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.

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.

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) Pharmacokinetic Properties and Human Use Characteristics of an FDA Approved IntranasalNaloxone Product for the Treatment of Opioid Overdose.

Krieter P, Chiang N, Gyaw S, Skolnick P, Crystal R, Keegan F, Aker J, Beck M, Harris J.

J Clin Pharmacol. 2016 May 5. doi: 10.1002/jcph.759. [Epub ahead of print]

Comment: Details on the pharmacokinetics and usability studies for the new nasal device.

2) The use of public health infrastructure probably the best strategy for national and large-scalenaloxone distribution programmes.

Madah-Amiri D, Clausen T.

Addiction. 2016 May 3. doi: 10.1111/add.13400. [Epub ahead of print] No abstract available.

Comment: Large-scale naloxone requires public health support.

3) The Opioid Epidemic in the United States.

Wilkerson RG, Kim HK, Windsor TA, Mareiniss DP.

Emerg Med Clin North Am. 2016 May;34(2):e1-e23. doi: 10.1016/j.emc.2015.11.002. Epub 2016 Feb 17. Review.

Comment: Focuses on risk factors for problematic opioid use and naloxone.

4) Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

Kunøe N, Opheim A, Solli KK, Gaulen Z, Sharma-Haase K, Latif ZE, Tanum L.

BMC Pharmacol Toxicol. 2016 Apr 28;17(1):18. doi: 10.1186/s40360-016-0061-1.

Comment: Methods paper for above planned study.

5) Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

Arelin V, Schmidt JJ, Kayser N, Kühn-Velten WN, Suhling H, Eden G, Kielstein JT.

Clin Nephrol. 2016 Apr 27. [Epub ahead of print]

Comment: Doesn’t really remove methadone, so not useful in an overdose but also not problematic for patients on methadone undergoing light-chain removal.

6) Utilizing a train-the-trainer model for multi-site naloxone distribution programs.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2016 Apr 14. pii: S0376-8716(16)30034-5. doi: 10.1016/j.drugalcdep.2016.04.007. [Epub ahead of print]

Comment: Title is self-explanatory.

7) Opioid-related Policies in New England Emergency Departments.

Weiner SG, Raja AS, Bittner JC, Curtis KM, Weimersheimer P, Hasegawa K, Espinola JA, Camargo CA Jr.

Acad Emerg Med. 2016 Apr 21. doi: 10.1111/acem.12992. [Epub ahead of print]

Comment: Intriguing look at ED policies in New England. 18% had an opioid screening tool, 78% used the PDMP, 41% alerted the primary doctor when prescribing opioids, 70% gave substance use treatment referrals, and 12% offered take-home naloxone.

8) Opioid Overdose Prevention in a Residential Care Setting: Naloxone Education and Distribution.

Pade P, Fehling P, Collins S, Martin L.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: Naloxone in a residential treatment program. Hopefully the first bit of data with much more to come.

9) Co-prescription of Naloxone as a Universal Precautions Model for Patients on Chronic Opioid Therapy – Observational Study.

Takeda MY, Katzman JG, Dole E, Bennett MH, Alchbli A, Duhigg D, Yonas H.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: New Mexico study of 164 chronic pain patients on opioids who were provided naloxone. There were no overdoses.

10) Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status.

Friedman MS, Manini AF.

J Med Toxicol. 2016 Apr 15. [Epub ahead of print]

Comment: Fascinating abstract – I don’t have full access. They set up “naloxone criteria” of (1) respiratory rate <12, miotic pupils, or drug paraphernalia, and (2) altered mental status by AVPU or GCS and then looked to see if those criteria predicted a beneficial effect of naloxone. They did – with an OR of 7 and 83% sensitivity. Miotic pupils were the best predictor of a response to naloxone. Authors also found that naloxone was underutilized – in only 44.2% of cases where it may have been beneficial. This is a fascinating area, as we don’t yet understand the reasons why naloxone is or is not administered in emergency services.

11) The toxicology of heroin-related death: estimating survival times.

Darke S, Duflou J.

Addiction. 2016 Apr 15. doi: 10.1111/add.13429. [Epub ahead of print]

Comment: 6-MAM, the best way to confirm heroin as a cause of overdose death, is only present if the death occurs in under 30 minutes. In this study, 6-MAM was present in 43% of heroin overdose cases, suggesting that most people took longer to expire.

12) Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.

Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG.

Am J Public Health. 2016 Apr 14:e1-e4. [Epub ahead of print]

Comment: Distribution program increased self-efficacy.

13) Findings and lessons learnt from implementing Australia’s first health service based take-home naloxone program.

Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze P, Lenton S, Kearley J, van Beek I.

Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12400. [Epub ahead of print]

Comment: First data on an Australian naloxone program. 83 people given naloxone. Among the 42% completing follow-up, 30 overdoses were successfully reversed and participants still felt informed and able to use naloxone.

14) OVERDOSED ON OPIOIDS: A deadly opioid epidemic sweeping the country has lawmakers working hard to find solutions.

Hoback J.

State Legis. 2016 Apr;42(4):9-13. No abstract available.

Comment: On a quick glance, seems a bit inflammatory.

15) Safety concerns with long-term opioid use.

Harned M, Sloan P.

Expert Opin Drug Saf. 2016 Apr 26:1-8. [Epub ahead of print]

Comment: Prospective trials are needed to evaluate longterm opioid therapy for chronic pain.

16) Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA Jr, Wilson D, McDonald R, Rotrosen J, Gourevitch MN, Gordon M, Fishman M, Chen DT, Bonnie RJ, Cornish JW, Murphy SM, O’Brien CP.

N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

Comment: Pretty good data on extended-release naltrexone and low overdose risk. Unfortunately, overdose wasn’t specifically asked about, but instead was treated as any other adverse events in a clinical trial and had to be reported by the participants.

17) Overdose Deaths in West Virginia.

Yablonsky TA, Thompson GL.

W V Med J. 2016 Mar-Apr;112(2):16-7. No abstract available.

Comment: Can’t access, but there are a lot.

18) [Accidental ingestion of methadone by children and suggestions for better prevention].

Hein H, Püschel K, Schaper A, Iwersen-Bergmann S.

Arch Kriminol. 2016 Jan-Feb;237(1-2):38-46. German.

