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) 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) Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria.

McDonald R, Strang J.

Addiction. 2016 Mar 30. doi: 10.1111/add.13326. [Epub ahead of print] Review.

Comments: Take-home naloxone meets all Bradford Hill criteria for causality in reducing opioid overdose mortality. Incidence of fatality among overdoses in the setting of take-home naloxone was 0.8%.

2) Managing Opioid Abuse in Older Adults: Clinical Considerations and Challenges.

Loreck D, Brandt NJ, DiPaula B.

J Gerontol Nurs. 2016 Apr 1;42(4):10-5. doi: 10.3928/00989134-20160314-04.

Comments: A review of the U.S. situation and treatments for opioid use disorder.

3) Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015.

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

Drug Alcohol Depend. 2016 May 1;162:206-10. doi: 10.1016/j.drugalcdep.2016.03.010. Epub 2016 Mar 18.

Comments: Heroin use is associated with 25-50 years of life lost. Over half of deaths and nearly two-thirds of years of life lost were due to opioid overdose.

4) Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.

Olsson MO, Bradvik L, Öjehagen A, Hakansson A.

Drug Alcohol Depend. 2016 May 1;162:176-81. doi: 10.1016/j.drugalcdep.2016.03.009. Epub 2016 Mar 17.

Comments: Accidental overdose death and suicide are distinct entities, with distinct predictive variables. This is important.

5) An Initial evaluation of law enforcement overdose training in Rhode Island.

Saucier CD, Zaller N, Macmadu A, Green TC.

Drug Alcohol Depend. 2016 May 1;162:211-8. doi: 10.1016/j.drugalcdep.2016.03.011. Epub 2016 Mar 19.

Comments: Harm reduction programs training law enforcement, a critical step forward.

6) Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

Levine M, Sanko S, Eckstein M.

Prehosp Emerg Care. 2016 Mar 28:1-4. [Epub ahead of print]

Comments: Studies of pre-hospital naloxone without transport to the hospital have uniformly shown extremely low rates of re-overdose or death in the ensuing 24 hours. This study examined 205 people over a much longer period and identified 3 deaths in the subsequent month. Again, this supports the relative safety of naloxone management and yet emphasizes the high risk of mortality in this population.

7) Opioid overdose and naloxone education in a substance use disorder treatment program.

Lott DC, Rhodes J.

Am J Addict. 2016 Apr;25(3):221-6. doi: 10.1111/ajad.12364. Epub 2016 Mar 22.

Comments: Education is excellent, but providing the medication on-site is critical.

8) Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses.

Kitch BB, Portela RC.

Prehosp Emerg Care. 2016 Mar-Apr;20(2):226-9. doi: 10.3109/10903127.2015.1076097.

Comments: Police administering naloxone in the setting of fentanyl overdoses.

9) Could chest wall rigidity be a factor in rapid death from illicit fentanyl abuse?

Burns G, DeRienz RT, Baker DD, Casavant M, Spiller HA.

Clin Toxicol (Phila). 2016 Mar 21:1-4. [Epub ahead of print]

Comments: Fascinating article! Many of us have wondered why fentanyl is such an extreme problem when used illicitly. This paper describes the phenomenon of chest wall rigidity with rapid IV administration of fentanyl, a possible explanation for the high risk of death in the setting of increased illicit fentanyl availability.

10) A Longitudinal Study of Multiple Drug Use and Overdose Among Young People Who Inject Drugs.

Riley ED, Evans JL, Hahn JA, Briceno A, Davidson PJ, Lum PJ, Page K.

Am J Public Health. 2016 May;106(5):915-7. doi: 10.2105/AJPH.2016.303084. Epub 2016 Mar 17.

Comments: Increased use is associated with increased overdose. This has been a persistent finding, potentially in conflict with the findings that periods of abstinence are associated with overdose. That is to say, even though low tolerance is a risk for overdose, it seems that more regular rather than more sporadic use increases overdose risk. Prevention messaging on this topic remains challenging.

11) Reducing the Risks of Relief – The CDC Opioid-Prescribing Guideline.

Frieden TR, Houry D.

N Engl J Med. 2016 Mar 15. [Epub ahead of print]

Comments: An editorial on the new CDC guidelines described below.

12) CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016.

Dowell D, Haegerich TM, Chou R.

JAMA. 2016 Mar 15. doi: 10.1001/jama.2016.1464. [Epub ahead of print]

Comments: New guidelines for opioid prescribing that emphasize reliance upon other therapies first and limited doses of opioids. They do recommend use of opioid agonist treatments for patients with co-morbid chronic pain and opioid use disorder, such as buprenorphine which can be prescribed by general practitioners in the U.S., and co-prescription of naloxone to patients on higher doses (>50 morphine equivalent milligrams) or other risk factors.

13) Engagement in a National Naloxone Programme among people who inject drugs.

McAuley A, Munro A, Bird SM, Hutchinson SJ, Goldberg DJ, Taylor A.

Drug Alcohol Depend. 2016 May 1;162:236-40. doi: 10.1016/j.drugalcdep.2016.02.031. Epub 2016 Mar 3.

Comments: Increased utilization but reduced likelihood of participants actually carrying naloxone on their person.

14) Improving Outcomes of Opioid Overdose: Preparing Nursing Students to Intervene.

Dion KA.

J Addict Nurs. 2016 Jan-Mar;27(1):7-11. doi: 10.1097/JAN.0000000000000106.

Comments: Training nursing students in opioid overdose management.

15) What is known about community pharmacy supply of naloxone? A scoping review.

Nielsen S, Van Hout MC.

Int J Drug Policy. 2016 Feb 15. pii: S0955-3959(16)30014-7. doi: 10.1016/j.drugpo.2016.02.006. [Epub ahead of print]

Comments: There’s some information out there but much more needed.

The next series of articles are all related to the lead author’s thesis that nasal naloxone is problematic; the final 5 being responses to the lead author’s recent article inAddiction critiquing nasal naloxone. Dr Strang has been a longtime advocate of naloxone, but not nasally administered. It’s important to note, as can be seen in the disclosures of his papers, that he/his employer hold a patent for buccal naloxone (#17 & 18). I’ll withhold any further comments.

16) Naloxone without the needle – systematic review of candidate routes for non-injectable naloxone for opioid overdose reversal.

Strang J, McDonald R, Alqurshi A, Royall P, Taylor D, Forbes B.

Drug Alcohol Depend. 2016 Mar 9. pii: S0376-8716(16)00141-1. doi: 10.1016/j.drugalcdep.2016.02.042. [Epub ahead of print] Review.

17) Amorphous Formulation and in Vitro Performance Testing of Instantly Disintegrating Buccal Tablets for the Emergency Delivery of Naloxone.

Alqurshi A, Kumar Z, McDonald R, Strang J, Buanz A, Ahmed S, Allen E, Cameron P, Rickard JA, Sandhu V, Holt C, Stansfield R, Taylor D, Forbes B, Royall PG.

Mol Pharm. 2016 Mar 28. [Epub ahead of print]

18) New approved nasal naloxone welcome, but unlicensed improvised naloxone spray kits remain a concern: proper scientific study must accompany innovation.

Strang J, Mcdonald R.

Addiction. 2016 Apr;111(4):590-2. doi: 10.1111/add.13319. No abstract available.

19) Ensure global access to naloxone for opioid overdose management.

Balster RL, Walsh SL.

Addiction. 2016 Apr;111(4):589-90. doi: 10.1111/add.13274. No abstract available.

20) Ethical issues and stakeholders matter.

Dale O.

Addiction. 2016 Apr;111(4):587-9. doi: 10.1111/add.13267. No abstract available.

21) Radical red tape reduction by government supported nasal naloxone: the Norwegian pilot project is innovative, safe and an important contribution to further development and dissemination of take-home naloxone.

Lobmaier PP, Clausen T.

Addiction. 2016 Apr;111(4):586-7. doi: 10.1111/add.13261. No abstract available.

22) Intranasal naloxone soon to become part of evolving clinical practice around opioid overdose prevention.

Dietze P, Cantwell K.

Addiction. 2016 Apr;111(4):584-6. doi: 10.1111/add.13260. No abstract available.

23) Tangled-up and blue: releasing the regulatory chokehold on take-home naloxone.

