Naloxone interventions

Primary care

1) 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 19:1-6. [Epub ahead of print]

Comment: A pilot of naloxone co-prescribing.

2) Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain.

Mueller SR, Koester S, Glanz JM, Gardner EM, Binswanger IA.

J Gen Intern Med. 2016 Oct 31. [Epub ahead of print]

Comment: Shows that naloxone for patients prescribed opioids must be appropriately framed.

3) Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain.

Behar E, Rowe C, Santos GM, Coffa D, Turner C, Santos NC, Coffin PO.

J Gen Intern Med. 2016 Nov 4. [Epub ahead of print]

Comment: When actually implemented, providers really like adding naloxone to opioid-related care. One of five papers out of the Naloxone for Opioid Safety Evaluation of a naloxone co-prescribing study in San Francisco.

Emergency department

4) Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing.

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

Acad Emerg Med. 2016 Apr;23(4):455-65. doi: 10.1111/acem.12910.

Comment: There needs to be some high-level leadership in emergency medicine before we see real movement from emergency docs.

5) Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment.

Drainoni ML, Koppelman EA, Feldman JA, Walley AY, Mitchell PM, Ellison J, Bernstein E.

BMC Res Notes. 2016 Oct 18;9(1):465.

Comment: Uptake of naloxone provision from emergency departments has been surprisingly challenging.

6) Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users.

Kestler A, Buxton J, Meckling G, Giesler A, Lee M, Fuller K, Quian H, Marks D, Scheuermeyer F.

Ann Emerg Med. 2016 Oct 10. pii: S0196-0644(16)30407-3. doi: 10.1016/j.annemergmed.2016.07.027. [Epub ahead of print]

Comment: If you offer it from emergency departments, you’ll get reasonable uptake. Interesting in the context of our other ED naloxone papers from this month.

Corrections

7)  Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths.

Parmar MK, Strang J, Choo L, Meade AM, Bird SM.

Addiction. 2016 Oct 24. doi: 10.1111/add.13668. [Epub ahead of print]

Comment: Interesting piece on the N-ALIVE trial, which was possibly our last real hope for a definitive randomized controlled trial of naloxone provision. Unfortunately it didn’t work out, but there is still room for some innovative trial designs to try to get close to such definitive data.

8) Stakeholder perceptions and operational barriers in the training and distribution of take-home naloxone within prisons in England.

Sondhi A, Ryan G, Day E.

Harm Reduct J. 2016 Feb 3;13:5. doi: 10.1186/s12954-016-0094-1.

Comment: Interesting elements of the challenges of providing naloxone in prisons, including identifying eligible inmates, inmate and staff perceptions, and logistical barriers.

Substance use treatment

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

Lott DC, Rhodes J.

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

Comment: If you don’t give them naloxone, they don’t go get it themselves. This is like a flu vaccination. People don’t go out of their way for preventive interventions.

Distribution program

10) Process evaluation of the Prevent Overdose in Toronto (POINT) program.

Leece P, Gassanov M, Hopkins S, Marshall C, Millson P, Shahin R.

Can J Public Health. 2016 Oct 20;107(3):e224-e230. doi: 10.17269/cjph.107.5480.

Comment: As above.

Law enforcement / emergency medical service response

11) Police Officers Can Safely and Effectively Administer Intranasal Naloxone.

Fisher R, O’Donnell D, Ray B, Rusyniak D.

Prehosp Emerg Care. 2016 Nov-Dec;20(6):675-680.

Comment: A relief that few patients become combative in this situation.

12) Law Enforcement Attitudes towards Naloxone Following Opioid OverdoseTraining.

Purviance D, Ray B, Tracy A, Southard E.

Subst Abus. 2016 Aug 11:0. [Epub ahead of print]

Comment: Changes in the role of police for people who use drugs is a meaningful element of this process.

13) Implementation of online opioid overdose prevention, recognition and response trainings for professional first responders: Year 1 survey results.

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

Drug Alcohol Depend. 2016 Oct 11;169:1-4. doi: 10.1016/j.drugalcdep.2016.10.003. [Epub ahead of print]

Comment: Evaluation of online naloxone training, with some innovative elements.

These two papers address early release by emergency medical personnel after naloxone administration.

14) Do heroin overdose patients require observation after receiving naloxone?