Comment: Lockboxes.

19) FASTER RESPONSE. Hospitals backing increased use of opioid antidote.

Asplund J.

Hosp Health Netw. 2016 Jan;90(1):20, 22, 2.

Comment: This is apparently about police and naloxone.

20) Increases in Drug and Opioid Overdose Deaths–United States, 2000-2014.

Rudd RA, Aleshire N, Zibbell JE, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1378-82. doi: 10.15585/mmwr.mm6450a3.

Comment: Really well done. Discusses opioids in a sophisticated and honest manner. Impressive work from the CDC.

21) Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.

Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF.

Ann Intern Med. 2016 Jan 5;164(1):1-9. doi: 10.7326/M15-0038. Epub 2015 Dec 29.

Comment: Patients who have an overdose usually continue to receive opioids. If opioids stop, they have a lower risk of recurrent overdose.

22) Prescription opioid related deaths in New York City: a 2 year retrospective analysis prior to the introduction of the New York State I-STOP law.

Sgarlato A, deRoux SJ.

Forensic Sci Med Pathol. 2015 Sep;11(3):388-94. doi: 10.1007/s12024-015-9699-z. Epub 2015 Aug 2.

Comment: 36.7% of decedents had a valid opioid prescription; benzos were involved in 68.4% of cases with alprazolam the most common (35.1%).

23) Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohort.

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

Addict Behav. 2015 Nov;50:78-83. doi: 10.1016/j.addbeh.2015.06.030. Epub 2015 Jun 14.

Comment: Heavy drinking was associated with overdose (OR 1.6).

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

Mertz KJ, Janssen JK, Williams KE.

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

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

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

Trafton JA, Oliva EM.

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

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

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

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

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

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

4) Methadone toxicity in a poisoning referral center.

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

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

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

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

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

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

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

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

Goodloe JM.

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

Comments: I’m unable to access this.

7) America embraces treatment for opioid drug overdose.

Alcorn T.

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

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

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

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

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

PMID: 24904666 [PubMed] Free PMC Article

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

2) Brugada Phenocopy in Concomitant Ethanol and Heroin Overdose.

Rambod M, Elhanafi S, Mukherjee D.

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

PMID: 24903622 [PubMed – as supplied by publisher]

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

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

Clark AK, Wilder CM, Winstanley EL.

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

PMID: 24874759 [PubMed – in process]

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

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

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

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

PMID: 24859230 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24854119 [PubMed – in process]

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

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

Wang KH, Fiellin DA, Becker WC.

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

PMID: 24853143 [PubMed – in process]

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

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

Koller AC, Salcido DD, Menegazzi JJ.

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

PMID: 24831102 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24973558 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24821348 [PubMed – in process]

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

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

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

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

PMID: 24811951 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24795288 [PubMed – as supplied by publisher]

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

12) Intranasal naloxone for treatment of opioid overdose.

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

PMID: 24662159 [PubMed – indexed for MEDLINE]

Comments: Unable to access.

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

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

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

PMID: 24131165 [PubMed – indexed for MEDLINE]

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

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

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

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

PMID: 23350582 [PubMed – indexed for MEDLINE]

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

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

Stöver HJ, Schäffer D.

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

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

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

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

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

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

PMID: 24938727 [PubMed – as supplied by publisher]

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

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

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

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

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

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

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

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

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

PMID: 24931395 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24925493 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24922133 [PubMed – as supplied by publisher]

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

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

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

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

PMID: 24909124 [PubMed – as supplied by publisher]

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

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

Mettner J.

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

PMID: 24868924 [PubMed – indexed for MEDLINE]

Comments: Can’t access.

22) Heroin: life, death, and politics.

Jacobson J.

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

PMID: 24759473 [PubMed – indexed for MEDLINE]

Comments: A news article on naloxone.

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

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

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

PMID: 24589873 [PubMed – indexed for MEDLINE]

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

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

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

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

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

Comments: In-prison methadone maintenance.

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

Nielsen MK, Johansen SS, Linnet K.

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

PMID: 23891033 [PubMed – indexed for MEDLINE]

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

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

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

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

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

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

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

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

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

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

Hansen A.

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

Comment: Naloxone in Norway.

4) Naloxone induces endoplasmic reticulum stress in PC12 cells.

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

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

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

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

Bailey AM, Wermeling DP.

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

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

6) A case of heroin induced sensorineural hearing loss.

Aulet RM, Flis D, Sillman J.

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

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

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

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

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

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

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

Dietze P.

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

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

1) The Toxicology Investigators Consortium Case Registry-The 2012 Experience.

Wiegand T, Wax P, Smith E, Hart K, Brent J.

J Med Toxicol. 2013 Nov 1. [Epub ahead of print]

Comments: Fascinating TocIC Registry, including cases that were attended to by boarded medical toxicologists (so this would represent a tiny subset of the type of accidental drug overdoses we generally discuss on this site). I’m unable to access the full article.

2) Acute coronary syndrome after methadone overdose in an opiate-naive patient.

De Cuyper A, Lambert M, Hantson P.

Acta Clin Belg. 2013 May-Jun;68(3):250-1. No abstract available.

Comments: Unable to access and no abstract available.

3) Delayed post-hypoxic leukoencephalopathy: case report with a review of disease pathophysiology.

Meyer MA.

Neurol Int. 2013 Jul 22;5(3):e13. doi: 10.4081/ni.2013.e13.

Comments: There was a similar review we discussed in 2012. This is a devastating white matter neurologic disease that has been reported after severe opioid overdoses; tends to occur days to weeks after the event.

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

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

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

Comments: Fascinating analysis of opioid analgesic overdose fatalities in New York City from 2000-2006, compared to heroin overdose deaths and non-overdose unintentional deaths. Opioid analgesic deaths basically fit in the middle in terms of neighborhood wealth and social structure, between heroin deaths (lower income, socially fragmented) and non-overdose deaths (higher income, less fragmented). This article is also the first academic publication I’ve seen that demonstrates the unique geographic nature of opioid analgesic overdose mortality in NYC – Staten Island is an epicenter, a location that was historically essentially exempt from heroin overdose death.

5) Opioid overdose mortality in kansas, 2001-2011: toxicologic evaluation of intent.