Winstanley EL.

Addiction. 2016 Apr;111(4):583-4. doi: 10.1111/add.13255. No abstract available.

1) Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic.

Becker WC, Merlin JS, Manhapra A, Edens EL.

Addict Sci Clin Pract. 2016 Jan 28;11(1):3. doi: 10.1186/s13722-016-0050-0.

Comment: Fascinating article. Worth a read if you’re interested in management of pain and opioids.

2) Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City.

Harocopos A, Allen B, Paone D.

Int J Drug Policy. 2015 Dec 29. pii: S0955-3959(15)00374-6. doi: 10.1016/j.drugpo.2015.12.021. [Epub ahead of print]

Comment: Great to see some of the path from prescription opioids to heroin. Makes sense that first step is moving from a drug co-formulated with acetaminophen.

3) Emergency Department-Based Opioid Harm Reduction: moving physicians from willing to doing.

Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg A, Bernstein E.

Acad Emerg Med. 2016 Jan 27. doi: 10.1111/acem.12910. [Epub ahead of print]

Comment: To get EDs to enhance practices will require pressure from the top.

4) Internal Medicine Resident Knowledge, Attitudes and Barriers to Naloxone Prescription in Hospital and Clinic Settings.

Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L.

Subst Abus. 2016 Jan 28:0. [Epub ahead of print]

Comment: Nice article from Baltimore finding that young physicians are ready and willing to prescribe naloxone, but aren’t routinely doing so yet.

5) Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?

Strang J, McDonald R, Tas B, Day E.
Addiction. 2016 Feb 3. doi: 10.1111/add.13209. [Epub ahead of print]

Comment: There are significant issues with this proscriptive publication. First, as noted in the disclosures, the author has interest as an inventor in a patent on a new formulation of naloxone owned by his employer that would address the concerns upon which he bases his conclusions. This is a quite a conflict of interest for an academic commentary that directs clinicians in how to act.

Second, a quote from the Discussion section describes where the authors have gone off course:

“In this situation [lay naloxone administration] the failure of effect of i.n. naloxone, for whatever reason, can delay the time to naloxone injection until an ambulance arrives.”

And what would occur if there was no naloxone, besides delay in the time of naloxone administration until an ambulance arrives? As we know from experience, getting a needle into places like pre-release prison is impossible in most settings – whereas getting the nasal device was achievable. While we have long sought a superior nasal device, the absence of such a product did not obviate the benefits of nasal naloxone. The authors’ views in this case are, I believe, inconsistent with public health aims.

Third, the authors ignore the years of on-the-ground experience that emergency medical providers in the United States have with the jerry-rigged nasal naloxone device in question. Numerous systems adopted the product because it took the risk of needle-sticks out of the equation and was as – or nearly as – effective as when injected. Some investigators have suggested, and many anesthesiologists would agree, that this relatively low dose of naloxone may be all that is needed in most cases since the goal isn’t to restore a Glasgow Coma Scale of 15 – that may actually complicate lay management of overdose – but to restore breathing. (On a slight tangent, some have suggested the fascinating hypothesis that the clinical response to nasal naloxone – which is better than would be expected based on peripheral blood concentrations – may be due to exposure to naloxone through the cribriform plate directly into the central nervous system.)

Finally, to suggest that there are ethical concerns in having used this device to expand access because it was not the perfect device ignores the reality of overdose – this isn’t something we can wait to address until everything is perfect. People’s lives are on the line. Public health providers would have been at far greater fault if they had done nothing. The lead author, based in England where naloxone provision has long been delayed, should be well aware of this problem.

This “debate” seems particularly odd from the U.S. perspective, where off-label prescription and use of medications is authorized by the Food and Drug Administration and common practice. This paper is apparently the first salvo in a discussion that will involve four additional papers coming out in April.

6) Naloxone (Narcan) nasal spray for opioid overdose.

Med Lett Drugs Ther. 2016 Jan 4;58(1485):1-2. No abstract available.