Willman MW, Liss DB, Schwarz ES, Mullins ME.

Clin Toxicol (Phila). 2016 Nov 16:1-7. [Epub ahead of print]

Comment: The short answer is “no”. Nice summary.

15) Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?

Kolinsky D, Keim SM, Cohn BG, Schwarz ES, Yealy DM.

J Emerg Med. 2016 Oct 18. pii: S0736-4679(16)30777-6. doi: 10.1016/j.jemermed.2016.09.015. [Epub ahead of print]

Comment: Probably per this paper. Yes per the parallel one that came out this month.

Miscellaneous

16) Can Naloxone Be Used to Treat Synthetic Cannabinoid Overdose?

Jones JD, Nolan ML, Daver R, Comer SD, Paone D.

Biol Psychiatry. 2016 Aug 18. pii: S0006-3223(16)32710-X. doi: 10.1016/j.biopsych.2016.08.013. [Epub ahead of print] No abstract available.

Comment: Interesting that naloxone seemed to help in these cases, in the absence of presence of opioids. There is an interaction between the opioid and cannabinoid receptor systems (which was actually an element of my undergraduate work with cannabinoids and pain – a theory suggested by the late J Michael Walker from Brown University).

Prescription opioids and chronic pain

17) Prescription drug abuse – A timely update.

Monheit B, Pietrzak D, Hocking S.

Aust Fam Physician. 2016 Dec;45(12):862-866.

Comment: Prescription opioids in Australia. And buprenorphine is really safe.

18) Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults.

Chang YP, Compton P.

J Gerontol Nurs. 2016 Dec 1;42(12):21-30. doi: 10.3928/00989134-20161110-06.

Comment: Hopefully the new efforts at opioid prescribing will help. I remain concerned that, without substantial investments in funding other pain management strategies, feelings of patient abandonment will worsen.

19) Challenges to Treatment of Chronic Pain and Addiction During the “Opioid Crisis”.

Krashin D, Murinova N, Sullivan M.

Curr Pain Headache Rep. 2016 Dec;20(12):65. Review.

Comment: Per title.

20) Turning the Tide or Riptide? the Changing Opioid Epidemic.

Kertesz SG.

Subst Abus. 2016 Nov 18:0. [Epub ahead of print]

Comment: A pointed analysis of issues with the continued focus on opioid prescribing, when reforms have been followed by explosions in the use and consequences of street opioids.

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

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

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

Comment: Everybody underestimates their overdose risk. The next question is what does this mean (e.g. does this apply to most medical disorders?) and what do we do with the information?

22) Opioid Overdose: Risk Assessment and Mitigation in Outpatient Treatment.

Lin LA, Hosanagar A, Park TW, Bohnert AS.

J Addict Med. 2016 Nov/Dec;10(6):382-386.

Comment: Can’t access this case report of a patient with comorbid chronic pain and substance use disorder who had a heroin overdose.

23) Declines in Opioid Prescribing After a Private Insurer Policy Change – Massachusetts, 2011-2015.

García MC, Dodek AB, Kowalski T, Fallon J, Lee SH, Iademarco MF, Auerbach J, Bohm MK.

MMWR Morb Mortal Wkly Rep. 2016 Oct 21;65(41):1125-1131. doi: 10.15585/mmwr.mm6541a1.

Comment: Opioid stewardship interventions reduced opioid prescribing in Massachusetts. No surprise there. But no analysis of what happened to patients who were no longer prescribed opioids. We’re in the midst of a crisis and really need to go further than just looking at opioid prescribing.

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

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

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

Comment: It takes a lot of work to manage patients well; many providers do not have the resources to pull this off.

25) Efficacy and safety of two methadone titration methods for the treatment of cancer-related pain: The EQUIMETH2 trial (methadone for cancer-related pain).

Poulain P, Berleur MP, Lefki S, Lefebvre D, Chvetzoff G, Serra E, Tremellat F, Derniaux A, Filbet M; EQUIMETH2 Study Group..

J Pain Symptom Manage. 2016 Sep 29. pii: S0885-3924(16)30312-8. doi: 10.1016/j.jpainsymman.2016.05.022. [Epub ahead of print]

Comment: Use of methadone as second-line pain control in cancer patients.

26) Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system.