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

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

Comments: Analysis of opioids in deaths in Kansas, including drug concentrations. The most notable finding is that there is a very wide range of concentrations in overdose deaths involving these agents, a result consistent with decades of toxicological literature suggesting that tolerance plays a big role on risk for overdose and subsequent death.

6) Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes.

Williams AV, Marsden J, Strang J.

Addiction. 2013 Sep 17. doi: 10.1111/add.12360. [Epub ahead of print]

Comments: Authors randomized family members to receive just information versus a 60-minute training. They found that family members who went through the training scored higher on the standardized knowledge and attitude scales authors had previously published. Of note, naloxone was administered in witnessed overdose events for 3 out of 92 who just received information and 5 out of 95 who received the 60-minute training. This raises the very different question of what is sufficient for non-medical personnel to safely and effectively administer naloxone in the community? Information alone may be the answer to that question. While in-depth trainings are fantastic when available and accessible, requiring such activities can easily become an unnecessary obstacle to dissemination of the intervention … perhaps similar to historic requirements for extensive counseling and consent processes prior to HIV testing.

So … there were an impressive 81 papers! Basic epidemiology and opioid analgesics dominate, but the list is quite diverse. I’ve roughly categorized papers, but many would fit into multiple categories, and I have not updated the comments …

EPIDEMIOLOGY

1) Drug overdose deaths — Florida, 2003-2009
Centers for Disease Control and Prevention
MMWR Morb Mortal Wkly Rep. 2011 Jul 8; 60(26):869-72

Comments: Again, oxycodone has arisen as a major source of overdose mortality. The use characteristics that lead to mortality, however, remain unexplained.

2) Characteristics of drug users who witness many overdoses: Implications for overdose prevention.

Bohnert AS, Tracy M, Galea S. Drug Alcohol Depend. 2011 Aug 10.

Comment: Another analysis from a non-fatal overdose survey in Harlem and the South Bronx. There have been some concerning results in terms of witness management of overdose from this study. We know that those who have overdosed are at higher risk of overdose and from a 2005 analysis also know that they are less likely to contact emergency medical services when they witness an overdose. Now we know that these findings apply to those who witness multiple overdoses as well (they appear to be almost the same population). Authors propose that prior negative experiences with medical service might dissuade contact at future overdoses, although perhaps successful prior lay resuscitation efforts also discourage calling for help.

3) Drug-Related Death Following Release from Prison: A Brief Review of the Literature with Recommendations for Practice.

Leach D, Oliver P. Curr Drug Abuse Rev. 2011 Aug 12. [Epub ahead of print]

Comment: I don’t have access to the full article and hope that naloxone distribution is discussed as one of the options.

4) Mortality among Substance-using Mothers in California: A 10-year Prospective Study.

Hser Y, Kagihara J, Huang D, Evans E, Messina N. Addiction. 2011 Aug 10

Comment: Mortality among pregnant or parenting women seeking substance abuse treatment (including heroin, cocaine, alcohol, marijuana, and methamphetamine) over ten years was 8.4x higher than the general population, the largest portion of which was from overdose (29%). The authors do not breakdown overdose by primary drug problem (i.e. can’t tell if most of the overdoses were among heroin users or if they were more evenly distributed).

5) An analysis of the root causes for opioid-related overdose deaths in the United States.

Webster LR, Cochella S, Dasgupta N, Fakata KL, Fine PG, Fishman SM, Grey T, Johnson EM, Lee LK, Passik SD, Peppin J, Porucznik CA, Ray A, Schnoll SH, Stieg RL, Wakeland W.

Pain Med. 2011 Jun;12 Suppl 2:S26-35.

Comment: A review of structural and individual factors related to opioid overdose increases in the U.S.

6) Influence of war on quantitative and qualitative changes in drug-induced mortality in Split-Dalmatia County, Croatia

Marasovic Susnjara I, Definis Gojanovic M, Vodopija D, Capkun V, Smoljanovic A.

Croat Med J. 2011 Oct 15;52(5):629-36.

Comment: Authors developed an interesting association of war and post-war periods with increased overdose deaths, the majority of which were due to heroin and half of which involved multiple drugs. Authors hypothesize that the reason for this increase is due to social instability and increased drug supply.

7) Mortality Among Young Injection Drug Users in San Francisco: A 10-Year Follow-up of the UFO Study.

Evans JL, Tsui JI, Hahn JA, Davidson PJ, Lum PJ, Page K.

Am J Epidemiol. 2012 Jan 6.

Comment: Thought I’d start with the best one this time, an excellent and desperately needed analysis that includes some estimates on mortality rates in one of the few prospective cohorts left.

8) HIV infection and risk of overdose: a systematic review and meta-analysis.

Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD.

AIDS. 2011 Nov 22.

Comment: In many areas of the world, overdose is the most common cause of death among those at risk for (or infected with) HIV. This study found that HIV-seropositivity was associated with a 74% increased risk overdose death (I can’t access the article to provide more detail about this).

9) Opioid-dependent error processing.

Fellows-Smith J.

J Opioid Manag. 2011 Nov-Dec;7(6):443-9.

Comment: The importance of this article is not reflected in the title. This is a data linkage study in Australia looking at mortality rates among those receiving methadone (0.7%) versus naltrexone (2.6%) for opioid therapy. Again this raises the major concerns about opioid overdose after naltrexone therapy, concerns that were clearly inadequately addressed prior to FDA approval of naltrexone for opioid dependence.

10) Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999-2008.

Rosca P, Haklai Z, Goldberger N, Zohar P, Margolis A, Ponizovsky AM.

Drug Alcohol Depend. 2012 Apr 6. [Epub ahead of print]

Comment: Rate of overdose mortality was 0.22/100 person-years (i.e. 0.22%), one-quarter to one-fifth the expected rate in most studies of other cohorts

11) The increasing mortality burden of liver disease among opioid-dependent people: cohort study.

Gibson A, Randall D, Degenhardt L.Addiction. 2011 Dec;106(12):2186-92. doi: 10.1111/j.1360-0443.2011.03575.x. Epub 2011 Oct 17.