Comment: As a follow-up to the oddly-timed prior article, we finally have an approved intranasal device. This is exciting and the product is priced within reach of a lot of insurers – less so community programs unfortunately. The one other potential issue is the pharmacokinetic data for this product, which suggest that the recipient may be exposed to the equivalent of around five times the standard 0.4mg intramuscular dose. Hopefully this won’t be an issue at all – and perhaps will instead be helpful for the fentanyl overdoses  seen with increasing frequency – but we will have to keep close watch for problems related to precipitated withdrawal.

7) Legal regimes surrounding naloxone access: considerations for prescribers.

Brodrick JE, Brodrick CK, Adinoff B.

Am J Drug Alcohol Abuse. 2016 Jan 25:1-12. [Epub ahead of print]

Comment: Another legal review of naloxone access.

8) A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

Dugosh K, Abraham A, Seymour B, McLoyd K, Chalk M, Festinger D.

J Addict Med. 2016 Jan 19. [Epub ahead of print]

Comment: I like the title of this article, as it hints at the primacy of medication.

9) Neighborhood-Level and Spatial Characteristics Associated with Lay NaloxoneReversal Events and Opioid Overdose Deaths.

Rowe C, Santos GM, Vittinghoff E, Wheeler E, Davidson P, Coffin PO.

J Urban Health. 2016 Jan 22. [Epub ahead of print]

Comment: How can we use geocoding data to enhance the public health response to overdose surveillance?

10) Relationship between Nonmedical Prescription-Opioid Use and Heroin Use.

Compton WM, Jones CM, Baldwin GT.

N Engl J Med. 2016 Jan 14;374(2):154-63. doi: 10.1056/NEJMra1508490. Review. No abstract available.

Comment: Interesting take on the trend of increasing heroin-related deaths. Most likely there is truth to both sides of this argument – opioid prescribing got lots of people hooked and taking away the opioids leaves a hole filled by illicit opioids.

11) Evaluation of Overdose Prevention Trainings in NYC: Knowledge and Self-efficacy among Participants Twelve Months after Training.

Maldjian L, Siegler A, Kunins HV.

Subst Abus. 2016 Jan 5:0. [Epub ahead of print]

Comment: Happy we have these data, and the lack of an age or racial differentiation in knowledge is very promising. The conclusions – that we need to improve training – is based on a pre-set idea of what knowledge is necessary to effectively respond to an overdose. I’m not sure we know that, so it’s hard to say that the trainings are insufficient. Also, with regard to the finding that some participants didn’t know naloxone could reverse opioids besides heroin, I’m curious if that finding translates to some emergency medical providers as well…

12) Risk factors of prescription opioid overdose among Colorado Medicaid beneficiaries.

Dilokthornsakul P, Moore G, Campbell JD, Lodge R, Traugott C, Zerzan J, Allen R, Page RL 2nd.

J Pain. 2015 Dec 22. pii: S1526-5900(15)00985-2. doi: 10.1016/j.jpain.2015.12.006. [Epub ahead of print]

Comment: Dose, use of methadone, substance use disorder, other psychiatric illness, benzodiazepine use, and number of pharmacies utilized.

13) An Initial Evaluation of Web-Based Opioid Overdose Education.

Roe SS, Banta-Green CJ.

Subst Use Misuse. 2015 Dec 28:1-8. [Epub ahead of print]

Comment: Web-based naloxone training!

14) Focused use of drug screening in overdose patients increases impact on management.

Erdmann A, Werner D, Hugli O, Yersin B.

Swiss Med Wkly. 2015 Dec 28;145:w14242. doi: 10.4414/smw.2015.14242. eCollection 2015.

Comment: Drug screening helps manage toxidromes in the ED.

15) An Evaluation of Naloxone Use for Opioid Overdoses in West Virginia: A Literature Review.

Beheshti A, Lucas L, Dunz T, Haydash M, Chiodi H, Edmiston B, Ford C, Bohn N, Stein JH, Berrett A, Sobota B, Horzempa J.

Am Med J. 2015 Jul 9;6(1):9-13.

Comment: Naloxone emerging in West Virginia, which has a remarkably high rate of opioid overdose mortality.

16) Opioid Overdose Deaths and Florida’s Crackdown on Pill Mills.

Kennedy-Hendricks A, Richey M, McGinty EE, Stuart EA, Barry CL, Webster DW.