Boscarino JA, Kirchner HL, Pitcavage JM, Nadipelli VR, Ronquest NA, Fitzpatrick MH, Han JJ.

Subst Abuse Rehabil. 2016 Sep 16;7:131-141.

Comment: Nice, large study, no surprising results.

27) Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates.

Dowell D, Zhang K, Noonan RK, Hockenberry JM.

Health Aff (Millwood). 2016 Oct 1;35(10):1876-1883.

Comment: Wow this is complicated. And I’m unsure that amalgamated national data can appropriately reflect the reasons for such complicated results. The real impact in terms of overdose mortality, if there is one, is from prescribed opioids. It seems a stretch to say these data show a reduction in overall opioid overdose mortality.

Toxicology reports:

28) Risk Factors for Mortality and Endotracheal Intubation after MethadoneIntoxication.

Hassanian-Moghaddam H, Soltaninejad K, Shadnia S, Kabir A, Movahedi M, Mirafzal A.

Basic Clin Pharmacol Toxicol. 2016 Mar;118(3):231-7. doi: 10.1111/bcpt.12476.

Comment: Interesting that age seemed to predict the worst outcomes in methadone overdose. Again makes me wonder about what makes older opioid users seem more likely to die of overdose while younger users overdose more frequently.

27) Non-cardiogenic pulmonary edema, rhabdomyolysis and myocardial injury following heroin inhalation: a case report.

Bazoukis G, Spiliopoulou A, Mourouzis K, Grigoropoulou P, Yalouris A.

Hippokratia. 2016 Jan-Mar;20(1):84-87.

Comment: Title says it all.

28) An Unusual Case of Alternating Ventricular Morphology on the 12-Lead Electrocardiogram.

Sammon M, Dawood A, Beaudoin S, Harrigan RA.

J Emerg Med. 2016 Oct 7. pii: S0736-4679(16)30686-2. doi: 10.1016/j.jemermed.2016.08.027. [Epub ahead of print]

Comment: An overdose reversal case that led to the diagnosis of a variant of Wolff-Parkinson White, which is a cardiac disorder that can be life threatening.

29) Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.

Toce MS, Burns MM, O’Donnell KA.

Clin Toxicol (Phila). 2016 Oct 19:1-6. [Epub ahead of print]

Comment: Effects are similar to other opioids for infants/toddlers, and duration of observation required is dependent upon dose.

Substance use disorder treatment

30) Striatal H3K27 Acetylation Linked to Glutamatergic Gene Dysregulation in Human Heroin Abusers Holds Promise as Therapeutic Target.

Egervari G, Landry J, Callens J, Fullard JF, Roussos P, Keller E, Hurd YL.

Biol Psychiatry. 2016 Sep 28. pii: S0006-3223(16)32833-5. doi: 10.1016/j.biopsych.2016.09.015. [Epub ahead of print]

Comment: Interesting exploration of novel interventions for opioid use disorder.

31)  Fifty Years in the Development of a Glutaminergic-Dopaminergic Optimization Complex (KB220) to Balance Brain Reward Circuitry in Reward Deficiency Syndrome: A Pictorial.

Blum K, Febo M, Badgaiyan RD.

Austin Addict Sci. 2016;1(2). pii: 1006.

Comment: More on novel pharmacotherapies for opioid use disorder.

32) Treatment utilization among persons with opioid use disorder in the United States.

Wu LT, Zhu H, Swartz MS.

Drug Alcohol Depend. 2016 Oct 19;169:117-127. doi: 10.1016/j.drugalcdep.2016.10.015. [Epub ahead of print]

Comment: Yup, the United States has issues with providing appropriate treatments for opioid use disorder. These issues are multi-faceted, ranging from the unbelievable stigma faced by a person who even admits to any drug use in a medical setting, to the finance issues in a fragmented, barely hung together healthcare system slated to be further trampled in the next couple of years.

Epidemilogy / qualitative results

33) Assessing gender disparities in excess mortality of heroin or cocaine users compared to the general population.

Brugal MT, Molist G, Sarasa-Renedo A, de la Fuente L, Espelt A, Mesías B, Puerta C, Guitart AM, Barrio G; Spanish Working Group for the Study of Mortality amongDrug Users..