Comment: This paper discusses another major interest of mine – hepatitis C. Hep C-related deaths have doubled since I began medical practice and will double again over the next 10-15 years. Broadened screening and improved access to treatment are desperately needed and will more than double the impact of the improved treatments we are already seeing.

12) A qualitative study exploring the reason for low dosage of methadone prescribed in the MMT clinics in China

Lin C, Detels R.

Drug Alcohol Depend. 2011 Aug 1;117(1):45-9. Epub 2011 Feb 9.

Comment: Interesting discussion of problems with methadone dosing in China.

13) Drug related deaths in the Split-Dalmatia County 1997-2007.

Susnjara IM, Smoljanović A, Gojanović MD.

Coll Antropol. 2011 Sep;35(3):823-8.

Comment: Basic epidemiology of overdose deaths in Croatia that again emphasizes the role of polydrug use.

14) Suicide verdicts as opposed to accidental deaths in substance-related fatalities (UK, 2001-2007).

Vento AE, Schifano F, Corkery JM, Pompili M, Innamorati M, Girardi P, Ghodse H.

Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jul 1;35(5):1279-83.

Comment: Can’t access full article and I’m unclear how the results tie to conclusions from the abstract.

15) Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds.

Whelan PJ, Remski K.

J Neurosci Rural Pract. 2012 Jan;3(1):45-50.

Comment: Includes a brief review of the lower overdose risk with buprenorphine.

16) Understanding drug-related mortality in released prisoners: A review of national coronial records.

Andrews JY, Kinner SA.

BMC Public Health. 2012 Apr 4;12(1):270. [Epub ahead of print]

Comment: An interesting exploration of circumstances surrounding prisoner death post-release.

17) Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users.

Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T.

Addict Behav. 2012 Feb 7. [Epub ahead of print]

Comment: Prior overdose, daily or binge drug use, and public injecting are associated with nonfatal overdose among recently released drug users.

18) Drug-related deaths with evidence of intracorporeal drug concealment at autopsy: five case reports.

Wilcher G.

Am J Forensic Med Pathol. 2011 Dec;32(4):314-8.

Comment: Intriguing review of 5 cases of drug-induced death among “body packers” or “body stuffers”, including a review of that language. Interestingly, most of the deaths were due to overdose on consumed drugs rather than toxicity from rupture of drug packets.

19) The influence of living along the U.S.-Mexico border on unintentional drug overdose death, New Mexico (USA), 2005-2009.

Shah NG, Lathrop SL, Flores JE, Landen MG.

Drug Alcohol Depend. 2012 Apr 16.

Comment: An analysis of New Mexico overdose deaths (many of us have been waiting with bated breath for a deeper analysis of deaths there). Authors found that living in a border region was associated with less overdose death, particularly from heroin or methadone; among their hypotheses is that this is a paradoxical benefit of reduced access to medical care and opioid prescriptions.

20) [Differences in depression severity and frequency of relapses in opiate addicts treated with methadone or opiate blocker after detoxification].

Jovanović T, Lazarević D, Nikolić G.

Vojnosanit Pregl. 2012 Apr;69(4):326-32. Serbian.

Comment: Does anyone read Serbian? I’d love to see some additional comment on this intriguing paper. The issues around depot naltrexone versus agonist maintenance are becoming a real issue. The concerns around overdose death in the setting of naltrexone have not been adequately addressed. This paper appears to compare depression scales for patients on those two therapies, but I can’t tell from the abstract exactly what the populations are or what the analysis showed.

21) HCV Infection Prevalence Lower Than Expected among 18-40-Year-Old Injection Drug Users in San Diego, CA.

Garfein RS, Rondinelli A,Barnes RF, Cuevas J, Metzner M, Velasquez M, Rodriguez D, Reilly M, Xing J,Teshale EH.

J Urban Health. 2012 Jul 6.[Epub ahead of print]

Comment: Focusing on the overdose component of the manuscript: Dr Garfein and colleagues found a relatively low rate of lifetime overdose in this cohort of 18-40 year olds of 28.1% (an analysis of these data with overdose as the outcome is clearly warranted). Most notably, they found an independent association of history of overdose with HCV infection.

This is consistent with other recent data suggesting an association between overdose and other drug-related risk behaviors such as syringe sharing. A poster this month at the International AIDS Conference shows that those who administer naloxone at their most recent witnessed overdose are less likely to share syringes than those who didn’t administer naloxone. Moreover, the reductions in overdose we have seen in regions with well-funded naloxone distribution programs have been far more impressive than mathematical modeling would suggest. All together, these data force me to wonder if naloxone distribution has an effect well in excess of its ability to reverse an overdose.

22) Estimating the prevalence of illicit opioid use in New York City using multiple data sources.

McNeely J, Gourevitch MN, Paone D, Shah S, Wright S, Heller D.

BMC Public Health. 2012 Jun 18;12(1):443. [Epub ahead of print]

Comment: An excellent team of authors has attempted the perhaps impossible task of estimating the number of opioid users in New York City – a task that was hard enough with heroin alone. The results seem consistent enough to what would be predicted by large-scale epidemiologic studies to be of substantial use in future. I’ve asked for additional thoughts on this approach and will post comments when they come.

24) Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users.

Harris JL, Lorvick J, Wenger L, Wilkins T, Iguchi MY, Bourgois P, Kral AH.

J Urban Health. 2012 Jun 12. [Epub ahead of print]

Comment: Among “low frequency” heroin users (who used 1-10 times in the past 30 days) 7.0% had overdosed in the past year. Among “high frequency” heroin users, 14.8% had overdosed in the past year. So infrequent heroin injectors overdose less in this sample. The low frequency injectors were marginally older, which may partially explain less overdose (that is, users who survive to older ages are less likely to overdose in a given year), yet I am still somewhat surprised by this result as I would presume low frequency injectors would have low or inconsistent opioid tolerance that might raise their risk of overdose. At this time, we clearly can’t consider bouts of abstinence as a behavioral risk factor for overdose.

25) Cheese: An old drug in a new wrapper.

Maxwell JC, Coleman JJ, Feng SY, Goto CS, Tirado CF.

Drug Alcohol Depend. 2012 Jul 3. [Epub ahead of print]

Comment: A mixture of heroin, Benadryl, and APAP (basically tylenol) – this is an intriguing report of the use of “cheese” heroin in Dallas, Texas, with an appropriate attention to overdose. As authors experienced, overdose data are limited and disappointing given the severity of that consequence.