Am J Public Health. 2016 Feb;106(2):291-7. doi: 10.2105/AJPH.2015.302953. Epub 2015 Dec 21.

Comment: While we usually discuss health system-related interventions on this site, there have been a few times when law enforcement-related activities have resulted in many lives saved. The Florida example described here is one of those. Another was in 2007, when the DEA shut down a fentanyl manufacturer in Mexico, ending a dramatic spate of deaths on the eastern seaboard.

17) Non-fatal overdoses and related risk factors among people who inject drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia.

Uusküla A, Raag M, Vorobjov S, Rüütel K, Lyubimova A, Levina OS, Heimer R.

BMC Public Health. 2015 Dec 18;15(1):1255. doi: 10.1186/s12889-015-2604-6.

Comment: Exciting to see these important data. Unfortunately the health of drug users – and the ability to study or intervene – has only worsened in Russia.

18) Barriers to Implementation of Opioid Overdose Prevention Programs in Ohio.

Winstanley EL, Clark A, Feinberg J, Wilder CM.

Subst Abus. 2015 Dec 18:0. [Epub ahead of print]

Comment: Drug use is stigmatized and naloxone’s too expensive.

19) Patient Perspectives on an Opioid Overdose Education and Naloxone Distribution Program in the US Department of Veterans Affairs.

Oliva EM, Nevedal A, Lewis ET, McCaa MD, Cochran MF, Konicki PE, Davis CS, Wilder C.

Subst Abus. 2015 Dec 16:0. [Epub ahead of print]

Comment: Fascinating focus groups on naloxone among veterans.

20) Mortality in the Melbourne injecting drug user cohort study (MIX).

Nambiar D, Agius PA, Stoové M, Hickman M, Dietze P.

Harm Reduct J. 2015 Dec 9;12:55. doi: 10.1186/s12954-015-0089-3.

Comment: Mortality rate was 1.0/100person-years, associated with prior incarceration, recent need for emergency care, and recent overdose. Only half of the deaths were likely accidental overdose, suggesting overall a lower rate of opioid overdose mortality than is standard in the literature – perhaps because 36% were in agonist maintenance treatment.

21) A Question About the Safety of Buprenorphine/Naloxone and Benzodiazepine Drugs.

Howland RH.

J Psychosoc Nurs Ment Health Serv. 2015 Dec 1;53(12):11-4. doi: 10.3928/02793695-20151117-01.

Comment: Buprenorphine is safer than other opioids.

22) Effectiveness of Scotland’s national naloxone programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison.

Bird SM, McAuley A, Perry S, Hunter C.

Addiction. 2015 Dec 7. doi: 10.1111/add.13265. [Epub ahead of print]

Comment: Very exciting data from Scotland supporting naloxone among inmates pre-release to reduce opioid-related mortality.

23) Naloxone Administration in US Emergency Departments, 2000-2011.

Frank JW, Levy C, Calcaterra SL, Hoppe JA, Binswanger IA.

J Med Toxicol. 2015 Nov 30. [Epub ahead of print]

Comment: Tough to interpret these data. Only a minority of opioid overdose cases had naloxone administered – this makes sense since overdose can often be safely managed without naloxone in monitored settings. In 14% of cases where naloxone was administered, an opioid agonist was also provided – this would surely be a high rate of iatrogenic overdose … Can’t access full article.

24) Mortality Risk Among Heroin Abusers: Clients and Non-clients of Public Treatment Centers for Drug Addiction.

Pavarin RM.

Subst Use Misuse. 2015;50(13):1690-6. doi: 10.3109/10826084.2015.1027932. Epub 2015 Nov 23.

Comment: The mortality rate was even higher among the cohort of Italian heroin users who sought treatment compared to those just accessing emergency care. This is fascinating. And only 17% of deaths were from opioid overdose.

25) The rise of opioid abuse in Iowa.

Strickler K.

Iowa Med. 2015 Summer;105(3):10-1. No abstract available.

Comment: Can’t access and no abstract.

26) Development and process evaluation of an educational intervention for overdoseprevention and naloxone distribution by general practice trainees.

Klimas J, Egan M, Tobin H, Coleman N, Bury G.