Int J Drug Policy. 2016 Nov 11;38:36-42. doi: 10.1016/j.drugpo.2016.10.009. [Epub ahead of print]

Comment: Gender comparison in overdose.

34) [Harm reduction interventions in drug users: current situation and recommendations].

Bosque-Prous M, Brugal MT.

Gac Sanit. 2016 Nov;30 Suppl 1:99-105. doi: 10.1016/j.gaceta.2016.04.020. Spanish.

Comment: Review of harm reduction strategies from Spain.

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

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

Drug Alcohol Depend. 2016 Nov 1;168:140-146. doi: 10.1016/j.drugalcdep.2016.08.638.

Comment: Psychological distress is a major and fascinating domain in substance use disorders.

36) Drug use in business bathrooms: An exploratory study of manager encounters in New York City.

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

Int J Drug Policy. 2016 Oct 18;39:69-77. doi: 10.1016/j.drugpo.2016.08.014. [Epub ahead of print]

Comment: Interesting argument for supervised injection facilities.

36) County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States.

Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, Bohm MK, Jones CM, Flanagan BE, Siddiqi AE, Iqbal K, Dent AL, Mermin JH, McCray E, Ward JW, Brooks JT.

J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):323-331.

Comment: Great paper. Innovative approach and analysis. Kudos.

37) Performance measures of diagnostic codes for detecting opioid overdose in the emergency department.

Rowe C, Vittinghoff E, Santos GM, Behar E, Turner C, Coffin P.

Acad Emerg Med. 2016 Oct 20. doi: 10.1111/acem.13121. [Epub ahead of print]

Comment: ICD coding for opioid poisoning in a safety net hospital detected only a quarter of opioid overdose cases, suggesting that surveillance of this issue based on billing codes in emergency departments may vastly underestimate the number of cases. It is also possible that there is huge variation in how cases are coded. Unfortunately, this is another strike against using “big data” in substance use research. The reasons for poor coding are many, including stigma.

38) Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre.

Latimer J, Ling S, Flaherty I, Jauncey M, Salmon AM.

Int J Drug Policy. 2016 Oct 14;37:111-114. doi: 10.1016/j.drugpo.2016.08.004. [Epub ahead of print]

Comment: Nice work by this team! Fentanyl injection had twice the risk of overdose of heroin injection and eight times the risk of injection other prescribed opioids. Although this is observational, it’s the first data we have to start to paint the picture.

39) Communicating risk in the context of methadone formulation changes: A qualitative study of overdose warning posters in Vancouver, Canada.

Markwick N, McNeil R, Anderson S, Small W, Kerr T.

Int J Drug Policy. 2016 Jan;27:178-81. doi: 10.1016/j.drugpo.2015.10.013. No abstract available.

Comment: Warnings should emphasize the specific risks for harm, not the potency.

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

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

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

Comment: Methadone use has increased from 4% in 2010 to 53% in 2012/13, and its use is associated with fewer HIV risk behaviors than heroin use.

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

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

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

Comment: Not really, in Australia at least.

Reviews

42) Drugs, guns and cars: how far we have come to improve safety in the United States; yet we still have far to go.

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

Pediatr Res. 2016 Oct 26. doi: 10.1038/pr.2016.193. [Epub ahead of print] Review.

Comment: So interesting to merge these three areas in thinking about public health interventions.

43) In Response to: “The Evolution of Recommended Naloxone Dosing for OpioidOverdose by Medical Specialty”.

Lombardi J, Villeneuve E, Gosselin S.

J Med Toxicol. 2016 Oct 24. [Epub ahead of print] No abstract available.

In Reply: “The Evolution of Recommended Naloxone Dosing for Opioid Overdose by Medical Specialty”.

Connors NJ, Nelson LS.

J Med Toxicol. 2016 Oct 24. [Epub ahead of print] No abstract available.

Comment: Can’t access these letters

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

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

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

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

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

Harocopos A, Allen B, Paone D.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brodrick JE, Brodrick CK, Adinoff B.

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

Comment: Another legal review of naloxone access.

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

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

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

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

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

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

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

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

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

Compton WM, Jones CM, Baldwin GT.

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

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

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

Maldjian L, Siegler A, Kunins HV.

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

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

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

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

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

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

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

Roe SS, Banta-Green CJ.

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

Comment: Web-based naloxone training!