26) Using poison center exposure calls to predict methadone poisoning deaths

Dasgupta N, Davis J, Jonsson Funk M, Dart R.

PLoS One. 2012;7(7):e41181. Epub 2012 Jul 19.

Comment: Intriguing analysis of calls to poison control centers. The number of methadone calls was associated with overall methadone mortality, although the calls tended to be from younger, and more often female, individuals that may not have required medical attention. How about a state-by-state breakdown of Google Methadone Trends?

27) Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users

Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T.

Addict Behav. 2012 Jun;37(6):691-6. Epub 2012 Feb 7.

Comment: More great data from Vancouver! Large cohort (N=2,515) of drug users; one-third had a non-fatal overdose in the past 6 months. Overdose was associated with more frequent use and more polydrug use. Older age was protective, which is interesting and supports the emerging concept that some drug users overdose … and some do not. Their findings around HIV and overdose risk are difficult to interpret and frankly require further evaluation. Those recently incarcerated were about twice as likely to report recent overdose.

28) Mortality risk in a cohort of subjects reported by authorities for cannabis possession for personal use. Results of a longitudinal study.
Pavarin RM, Berardi D.
Epidemiol Prev. 2011 Mar-Apr;35(2):89-93.
Comment: A database-linkage study of people arrested for marijuana possession in Bologna from 1990-2004. I’m unable to access the full article, but the abstract reports a standardized mortality ratio (sort of like an odds ratio) for those who ultimately sought public drug treatment of 15 and those who didn’t seek public treatment of 2. Overdose was a leading cause of death for both groups.

29) A procedure that differentiates unintentional from intentional overdose in opioid abusers.

Britton PC, Bohnert AS, Wines JD Jr, Conner KR.

Addict Behav. 2011 Sep 2.

Comment: The intentionality of overdose is a recurrent issue. I read this article and frankly do not understand what the authors did.

TOXICOLOGY / TOXICITIES

1) Sudden Bilateral Sensorineural Hearing Loss following Polysubstance Narcotic Overdose.
Schweitzer VG, Darrat I, Stach BA, Gray E.
J Am Acad Audiol. 2011 Apr;22(4):208-14.
Comment: A report of hearing loss after a poly-drug binge (heroin, benzos, alcohol, and crack). Again, I’m unable to access the full article. However, this has been reported before in relation to some opioids and the mechanism remains unclear.

2) Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users.

Todorović MS, Mitrović S, Aleksandrić B, Mladjenović N, Matejić S.

Vojnosanit Pregl. 2011 Aug;68(8):639-42.

Comment: This is a really interesting paper out of Serbia. Pulmonary edema (water in the lungs) by far most common pathological finding in drug users who died suddenly, most of whom were opioid users. This makes sense and is not inconsistent with the known mechanism of death from opioids. Of note, pulmonary edema has been reported in people who were administered naloxone, but this is almost certainly due to the overdose itself rather than any toxicity from naloxone.

3) Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse.

Upadhyay SP, Mallick PN, Elmatite WM, Jagia M, Taqi S.

Indian J Palliat Care. 2011 Sep;17(3):251-4.

Comment: An interesting use of a particular sedative to assist with opioid withdrawal in an intensive care unit.

4) Chromatographic determination of drugs of abuse in vitreous humor using solid-phase extraction.

Fernández P, Seoane S, Vázquez C, Tabernero MJ, Carro AM, Lorenzo RA.

J Appl Toxicol. 2012 Feb 15. doi: 10.1002/jat.2722. [Epub ahead of print]

Comment: An interesting method for identifying several drugs of abuse simoultaneously.

5) “Foam Cone” exuding from the mouth and nostrils following heroin overdose.

Dinis-Oliveira RJ, Santos A, Magalhães T.

Toxicol Mech Methods. 2012 Feb;22(2):159-60.

Comment: I’m not able to access. Anyone?

6) Comparative analysis of pathological and toxicological features of opiate overdose and non-overdose fatalities.

Soravisut N, Rattanasalee P, Junkuy A, Thampitak S, Sribanditmongkol P.

J Med Assoc Thai. 2011 Dec;94(12):1540-6.

Comment: There’s an error in this title – it should be opiate versus non-opiate overdose deaths. Basic epidemiology.

7) Methadone, another cause of opioid-associated hearing loss: a case report.

Shaw KA, Babu KM, Hack JB.

J Emerg Med. 2011 Dec;41(6):635-9. Epub 2010 Dec 9.

Comment: An unusual toxicity to opioid overdose, but one that has been previously documented. Generally neurologic in origin and reversible with removal of the offending opioid agent.

8) Delayed leukoencephalopathy after alprazolam and methadone overdose: A case report and review of the literature.

Carroll I, Heritier Barras AC, Dirren E, Burkhard PR, Horvath J.

Clin Neurol Neurosurg. 2012 Feb 16. [Epub ahead of print] No abstract available.

Comment: The precipitating event in this case is a hypoxic event in a patient with an enzyme deficiency, not a direct opioid or benzodiazepine toxicity.

9) A Novel Case of Transient Right Ventricular Failure in a Patient With Respiratory Distress.

Liu SS, Kovell LC, Horne A Jr, Chang D, Petronis JD, Zakaria S.

J Intensive Care Med. 2012 Apr 29.

Comment: This patient overdosed on opioids and wasn’t breathing. After no response to naloxone she was intubated and eventually recovered. It appears that the right ventricle of her heart stopped working for a while due to hypoxia. This should serve as a reminder that medical intervention is often needed in overdose, particularly if the overdose isn’t addressed quickly.

10) Comparative analysis of pathological and toxicological features of opiate overdose and non-overdose fatalities.

Soravisut N, Rattanasalee P, Junkuy A, Thampitak S, Sribanditmongkol P.

J Med Assoc Thai. 2011 Dec;94(12):1540-6.

Comment: An interesting analysis of medical examiner cases in Chiang Mai. Interesting that tourists represented a growing proportion of cases over time.

11) Tramadol-induced apnea

Hassanian-Moghaddam H, Farajidana H, Sarjami S, Owliaey H.

