1) Drugs, Guns and Cars: How Far We Have Come to Improve Safety in the United States; Yet We Still Have Far to Go.

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

Pediatr Res. 2016 Sep 27. doi: 10.1038/pr.2016.193. [Epub ahead of print] Review.

Comment: Review of safety efforts in public health.

2) Primary Care Patient Experience with Naloxone Prescription.

Behar E, Rowe C, Santos GM, Murphy S, Coffin PO.

Ann Fam Med. 2016 Sep;14(5):431-6. doi: 10.1370/afm.1972.

Comment: This is a partner paper to the study results reported a couple of months ago. Mixed methods interviews with 60 randomly selected patients on longterm opioid therapy for chronic pain who had been prescribed naloxone. The co-prescribing effort reached a population that was not really accessing naloxone through other community distribution sites in San Francisco. Some reported improved safety with opioids since receiving naloxone and none reported more high-risk use behaviors. About half of those who had overdosed denied “overdose” and described it as a bad reaction.

3) Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural versus an Urban Setting.

Dunn KE, Barrett FS, Yepez-Laubach C, Meyer AC, Hruska BJ, Petrush K, Berman S, Sigmon SC, Fingerhood M, Bigelow GE.

J Subst Abuse Treat. 2016 Dec;71:1-7.

Comment: Can’t access the paper, but the abstract suggests higher rates of overdose among rural drug users versus urban, while there were fewer overdose risk behaviors among rural users (potentially raising concerns about our risk behaviors, which were retrospectively developed).

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

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

Drug Alcohol Depend. 2016 Sep 11;168:140-146. doi: 10.1016/j.drugalcdep.2016.08.638. [Epub ahead of print]

Comment: People who inject drugs have more psychological distress than the general population. Not surprised that intentional overdose (i.e. suicide attempt) is associated with psychological distress.

5) Notes from the Field: Furanyl-Fentanyl Overdose Events Caused by Smoking Contaminated Crack Cocaine – British Columbia, Canada, July 15-18, 2016.

Klar SA, Brodkin E, Gibson E, Padhi S, Predy C, Green C, Lee V.

MMWR Morb Mortal Wkly Rep. 2016 Sep 23;65(37):1015-1016. doi: 10.15585/mmwr.mm6537a6.

Comment: Fentanyl in crack. Ugh.

6) Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Sep 02.

Comment: Buprenorphine is safe, effective, and cost-effective compared to methadone.

7) Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain.

Dunn KE, Barrett FS, Fingerhood M, Bigelow GE.

Pain Med. 2016 Sep 20. pii: pnw228. [Epub ahead of print]

Comment: Not enough of these type of studies – addressing opioid overdose experience and knowledge among patients on opioids for chronic pain. 19% had a lifetime history of opioid overdose – similar to the study #2 above, although that study found that number to double when patients were asked about “bad reactions” that were characterized by not breathing or not being able to be woken up without help after using opioids.

8) Co-prescribing naloxone does not increase liability risk.

Davis CS, Burris S, Beletsky L, Binswanger I.

Subst Abus. 2016 Sep 20:0. [Epub ahead of print]

Comment: There is no particular liability in prescribing naloxone.

9) Trends in the Distribution of Opioids in Puerto Rico, 1999-2013.

El Burai Félix S, Mack KA, Jones CM.

P R Health Sci J. 2016 Sep;35(3):165-9.

Comment: Interesting that overdose deaths aren’t increasing as Rx opioid distribution is increasing. Hmm.

10) Standing Against Addiction.

Berlin J.

Tex Med. 2016 Sep 1;112(9):49-54.

Comment: Standing orders for naloxone in Texas.

11) Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients.

Fife A, Postier A, Flood A, Friedrichsdorf SJ.

J Opioid Manag. 2016 May-Jun;12(2):123-30. doi: 10.5055/jom.2016.0324.

Comment: When we convert people from one opioid to another we use conversion ratios. When converting to methadone, kids were very under-dosed.

12) Location of fatal prescription opioid-related deaths in 12 states, 2008-2010: Implications for prevention programs.

Easterling KW, Mack KA, Jones CM.

J Safety Res. 2016 Sep;58:105-9. doi: 10.1016/j.jsr.2016.07.004. Epub 2016 Aug 7.

Comment: Most overdose deaths occur at home, more so for prescription opioid deaths.

13) Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time series analysis.

McAuley A, Bouttell J, Barnsdale L, Mackay D, Lewsey J, Hunter C, Robinson M.

Addiction. 2016 Sep 10. doi: 10.1111/add.13602. [Epub ahead of print]

Comment: Naloxone distribution was not associated with a reduction in ambulances attending opioid overdoses. There could be other explanations for this, but the authors believe it suggests that people call for emergency medical assistance just as often when naloxone is available as when it is not.

14) Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems.

Elzey MJ, Fudin J, Edwards ES.

Expert Opin Drug Deliv. 2016 Sep 16:1-14. [Epub ahead of print]

Comment: Hmm … an unambiguous endorsement – that nothing but the auto-injector should be used – coming from the makers of the auto-injector.

15) Analysis of Novel Synthetic Opioids U-47700, U-50488 and Furanyl Fentanyl by LC-MS/MS in Postmortem Casework.

Mohr AL, Friscia M, Papsun D, Kacinko SL, Buzby D, Logan BK.

J Anal Toxicol. 2016 Sep 1. [Epub ahead of print]

Comment: Synthetic opioids. Harrumph.