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

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

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

Comment: Drug screening helps manage toxidromes in the ED.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comment: Fascinating focus groups on naloxone among veterans.

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

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

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

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

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

Howland RH.

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

Comment: Buprenorphine is safer than other opioids.

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

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

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

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

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

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

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

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

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

Pavarin RM.

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

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

25) The rise of opioid abuse in Iowa.

Strickler K.

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

Comment: Can’t access and no abstract.

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

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

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

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

27) Acetylfentanyl: An Emerging Drug of Abuse.

Rogers JS, Rehrer SJ, Hoot NR.

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

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

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

Larney S, Degenhardt L, Farrell M.

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

Comment: Opioid agonist treatment in prison helps too.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comment: Pain patients underestimate overdose risk.

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

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

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

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

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

Wise J.

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

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

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

Beletsky L.

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

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

1) Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic.

Dahlem CH, Horstman MJ, Williams BC.

J Am Assoc Nurse Pract. 2015 Mar 26. doi: 10.1002/2327-6924.12249. [Epub ahead of print]

Comments: Naloxone programs have been providing kits to settings where homeless people receive services for many years. This is a description of a program at a homeless health clinic.

2) Quantification of morphine, morphine 6-glucuronide, buprenorphine, and the enantiomers of methadone by enantioselective mass spectrometric chromatography in whole blood.

Christoffersen DJ, Brasch-Andersen C, Thomsen JL, Worm-Leonhard M, Damkier P, Brøsen K.

Forensic Sci Med Pathol. 2015 Jun;11(2):193-201. doi: 10.1007/s12024-015-9673-9. Epub 2015 Mar 24.

Comments: It’s been awhile since we had a forensics paper here. I think this is a novel method of identifying enantiomers.

3) A Comparison of Liver Disease Mortality With HIV and Overdose Mortality Among Georgia Prisoners and Releasees: A 2-Decade Cohort Study of Prisoners Incarcerated in 1991.

Spaulding AC, Sharma A, Messina LC, Zlotorzynska M, Miller L, Binswanger IA.

Am J Public Health. 2015 May;105(5):e51-7. doi: 10.2105/AJPH.2014.302546. Epub 2015 Mar 19.

Comments: Stunningly low rate of drug overdose mortality in this cohort of prisoners in Georgia. This is one of the first times I’ve seen a paper on opioid overdose find radically different results in a different setting. I can’t access for details.

4) A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming Into Clinical Practice.

Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA.

Subst Abus. 2015 Mar 16:1-14. [Epub ahead of print]

Comments: A review toward the end of using community distribution data to build clinical care naloxone prescription.

5) Long-term course of opioid addiction.

Hser YI, Evans E, Grella C, Ling W, Anglin D.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):76-89. doi: 10.1097/HRP.0000000000000052.

Comments: This is a systematic review of long-term studies of opioid users. Among many fascinating data reported, the length of time not using a drug of choice increases the likelihood of continuing to not use that drug. This seems obvious to many, but I don’t believe it’s been documented before. Good read for anyone looking to understand some of the longitudinal outcome data.

6) Medication-assisted treatment of opioid use disorder: review of the evidence and future directions.

Connery HS.

Harv Rev Psychiatry. 2015 Mar-Apr;23(2):63-75. doi: 10.1097/HRP.0000000000000075.

Comments: Nice review of treatment options for opioids. Strong evidence for methadone and buprenorphine. Weak evidence of naltrexone therapies – with oral increasing mortality and early but favorable evidence for injectable naltrexone.

7) The impact of chronic pain on opioid addiction treatment: a systematic review protocol.

Dennis BB, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z.

Syst Rev. 2015 Apr 16;4(1):49. doi: 10.1186/s13643-015-0042-2.

Comments: A paper describing a planned paper. Hmm.

8) Acute fatal posthypoxic leukoencephalopathy following benzodiazepine overdose: a case report and review of the literature.

Aljarallah S, Al-Hussain F.

BMC Neurol. 2015 Apr 30;15(1):69. doi: 10.1186/s12883-015-0320-6.

Comments: Usually we see this after opioid overdose. Interesting.

9) Functional mu opioid receptor polymorphism (OPRM1 A¹¹⁸ G) associated with heroinuse outcomes in Caucasian males: A pilot study.