Am J Emerg Med. 2012 Jul 16. [Epub ahead of print]

Comment: Tramadol is an opioid-like drug that has been involved in some overdose events. The risks for a tramadol overdose are poorly understood. I’m not sure how much this paper adds.

12) Aversive and reinforcing opioid effects: a pharmacogenomic twin study.

Angst MS, Lazzeroni LC, Phillips NG, Drover DR, Tingle M, Ray A, Swan GE, Clark JD.

Anesthesiology. 2012 Jul;117(1):22-37.

Comment: This is a twin study to look at the genetic contribution to opioid effects. I would recommend perusing the full article (which may be available here) if you work with opioid users, as the results are really intriguing. Directly relevant to overdose is the finding that 30% of the respiratory depression effect is genetic. Furthermore, respiratory depression increases with age (that is, older opioid users tolerate higher CO2 concentrations), more so among men.

OPIOID ANALGESICS:

1) Pharmaceutical opioid analgesic and heroin dependence: How do treatment-seeking clients differ in Australia?

Nielsen S, Bruno R, Lintzeris N, Fischer J, Carruthers S, Stoové M.

Drug Alcohol Rev. 2011 May;30(3):291-299.

Comment: This review of individuals seeking treatment in Australia found that, compared to heroin users, prescription opioid users were roughly 10% less likely to report a history of overdose and over twice as likely to report initial use for pain control. Demographics, overall health, and history of injection drug use (IDU) were similar for the two groups. The authors admit that the treatment system is oriented toward IDUs which might explain the similarity of these two groups and limits generalizability. Notably, this to determine the relative risk of overdose among prescription opioid users compared to heroin users.

2) The prescription drug epidemic in the United States: A perfect storm.

Maxwell JC.

Drug Alcohol Rev. 2011 May;30(3):264-70.

Comment: This appears to be a thorough and thoughtful review for anyone interested in the issues around prescription opioid abuse in the United States (I can’t access the full article at this time). Data sources include patient surveys, emergency department visits, and mortality and toxicology. Clinical and policy responses are also discussed, including clinician training, risk assessments, treatment agreements, prescription drug monitoring programs, and options for disposal of leftover medication. The author notes the concern that responses could raise many barriers to appropriate pain treatment and yet fail to decrease abuse.

3) Prescription of opioid analgesics and related harms in Australia.

Roxburgh A, Bruno R, Larance B, Burns L.

Med J Aust. 2011 Sep 5;195(5):280-4.

Comment: Oxycodone is becoming an issue in Australia, although not nearly as substantial as in the U.S.

4) Vital signs: overdoses of prescription opioid pain relievers — United States, 1999–2008

MMWR Morb Mortal Wkly Rep. 2011 Nov 4;60:1487-92.

Comment: This report summarizes the impressive outbreak of death from opioid analgesics (around 15,000 in 2008) in the United States – providing a helpful state-by-state breakdown.

5) Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 2: special populations.

Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A.

Can Fam Physician. 2011 Nov;57(11):1269-76.

Comment: Title is really self-explanatory – recommendations for managing opioids in adolescents.

6) Management of chronic noncancer pain in depressed patients.

Barkin RL, Barkin SJ, Irving GA, Gordon A.

Postgrad Med. 2011 Sep;123(5):143-54. Review.

Comment: Another review for physicians of how to not rely so much on opioids for chronic pain.

7) The source of methadone in overdose deaths in Western virginia in 2004.

Weimer MB, Korthuis PT, Behonick GS, Wunsch MJ.

J Addict Med. 2011 Sep;5(3):188-202.

Comment: Interesting data suggesting that two-thirds of methadone-related fatalities were from diverted drug (i.e. not prescribed to the person who died); 28% were prescribed methadone for analgesia. I can’t access the full article, but regardless this suggests very few were agonist maintenance patients.

8) A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death.

Paulozzi LJ, Kilbourne EM, Shah NG, Nolte KB, Desai HA, Landen MG, Harvey W, Loring LD.

Pain Med. 2011 Oct 25. doi: 10.1111/j.1526-4637.2011.01260.x.

Comment: Our understanding of opioid analgesic deaths is so poor for many reasons – most notably it is hard to study this population because they are hidden. The authors here used a case-control design (I can’t access the full article and their methods are not so well-described in the abstract) to identify risk factors for death. They found receipt of prescriptions for selected opioids and >40mg morphine equivalents daily to be substantial risk factors for overdose death. This is consistent with earlier studies.

9) Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment.

Green TC, Black R, Grimes Serrano JM, Budman SH, Butler SF.

PLoS One. 2011;6(11):e27244. Epub 2011 Nov 2.

Comment: This one takes a while to read through, but is intensely interesting. I highly recommend taking a close look at the article, the figures and tables, and even (!) digging through the entire text. Keep in mind this is a sample seeking substance abuse treatment – this is not an analysis of the general population of people who use prescription opioid.

10) CDC Grand Rounds: Prescription Drug Overdoses – a U.S. Epidemic.

Centers for Disease Control and Prevention (CDC)

MMWR Morb Mortal Wkly Rep. 2012 Jan 13;61:10-3.

Comment: This is watered down; I’m not sure of the message.

11) Correlates of non-medical prescription drug use among a cohort of injection drug users in Baltimore City.

Khosla N, Juon HS, Kirk GD, Astemborski J, Mehta SH.

Addict Behav. 2011 Dec;36(12):1282-7. Epub 2011 Aug 5.

Comment: Lots of prescription opioid use among injectors.

12) Vital signs: risk for overdose from methadone used for pain relief – United States, 1999-2010.

Centers for Disease Controland Prevention (CDC).

MMWR Morb Mortal Wkly Rep.2012 Jul 6;61:493-7.

Comment: Methadone has been the likely culprit for a large portion of prescription opioid deaths in the U.S. in the past 8-9 years. This likely occurred for a couple of reasons. First, extended release oxycodone was associated with a surge in opioid overdose deaths 10-12 years ago, so switching to methadone as the long-acting opioid seemed reasonable at the time. Unfortunately, dosing of methadone is complicated, with a non-linear dose-response curve that makes doses over 30mg dangerous for methadone-naive patients.