1) Notes from the field: acetyl fentanyl overdose fatalities – rhode island, march-may 2013.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2013 Aug 30;62(34):703-4.

Comment: The evidence of synthetic fentanyl was difficult to detect and concerning to many as heralding a possible repeat of the 2006/2007 fentanyl-tainted heroin overdose outbreak.

2) Methadone induced sensorineural hearing loss.

Saifan C, Glass D, Barakat I, El-Sayegh S.

Case Rep Med. 2013;2013:242730. doi: 10.1155/2013/242730. Epub 2013 Jul 29.

Comment: In this case the patient was restarted on methadone and the sensorineural hearing loss was permanent.

3) Opioids compared to placebo or other treatments for chronic low-back pain.

Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC.

Cochrane Database Syst Rev. 2013 Aug 27;8:CD004959. doi:

Comment: There are no quality data to support long-term management of non-cancer pain with opioids.

4) Cory monteith dies of a heroin overdose at age 31.

Willens JS.

Pain Manag Nurs. 2013 Sep;14(3):125. doi: 10.1016/j.pmn.2013.07.004. No abstract available.

Comment: The Glee star.

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

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

Clin Toxicol (Phila). 2013 Aug 23. [Epub ahead of print]

Comment: Accidental poisonings among family in Iran for (insufficiently-labeled) take-home methadone syrup.

6) The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department.

Teo A, Cooper J.

Scott Med J. 2013 Aug;58(3):149-53. doi: 10.1177/0036933013496951.

Comment: I’m unable to access this paper. It’s a review of overdose events at a Scottish hospital; 4% were administered naloxone.

7) Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach.

Gilbert L, Primbetova S, Nikitin D, Hunt T, Terlikbayeva A, Momenghalibaf A, Ruziev M, El-Bassel N.

Drug Alcohol Depend. 2013 Aug 13. doi:pii: S0376-8716(13)00282-2.

Comment: A really interesting approach to thinking about HIV and drug overdose mortality, through the lens of syndemics – a hot topic in public health – and risk environments. With the bonus of an important review of data from several Central Asian states.

8) Increased densities of nitric oxide synthase expressing neurons in the temporal cortex and the hypothalamic paraventricular nucleus of polytoxicomanic heroin overdose victims: Possible implications for heroin neurotoxicity.

Bernstein HG, Trübner K, Krebs P, Dobrowolny H, Bielau H, Steiner J, Bogerts B.

Acta Histochem. 2013 Aug 13. doi:pii: S0065-1281(13)00145-1.

Comment: Interesting analysis comparing heroin overdose patients to controls, although I’m unclear it’s direct relationship to the pathologic processes of overdose.

9) Associations Between Injection Risk and Community Disadvantage Among Suburban Injection Drug Users in Southwestern Connecticut, USA.

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

AIDS Behav. 2013 Aug 7. [Epub ahead of print]

Comment: Intriguing paper on rural heroin use.

10) Non-Fatal Opioid Overdose and Major Depression among Street-Recruited Young Heroin Users.

Chahua M, Sordo L, Barrio G, Domingo-Salvany A, Brugal MT, Molist G, de la Fuente L, Bravo MJ.

Eur Addict Res. 2013 Aug 1;20(1):1-7. [Epub ahead of print]

Comment: There haven’t been many overdose studies out of Spain. Nice to see this.

11) Reducing the health consequences of opioid addiction in primary care.

Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD.

Am J Med. 2013 Jul;126(7):565-71. doi: 10.1016/j.amjmed.2012.11.031. Epub 2013 May 8. Review.

Comment: Kudos to the authors for getting out to primary care providers information on simple harm reduction practices that can be employed in clinical settings.

12) Opioid antagonists for pain.

Taylor R Jr, Pergolizzi JV Jr, Porreca F, Raffa RB.

Expert Opin Investig Drugs. 2013 Apr;22(4):517-25. doi: 10.1517/13543784.2013.778973. Review.

Comment: Fascinating paper on the analgesic properties of opioid ANTagonists.

13) Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?

Jozaghi E, Andresen MM.

Harm Reduct J. 2013 Feb 16;10:1. doi: 10.1186/1477-7517-10-1.

Comment: A discussion including the benefits of supervised injection facilities in reducing overdose deaths, sharing of injection equipment, public drug use, and utilization of emergency medical services.

14) Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006).

Algren DA, Monteilh CP, Punja M, Schier JG, Belson M, Hepler BR, Schmidt CJ, Miller CE, Patel M, Paulozzi LJ, Straetemans M, Rubin C.

J Med Toxicol. 2013 Mar;9(1):106-15. doi: 10.1007/s13181-012-0285-4.

Comment: A review of pathological details related to the tragic 2005-2007 fentanyl-tainted heroin outbreak.

15) ‘I saved a life’: a heroin addict’s reflections on managing an overdose using ‘take home naloxone’.

George S, Boulay S, Begley D.

BMJ Case Rep. 2010 Sep 7;2010. doi:pii: bcr0520102986.

Comment: A rare example in the medical literature, this paper includes several paragraphs of direct patient perspective on administering naloxone. Read the free full-text from BMJ.

16) Clinical safety of 1500 mg oral naltrexone overdose.

Reece AS.

BMJ Case Rep. 2010 Sep 7;2010. doi:pii: bcr0420102871. 10.1136/bcr.04.2010.2871. Review.

Comment: The hepatotoxicity concerns with naltrexone were based on doses of around 2 grams, which would be considered massive today.