Woodcock EA, Lundahl LH, Burmeister M, Greenwald MK.

Am J Addict. 2015 Apr 24. doi: 10.1111/ajad.12187. [Epub ahead of print]

Comments: The 118G allele was once associated with better responsiveness to naltrexone for alcohol dependence. Interesting now to see it associated with more troubling heroin use patterns. Can’t access full article for details.

10) Comparative Usability Study of a Novel Auto-Injector and an Intranasal System for Naloxone Delivery.

Edwards ET, Edwards ES, Davis E, Mulcare M, Wiklund M, Kelley G.

Pain Ther. 2015 Apr 25. [Epub ahead of print]

Comments: The naloxone autoinjector is easier to use than the jerry-rigged intranasal device.

11) Disparity in Naloxone Administration by Emergency Medical Service Providers and the Burden of Drug Overdose in US Rural Communities.

Faul M, Dailey MW, Sugerman DE, Sasser SM, Levy B, Paulozzi LJ.

Am J Public Health. 2015 Apr 23:e1-e7. [Epub ahead of print]

Comments: Basic life support-trained EMTs generally don’t administer naloxone – and they deal with most overdoses in rural areas.

12) HIV prevention and treatment strategies can help address the overdose crisis.

Walley AY.

Prev Med. 2015 Apr 18. pii: S0091-7435(15)00109-7. doi: 10.1016/j.ypmed.2015.04.004. [Epub ahead of print]

Comments: Yup.

13) Rates of Opioid Dispensing and Overdose After Introduction of Abuse-Deterrent Extended-Release Oxycodone and Withdrawal of Propoxyphene.

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

JAMA Intern Med. 2015 Apr 20. doi: 10.1001/jamainternmed.2015.0914. [Epub ahead of print]

Comments: Being that I’m not a pharmaceutical company, my interest is in the welfare of people regardless of what they are putting into their bodies. Oxycodone, morphine, methadone, hydromorphone, oxymorphone, or heroin. The clear uptick in heroin use and heroin (as well as overall opioid) overdose mortality began when we started using injection-deterrent formulations (the formulations only address injection – not other potentially problematic use patterns).

14) Paramedic supplied “take home” naloxone: a randomised feasibility study.

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

Emerg Med J. 2015 May;32(5):421-2. doi: 10.1136/emermed-2015-204877.3.

Comments: Great idea. I believe the naloxone program in Inverness, Scotland, first inspired this idea by following up with overdose patients in the month after a paramedic reversal.

15) Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio.

Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, Starr S.

Subst Abuse Treat Prev Policy. 2015 Mar 28;10(1):13. doi: 10.1186/s13011-015-0009-2.

Comments: Unfortunately there are multiple barriers. Physician availability, reimbursement, etc.

16) Prescription opioid abuse: Problems and responses.

Compton WM, Boyle M, Wargo E.

Prev Med. 2015 Apr 11. pii: S0091-7435(15)00103-6. doi: 10.1016/j.ypmed.2015.04.003. [Epub ahead of print]

Comments: Review of prescription opioid use problems and responses, including agonist treatment and naloxone.

17) Reducing the harm of opioid overdose with the safe use of naloxone : a pharmacologic review.

Kim HK, Nelson LS.

Expert Opin Drug Saf. 2015 Apr 12:1-10. [Epub ahead of print]

Comments: Naloxone is safe. Don’t use massive doses or people go into severe withdrawal. Lay programs generally use 0.4mg intramuscular. The intranasal 2mg dose has some variability, but is probably equivalent to 0.3-0.4mg intramuscular for many people.

18) Lessons learned from the expansion of naloxone access in Massachusetts and North Carolina.

Davis CS, Walley AY, Bridger CM.

J Law Med Ethics. 2015 Mar;43 Suppl 1:19-22. doi: 10.1111/jlme.12208.

Comments: Laws aren’t enough. Providers need education and the formulations are problematic.

19) Naloxone’s basic benefit. Why the overdose-reversal drug is worth expanding beyond just ALS providers.

Furlano E.

EMS World. 2014 Oct;43(10):28-30, 32-4. No abstract available.

Comments: Basic life support-trained providers should have naloxone.

20) Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution program.