BMC Med Educ. 2015 Nov 20;15(1):206. doi: 10.1186/s12909-015-0487-y.

Comment: Authors utilized the British OOKS/OOAS scales to test their training efficacy.

27) Acetylfentanyl: An Emerging Drug of Abuse.

Rogers JS, Rehrer SJ, Hoot NR.

J Emerg Med. 2015 Nov 14. pii: S0736-4679(15)01148-8. doi: 10.1016/j.jemermed.2015.10.014. [Epub ahead of print]

Comment: Case report of acetyl-fentanyl overdose targeted at emergency providers.

28) Response to Bird et al.: The importance of post-release engagement in treatment in estimating impacts on post-release deaths.

Larney S, Degenhardt L, Farrell M.

Addiction. 2015 Nov 21. doi: 10.1111/add.13208. [Epub ahead of print] No abstract available.

Comment: Opioid agonist treatment in prison helps too.

29) Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada.

Amlani A, McKee G, Khamis N, Raghukumar G, Tsang E, Buxton JA.

Harm Reduct J. 2015 Nov 14;12:54. doi: 10.1186/s12954-015-0088-4.

Comment: 29% of participants tested positive for fentanyl while 73% denied any use – this adulterant is not good news.

30) Emergence of methadone as a street drug in St. Petersburg, Russia.

Heimer R, Lyubimova A, Barbour R, Levina OS.

Int J Drug Policy. 2016 Jan;27:97-104. doi: 10.1016/j.drugpo.2015.10.001. Epub 2015 Oct 19.

Comment: Even when in the illicit market (because it’s not legal in Russia), methadone use is associated with reduced HIV risk behaviors.

31) Short-Term Outcomes for Opiate and Crack Users Accessing Treatment: The Effects of Criminal Justice Referral and Crack Use.

Jones A, Hayhurst KP, Millar T, Pierce M, Dunn G, Donmall M.

Eur Addict Res. 2016;22(3):145-52. doi: 10.1159/000438987. Epub 2015 Nov 17.

Comment: Improvements in drug use behaviors were not mediated by whether or not treatment was due to criminal justice referral.

32) Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.

Wilder CM, Miller SC, Tiffany E, Winhusen T, Winstanley EL, Stein MD.

J Addict Dis. 2016 Jan-Mar;35(1):42-51. doi: 10.1080/10550887.2016.1107264.

Comment: Pain patients underestimate overdose risk.

33) Do drug seizures predict drug-related emergency department presentations or arrests for drug use and possession?

Wan WY, Weatherburn D, Wardlaw G, Sarafidis V, Sara G.

Int J Drug Policy. 2016 Jan;27:74-81. doi: 10.1016/j.drugpo.2015.09.012. Epub 2015 Oct 23.

Comment: Overall, it appears that more drug supply leads to more overdoses. This is a critical issue certainly worthy of additional investigation.

34) Heroin deaths increase by two thirds in two years, UK figures show.

Wise J.

BMJ. 2015 Sep 3;351:h4754. doi: 10.1136/bmj.h4754. No abstract available.

Comment: Increased deaths in England and Wales is concerning. A smaller increase also occurred in Scotland, again suggesting that naloxone programming – while perhaps able to blunt spikes in mortality – can’t avoid the problem altogether.

35) The benefits and potential drawbacks in the approval of EVZIO for lay reversal of opioid overdose.

Beletsky L.

Am J Prev Med. 2015 Mar;48(3):357-9. doi: 10.1016/j.amepre.2014.09.011. Epub 2014 Dec 26. Review. No abstract available.

Comment: Great commentary, emphasizing both the pricing of naloxone and the need for a broader program to prevent overdose mortality.

1) Characterization of opioid overdose and response in a high-risk community corrections sample: A preliminary study.

Cropsey KL, Martin S, Clark CB, McCullumsmith CB, Lane PS, Hardy S, Hendricks PS, Redmond N.

J Opioid Manag. 2013 Nov-Dec;9(6):393-400.

Comments: Valuable survey of persons in the corrections system, under community supervision. Nearly half had used opioids and 40% of those had experienced an opioid overdose. Those who had overdosed were more likely to be white, female, and have higher educational attainment; they were also much more likely to have witnessed overdose, have seen someone die of overdose, and want training in overdose prevention and management.