13) Risk Evaluation and Mitigation Strategies (REMS) for Extended-Release and Long-Acting Opioid Analgesics: Considerations for Palliative Care Practice.

Gudin J.

J Pain Palliat Care Pharmacother. 2012 Jun;26(2):136-43.

Comment: I don’t have access to this one, but it’s an interesting piece on prescription opioids requirements emerging from the FDA. The Project Lazarus site has more information.

14) Patterns of Prescription Drug Misuse among Young Injection Drug Users.

Lankenau SE, Teti M, Silva K, Bloom JJ, Harocopos A, Treese M.

J Urban Health. 2012 Jun 9. [Epub ahead of print]

Comment: Very interesting qualitative piece on use of prescription opioids by young heroin injectors. One harm reduction strategy noted by study participants was to substitute prescription opioids for heroin when there was an outbreak of heroin overdose deaths in the community.

15) Prevalence and correlates for nonmedical use of prescription opioids among urban and rural residents

Wang KH, Becker WC, Fiellin DA.

Drug Alcohol Depend. 2012 Jul 20. [Epub ahead of print]

Comment: Based on the 2008-2009 National Survey on Drug Use and Health, authors looked at nonmedical use of prescription opioids by county. Overall use rates were similar in urban and rural counties, with high rates of psychological distress and non-medical use of other prescription drugs.

16) American Society of Interventional Pain Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain: Part 2 – Guidance

Manchikanti L, Abdi S, Atluri S, et al.

Pain Physician. 2012 Jul;15(3 Suppl):S67-S116.

Comment: There are some nice summaries of current understanding related to prescription opioid overdose in this long paper. Although there is brief mention of the idea of using buprenorphine/naloxone combinations for opioid dependent persons with chronic pain, no mention is made of dispensing naloxone. Of note there is a contradiction in the paper: on page S74 authors write that the evidence that prescription drug monitoring programs reduce overdose is “poor”, then in the recommendation for such programs state that the evidence is “good to fair.”

17) Fatal overdose after ingestion of a transdermal fentanyl patch in two non-human primates

Deschamps JY, Gaulier JM, Podevin G, Cherel Y, Ferry N, Roux FA.

Vet Anaesth Analg. 2012 Jul 13. doi: 10.1111/j.1467-2995.2012.00749.x. [Epub ahead of print]

Comment: Two primates were given fentanyl patches for post-operative anesthesia, they of course ate the patches, and they died. I’ll leave further comments to you.

18) Management of opioid analgesic overdose

Boyer EW.

N Engl J Med. 2012 Jul 12;367(2):146-55. Review. No abstract available.

Comment: A review of management of opioid analgesic overdose in emergency departments or hospitals.

19) ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy

ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine.

Obstet Gynecol. 2012 May;119(5):1070-6.

Comment: A nice summary supporting established recommendations for opioid agonist maintenance therapy in pregnancy, noting both that tapering pregnant women off of opioids is dangerous and unnecessary and that breastfeeding is okay for women on agonist therapy.

NALOXONE:

1) Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania
Bennett AS, Bell A, Tomedi L, Hulsey EG, Kral AH
J Urban Health. 2011 Jul 20 [Epub]

Comment: A substantial contribution to the growing literature evaluating naloxone programs, this paper is a must-read for anyone interested in opioid overdose prevention.

2) Opioid overdose prevention and naloxone distribution in Rhode Island.

Yokell MA, Green TC, Bowman S, McKenzie M, Rich JD.

Med Health R I. 2011 Aug;94(8):240-2.

Comment: A review of programmatic data from the Rhode Island naloxone distribution program

3) Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania.

Bennett AS, Bell A, Tomedi L, Hulsey EG, Kral AH.

J Urban Health. 2011 Jul 20.

Comment: A very useful review of the PA naloxone distribution program, including the rate of survival among those administered naloxone.

4) Pilot scheme shows that giving naloxone to families of drug users would save lives

Hurley R.

BMJ. 2011 Aug 25;343:d5445. doi: 10.1136/bmj.d5445. No abstract available.

Comment: A brief summary of the pilot program at drug treatment programs in England. 495 “carers” (generally family members) were trained and a subgroup (number not in the text) were also given naloxone in 2009 and 2010. Twenty ODs were witnessed and naloxone was given in 18 of those; all survived. These are important results, particularly in two settings: 1) regions where drug users frequently live with family, and 2) settings such as abstinence-based treatment or youth programs where there might be reluctance to provide a drug user with naloxone.

5) Naloxone pro-drug rescues morphine induced respiratory depression in Sprague-Dawley rats.

Wallisch M, El Rody NM, Huang B, Koop DR, Baker JR Jr, Olsen GD.

Respir Physiol Neurobiol. 2011 Oct 19.

Comment: I don’t usually include animal studies, but this was intriguing. Authors developed a depot pro-drug of naloxone that is released in the setting of hypoxemia – that is, when there’s a low-level of oxygen in the blood naloxone is released, reversing the (presumed) opiate effect.

6) Community-based opioid overdose prevention programs providing naloxone – United States, 2010.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2012 Feb 17;61:101-5.

Comment: Hooray! Read this for a review of U.S. nationwide naloxone program data.

7) Attitudes and knowledge about naloxone and overdose prevention among detained drug users in Ningbo, China.

Liu Y, Bartlett N, Li L, Lv X, Zhang Y, Zhou W.

Subst Abuse Treat Prev Policy. 2012 Feb 8;7(1):6. [Epub ahead of print]

Comment: Incarcerated drug users would like to have naloxone.

8) Offer of a quick fix.

Gould M.

Nurs Stand. 2011 Nov 16-22;26(11):24-5.

Comment: I was only able to access this through my university account, but it is a really interesting discussion of the British prison-release take-home naloxone trial. Scotland dropped out and began routine naloxone distribution for all released prisoners. The ethics around the trial are complex – many doubt the need for proof while others point to the frustrating history of treatments assumed to work and later proven to be harmful. While it is true that similar interventions for other populations would not require proof for wide dissemination, broad application of naloxone distribution will be limited by the lack of randomized trial data.

9) Naloxone reversal of an overdose of a novel, long-acting transdermal fentanyl solution in laboratory Beagles.

Freise KJ, Newbound GC,Tudan C, Clark TP.