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

Addiction. 2015 Apr 27. doi: 10.1111/add.12961. [Epub ahead of print]

Comments: Among recipients of take-home naloxone, those most likely to report using it to reverse an overdose are active drug users themselves. This emphasizes the top priority of getting naloxone into the hands of drug users.

21) Causes of death in a cohort treated for opioid dependence between 1985 and 2005.

Degenhardt L, Larney S, Randall D, Burns L, Hall W.

Addiction. 2014 Jan;109(1):90-9. doi: 10.1111/add.12337. Epub 2013 Oct 9.

Comments: Another stellar longitudinal paper. Overdose is of course the driver of mortality, but major organ disease-related mortality becomes a close competitor after age 45. Suicide is common, accounting for 10-15% of mortality. Another must read.

26) Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users.

Espelt A, Barrio G, Álamo-Junquera D, Bravo MJ, Sarasa-Renedo A, Vallejo F, Molist G, Brugal MT.

Eur Addict Res. 2015 May 28;21(6):300-306. [Epub ahead of print]

Comments: Authors of this study from Madrid and Barcelona come to a similar conclusion as some older papers on heroin overdose – that approximately 4% are fatal. Of note, these are young heroin users, which implies events that are more likely to be witnessed. Mortality is likely higher among older users, who are more likely to be socially isolated, leading to an overall estimated mortality of approximately 10%.

27) Dynamic model of nonmedical opioid use trajectories and potential policy interventions.

Wakeland W, Nielsen A, Geissert P.

Am J Drug Alcohol Abuse. 2015 May 18:1-11. [Epub ahead of print]

Comments: I can’t access. I believe this was also presented as a poster at CPDD this year.

28) Fentanyls: Are we missing the signs? Highly potent and on the rise in Europe.

Mounteney J, Giraudon I, Denissov G, Griffiths P.

Int J Drug Policy. 2015 Apr 17. pii: S0955-3959(15)00097-3. doi: 10.1016/j.drugpo.2015.04.003. [Epub ahead of print]

Comments: Ugh. Fentanyl is scary because it is dosed in micrograms – which is really hard to do safely, especially in an illicit market.

29) Trends and characteristics of heroin overdoses in Wisconsin, 2003-2012.

Meiman J, Tomasallo C, Paulozzi L.

Drug Alcohol Depend. 2015 Jul 1;152:177-184. doi: 10.1016/j.drugalcdep.2015.04.002. Epub 2015 Apr 18.

Comments: Most states/localities saw a stark inflection point in heroin overdose events after 2010; that inflection seems less pronounced in this study.

30) 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 Mar-Apr;28(2):146-54. doi: 10.1016/j.gaceta.2013.10.012. Epub 2014 Jan 10.

Comments: Study out of Barcelona looking at predictors of less overdose prevention knowledge.

31) Griffith Edwards, the Addiction Research Unit and research on the criminal justice system.

Farrell M, Marsden J, Strang J.

Addiction. 2015 Jul;110 Suppl 2:54-8. doi: 10.1111/add.12910.

Comments: Review of Griffith Edwards’s work in the 1960s and 1970s addressing the transition from correctional to community settings. Important prelude to what’s been done over the past 20 years and what we hope will be achieved in the years to come.

32) Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths.

Strang J.

Addiction. 2015 Jul;110 Suppl 2:27-35. doi: 10.1111/add.12904.

Comments: Let’s move on to implementation science?

33) Reversal of overdose on fentanyl being illicitly sold as heroin with naloxone nasal spray: A case report.

Fareed A, Buchanan-Cummings AM, Crampton K, Grant A, Drexler K.

Am J Addict. 2015 Jun 3. doi: 10.1111/ajad.12230. [Epub ahead of print]

Comments: Report out of the Veterans’ Administration, which is admirably taking on overdose prevention.

34) Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial.

Rich JD, McKenzie M, Larney S, Wong JB, Tran L, Clarke J, Noska A, Reddy M, Zaller N.

Lancet. 2015 May 28. pii: S0140-6736(14)62338-2. doi: 10.1016/S0140-6736(14)62338-2. [Epub ahead of print]

Comments: With respect to the excellent investigators, are we really living in a world where this kind of study is either needed or permitted? “Usual care” as forced withdrawal of a life-saving medication is … leaving me speechless.