2) Opioids Compared to Placebo or Other Treatments for Chronic Low Back Pain: An Update of the Cochrane Review.

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

Spine (Phila Pa 1976). 2014 Jan 29. [Epub ahead of print]

Comments: A review of studies evaluating short term use of opioids for chronic lower back pain. The studies evaluated all have major shortcomings so we’re left with little new information.

3) Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy.

Adrish M, Duncalf R, Diaz-Fuentes G, Venkatram S.

Am J Case Rep. 2014 Jan 15;15:22-6

Comments: Being “down” with an overdose for a prolonged period can lead to complications such as rhabdomyolysis and nerve compression. This patient developed compartment syndrome, which is to say high pressure within the fascial compartment of the buttocks, requiring surgical intervention to spare her extremity.

4) Would legalizing illicit opioids reduce overdose fatalities? Implications from a natural experiment.

Darke S, Farrell M.

Addiction. 2014 Jan 24. doi: 10.1111/add.12456. [Epub ahead of print]

Comments: If anyone is reading this, this article should lead to some discussion. It is hard to argue with the recent United States experience with broad availability of opioid analgesics and resultant four-fold increase in opioid overdose death rates. When OxyContin was the choice longacting agent, that was the offender, then providers shifted to prescribing methadone and that became the principal offender, then the offender switched to whichever longacting opioid became the dominant prescribed opioid in a given community. When those communities stop prescribing opioids, heroin tops the charts. While there is room for a lively debate and this paper does not help us solve the current US crisis, the central conclusion that merely making opioids widely available at a known dose and free of adulterants would not reduce overdose mortality on a community or national level seems valid. That said, it is conceivable that such availability reduces mortality among those already dependent on opioids – complicating any assessment.

5) Reducing drug related deaths: a pre-implementation assessment of knowledge,barriers and enablers for naloxone distribution through general practice.

Matheson C, Pflanz-Sinclair C, Aucott L, Wilson P, Watson R, Malloy S, Dickie E, McAuley A.

BMC Fam Pract. 2014 Jan 15;15(1):12.

Comments: A survey of general practitioners in Scotland demonstrating mixed knowledge and interest in overdose prevention. Many seemed to feel this was a specialist service rather than one that a generalist should provide. Those with more experience with drug use were generally more supportive.

6) Commentary on Williams et al. (2014): Family matters-new resources for managing opioid overdose with take-home naloxone.

Tait RJ, Lenton S.

Addiction. 2014 Feb;109(2):260-1.

Comments: A commentary on the OOKS and OOAS overdose scales produced in the UK.

7) Unintentional opioid overdose deaths in New York City, 2005-2010: A place-based approach to reduce risk.

Siegler A, Tuazon E, Bradley O’Brien D, Paone D.

Int J Drug Policy. 2013 Nov 8. pii: S0955-3959(13)00178-3. [Epub ahead of print]

Comments: I’ve been anxiously awaiting the papers coming out of New York. They’ve done a great job dedicating resources to tracking and attempting to reduce opioid overdose mortality. Please keep writing!

8) Does take-home naloxone reduce non-fatal overdose?

Bennett T, Holloway K, Bird SM.

Lancet. 2014 Jan 11;383(9912):124-5.

Comments: The title doesn’t really match the text, but this is a very nice brief analysis of non-fatal overdose events in Wales. 47% of opioid injectors had overdosed and 15% had overdosed in the preceding 12 months, with a median 2 overdose events during that period. Data such as these are invaluable in generating event-level estimates of opioid overdose occurrence and outcome.

9) Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000-2011.

Handley SA, Flanagan RJ.

Clin Toxicol (Phila). 2014 Jan 7. [Epub ahead of print]

Comments: Nice trend analysis of poisoning deaths in England and Wales demonstrating a fairly stable number of opioid related deaths over that period.

10) [Long-acting naltrexone–a new way out of opiate addiction?].

Stavseth LS, Kunøe N, Tanum L.

Tidsskr Nor Laegeforen. 2013 Nov 12;133(21):2231-2. Norwegian.

Comments: This appears to be a letter but that’s all I can tell!

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.