tested, 25% had the other drug class – half of those cases were not prescribed the other class of drugs. 19% of specimens testing positive for prescribed opioids also had non-prescribed benzodiazepines and 15% of specimens testing positive for prescribed benzodiazepines also had non-prescribed opioids. These data are a bit confusing as many are presented as specimen data rather than patient data; clearly a person who is tested frequently is more likely to have non-prescribed use and results would be similar within-person.

36) The Curious (Dis)Connection between the Opioid Epidemic and Crime.

Szalavitz M, Rigg KK.

Subst Use Misuse. 2017 Sep 27:1-5. doi: 10.1080/10826084.2017.1376685. [Epub ahead of print]

Comment: “That trend—towards viewing addiction as a medical, rather than a moral problem—has also been given a tremendous boost by the media focus on opioid addiction as a white problem.”

37) Community use of naloxone for opioid overdose.

Jauncey ME, Nielsen S.

Aust Prescr. 2017 Aug;40(4):137-140. doi: 10.18773/austprescr.2017.043. Epub 2017 Aug 1. Review. No abstract available.

Comment: Pharmacy review.

38) Modifiable risk factors for external cause mortality after release from prison: a nested case-control study.

Spittal MJ, Forsyth S, Borschmann R, Young JT, Kinner SA.

Epidemiol Psychiatr Sci. 2017 Sep 25:1-10. doi: 10.1017/S2045796017000506. [Epub ahead of print]

Comment: Use of opioids in the community more than doubles the risk of death on prison release.

39) Methods for delivering the UK’s multi-centre prison-based naloxone-on-release pilot randomised trial (N-ALIVE): Europe’s largest prison-based randomised controlled trial.

Meade AM, Bird SM, Strang J, Pepple T, Nichols LL, Mascarenhas M, Choo L, Parmar MKB.

Drug Alcohol Rev. 2017 Sep 21. doi: 10.1111/dar.12592. [Epub ahead of print]

Comment: Feasibility of RCT in prison.

40) Opioid Overdose Outbreak – West Virginia, August 2016.

Massey J, Kilkenny M, Batdorf S, Sanders SK, Ellison D, Halpin J, Gladden RM, Bixler D, Haddy L, Gupta R.

MMWR Morb Mortal Wkly Rep. 2017 Sep 22;66(37):975-980. doi: 10.15585/mmwr.mm6637a3.

Comment: 20 overdoses in 2 days in a town in West Virginia, lots of fentanyl products.

41) A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder.

Chang DC, Klimas J, Wood E, Fairbairn N.

J Addict Med. 2017 Sep 19. doi: 10.1097/ADM.0000000000000359. [Epub ahead of print]

Comment: Are we still surprised by this? Detox is extremely dangerous.

42) Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments.

Lacroix L, Thurgur L, Orkin AM, Perry JJ, Stiell IG.

CJEM. 2017 Sep 18:1-7. doi: 10.1017/cem.2017.390. [Epub ahead of print]

Comment: 86% of ED docs were willing to prescribe naloxone. That’s substantial.

43) Advances in the delivery of buprenorphine for opioid dependence.

Rosenthal RN, Goradia VV.

Drug Des Devel Ther. 2017 Aug 28;11:2493-2505. doi: 10.2147/DDDT.S72543. eCollection 2017. Review.

Comment: Patches, injections, and implants, oh my.

44) Deaths from Opioid Overdosing: Implications of Coroners’ Inquest Reports 2008-2012 and Annual Rise in Opioid Prescription Rates: A Population-Based Cohort Study.

Shipton EE, Shipton AJ, Williman JA, Shipton EA.

Pain Ther. 2017 Sep 8. doi: 10.1007/s40122-017-0080-7. [Epub ahead of print]

Comment: A 33% increase in opioid death from 2001 to 2012 in New Zealand.

45) Treating Acute Pain in the Opiate-Dependent Patient.

Dever C.

J Trauma Nurs. 2017 Sep/Oct;24(5):292-299. doi: 10.1097/JTN.0000000000000309.

Comment: Per title, can’t access.

46) Mobile Technology to Increase HIV/HCV Testing and Overdose Prevention/Response among People Who Inject Drugs.

Aronson ID, Bennett A, Marsch LA, Bania TC.

Front Public Health. 2017 Aug 23;5:217. doi: 10.3389/fpubh.2017.00217. eCollection 2017.

Comment: Combining HIV, HCV, and overdose into a tablet.

47) Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis.

Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ.

Drug Alcohol Depend. 2017 Aug 10;180:33-38. doi: 10.1016/j.drugalcdep.2017.07.016. [Epub ahead of print]

Comment: Public injecting was associated with detectable HIV viral load, incarceration, and daily injection. Overdose was more likely in bivariate but not adjusted analyses.

48) Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region – United States, 2006-2015.

O’Donnell JK, Gladden RM, Seth P.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):897-903. doi: 10.15585/mmwr.mm6634a2.

Comment: Mortality increased throughout the nation, least in the West and most in the Northeast

49) Overdose Deaths Related to Fentanyl and Its Analogs – Ohio, January-February 2017.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore IE, Harshbarger KE, Antonides HM, Carlson RR.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):904-908. doi: 10.15585/mmwr.mm6634a3.

Comment: Fentanyl and related products overtaking

50) Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid.

Frazier W, Cochran G, Lo-Ciganic WH, Gellad WF, Gordon AJ, Chang CH, Donohue JM.

JAMA. 2017 Aug 22;318(8):750-752. doi: 10.1001/jama.2017.7818. No abstract available.

Comment: Slight increase in pharmacotherapy for opioid use disorder after overdose event

51) Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015.

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

Public Health Rep. 2017 Sep/Oct;132(5):563-569. doi: 10.1177/0033354917717230. Epub 2017 Jul 27.

Comment: 22% of people who inject drugs had take-home naloxone.