35) The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales.

Marteau D, McDonald R, Patel K.

BMJ Open. 2015 May 29;5(5):e007629. doi: 10.1136/bmjopen-2015-007629.

Comments: Buprenorphine is six times safer than methadone with regard to risk of drug overdose death. This is, of course, observational, and does not take into account differing characteristics of opioid dependent persons that may drive them to one treatment or another. Methadone is an invaluable tool for a large proportion of individuals in need.

36) Distribution of naloxone for overdose prevention to chronic pain patients.

Coe MA, Walsh SL.

Prev Med. 2015 May 27. pii: S0091-7435(15)00175-9. doi: 10.1016/j.ypmed.2015.05.016. [Epub ahead of print]

Comments: Commentary on the concept of co-prescribing naloxone to pain patients on opioids.

37) Responding to illicit drug use in family practice.

Robertson JR, Robertson AR.

Curr Opin Psychiatry. 2015 Jul;28(4):286-91. doi: 10.1097/YCO.0000000000000174.

Comments: Review of substance use issues affecting family practice providers.

38) Reducing opioid analgesic deaths in america: what health providers can do.

Agarin T, Trescot AM, Agarin A, Lesanics D, Decastro C.

Pain Physician. 2015 May-Jun;18(3):E307-22.

Comments: Nobody knows yet.

39) Opioid education and nasal naloxone rescue kits in the emergency department.

Dwyer K, Walley AY, Langlois BK, Mitchell PM, Nelson KP, Cromwell J, Bernstein E.

West J Emerg Med. 2015 May;16(3):381-284. doi: 10.5811/westjem.2015.2.24909. Epub 2015 Apr 1.

Comments: Nice initial observational study of naloxone from emergency departments. Low response rate.

40) Buprenorphine treatment for narcotic addiction: not without risks.

Sansone RA, Sansone LA.

Innov Clin Neurosci. 2015 Mar-Apr;12(3-4):32-6.

Comments: Buprenorphine is hard to overdose on in the absence of sedatives such as benzodiazepines. There is diversion, but largely to individuals already dependent on opioids who are seeking to stave off withdrawal or often self-detox. It’s about time we moved on to more sophisticated diversion research, which differentiated the type of prescription drug diversion most people have engaged in – like sharing your leftover amoxicillin or hydrocortisone cream – and more dangerous forms.

41) Coherent long-term treatment approaches-superior in the treatment of opioid dependence.

Clausen T.

Addiction. 2015 Jun;110(6):1006-7. doi: 10.1111/add.12922. No abstract available.

Comments: Nice commentary on the role and importance of agonist medications in treating opioid use disorder.

42) Economic impact of a novel naloxone autoinjector on third-party payers.

Weiss RC, Bazalo GR, Thomson H, Edwards E.

Manag Care. 2015 Feb;24(2):41-8.

Comments: I can no longer claim to have the only mathematical model of opioid overdose! This is a model from the payer perspective. Funded and co-authored by the manufacturers of the naloxone autoinjector.

43) Take home naloxone for Ireland.

Bury G.

Ir Med J. 2015 Mar;108(3):70. No abstract available.

Comments: can’t access.

44) [The message from heroin overdoses].

Pap Á, Hegedűs K.

Orv Hetil. 2015 Mar 1;156(9):352-7. doi: 10.1556/OH.2015.30091. Review. Hungarian.

Comments: Review of overdose / prevention in Hungary.

45) Out-of-hospital mortality among patients receiving methadone for noncancer pain.

Ray WA, Chung CP, Murray KT, Cooper WO, Hall K, Stein CM.

JAMA Intern Med. 2015 Mar;175(3):420-7. doi: 10.1001/jamainternmed.2014.6294.

Comments: More on the potential hazards of methadone when used for chronic noncancer pain. I remain mixed on these data. There is a mechanistic argument that methadone is more risky, but at the same time it is generally prescribed to lower income patients with less optimal insurance that doesn’t cover the more expensive long-acting opioid formulations. It’s hard to convincingly disentangle the risks of the population from the risks of the drug.

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

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

Acta Histochem. 2014 Jan;116(1):182-90. doi: 10.1016/j.acthis.2013.07.006. Epub 2013 Aug 13.

Comments: Interesting. Not sure what to make of this one.