J Vet Pharmacol Ther. 2012Aug;35 Suppl 2:45-51.

Comment: Naloxone reverses this long-acting fentanyl solution in beagles. I’m not clear from this what the dose requirements are for naloxone in this situation.

10) Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses

Lankenau SE, Wagner KD, Silva K, Kecojevic A, Iverson E, McNeely M, Kral AH.

J Community Health. 2012 Jul 31. [Epub ahead of print]

Comment: An exciting article from a mixed methods study of Los Angeles area naloxone recipients. The authors note the possible need for booster sessions after naloxone distribution – an interesting idea that plays into the possible behavioral effect of naloxone. Hopefully this is the first of many such analyses.

AGONIST MAINTENANCE

1) The effectiveness of opioid maintenance treatment in prison settings: a systematic review.

Hedrich D, Alves P, Farrell M, Stöver H, Møller L, Mayet S.

Addiction. 2011 Sep 29. doi: 10.1111/j.1360-0443.2011.03676.x.

Comment: Some data that agonist maintenance therapy in prison reduces post-release overdose mortality

2) Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence: First Use of the Buprenorphine-Naloxone Dosage Adequacy Evaluation (BUDAVA) Questionnaire.

D’Amore A, Romano F, Biancolillo V, Lauro G, Armenante C, Pizzirusso A, Del Tufo S, Ruoppolo C, Auriemma F, Cassese F, Oliva P, Amato P.

Clin Drug Investig. 2012 May 4.

Comment: A dosing scale that includes non-fatal overdose as a marker for adjusting buprenorphine dosage. Again, I can’t access the article to get details! I’d love comments from anyone who can.

EMERGENCY MEDICAL SERVICES

1) Treatment of opioid overdose in a physician-based prehospital EMS: Frequency and long-term prognosis.

Nielsen K, Nielsen SL, Siersma V, Rasmussen LS.

Resuscitation. 2011 Jun 15.

Comment: These data from Denmark again demonstrate the increasing risk of mortality among those who have overdosed multiple times

2) Treatment of opioid overdose in a physician-based prehospital EMS: frequency and long-term prognosis.

Nielsen K, Nielsen SL, Siersma V, Rasmussen LS.

Resuscitation. 2011 Nov;82(11):1410-3. Epub 2011 Jun 15.

Comment: Very useful review of opioid overdoses attended by emergency medical services in Copenhagen. Of 3245 cases, 69% were released at the scene without transport to the hospital, 11% had cardiac arrest at the scene, 21% were admitted to the hospital, and 10% died. These data seem pretty consistent with my current understanding of EMS attended overdoses. Nonetheless, I find these data intensely interesting because, notwithstanding many theories, we still don’t really know what happens to the overdoses that occur in the community.

3) Prehospital treatment of opioid overdose in Copenhagen–is it safe to discharge on-scene?

Rudolph SS, Jehu G, Nielsen SL, Nielsen K, Siersma V, Rasmussen LS.

Resuscitation. 2011 Nov;82(11):1414-8. Epub 2011 Jul 2.

Comment: This is a sub-analysis of the prior study. They looked at the 69% of people that were released after naloxone was given and not transported to the hospital. They found that 3 of 2241 individuals died from a suspected “rebound overdose” after naloxone was given. Put in other words, 0.1% of overdose victims who were given naloxone at the scene and then released fell back into an opioid overdose and died. The authors looked pretty deeply into the circumstances post-release, so I think these data are reliable. While this figure is impressively low, it does reaffirm the need for bystanders to stay with overdose victims for several hours after reversing an overdose.

4) Can Nebulized Naloxone Be Used Safely and Effectively by Emergency Medical Services for Suspected Opioid Overdose?

Weber JM, Tataris KL, Hoffman JD, Aks SE, Mycyk MB.

Prehosp Emerg Care. 2011 Dec 22.

Comment: Nebulized naloxone is an interesting option for emergency medical services, although not widely available as a means of lay administration.

OTHER APPROACHES TO OVERDOSE

1) Overdose deaths and Vancouver’s supervised injection facility.

Christian G, Pike G, Santamaria J, Reece S, DuPont R, Mangham C.

Lancet. 2012 Jan 14;379(9811):117; author reply 118-9. No abstract available.

Comment: An interesting critique of the seminal paper on the overdose fatality reduction associated with Vancouver’s supervised injection facility. The authors’ response appears to effectively belie the critique.

2) Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States.

Semaan S, Fleming P, Worrell C, Stolp H, Baack B, Miller M.

Drug Alcohol Depend. 2011 Nov 1;118(2-3):100-10. Epub 2011 Apr 23.

Comment: A review of data on supervised injection facilities, which have impressive data on reducing local overdose mortality in Vancouver.

3) Intravenous use of illicit buprenorphine/naloxone to reverse an acute heroinoverdose.

Yokell MA, Zaller ND, Green TC, McKenzie M, Rich JD.

J Opioid Manag. 2012 Jan-Feb;8(1):63-6.

Comment: Buprenorphine is a partial agonist with a ceiling effect that limits the capacity for overdose among those with a tolerance to opioids. Like naloxone, buprenorphine really likes binding to opioid receptors and kicks most other opioids out. Since buprenorphine out-competes other opioids for receptors and has a ceiling effect, administration in the setting of overdose may result in reversal of opioid overdose. That said, this wouldn’t be the approach I would advocate for dissemination since (1) buprenorphine could cause overdose in an opioid user with minimal tolerance and (2) buprenorphine could cause prolonged withdrawal (for over a day) in those with a very high tolerance.

4) Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide.

Goli V, Webster LR, Lamson MJ, Cleveland JM, Sommerville KW, Carter E.

Harm Reduct J. 2012 Mar 15;9(1):13. [Epub ahead of print]

Comment: An intriguing analysis of whether or not injecting the pre-formulated morphine + naltrexone actually blocks the effects of morphine. It appears to partially, but not completely, block the effect.

5) Canada’s highest court unchains injection drug users; Implications for harm reduction as standard of healthcare

Small D.

Harm Reduct J. 2012 Jul 20;9(1):34. [Epub ahead of print]

Comment: A review of the 2011 Supreme Court of Canada decision supporting the Vancouver supervised injection facility.