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

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

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

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

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

May T, Bennett T, Holloway K.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Russolillo A, Moniruzzaman A, Somers JM.

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

Comment: Methadone prevents death.

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

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

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

Comment: Nice.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Strand MA, Eukel H, Burck S.

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

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

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

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

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

Comment: Short training helps.

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

Hines J, Deja E, Black EP.

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

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

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

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

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

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

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

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

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

Comment: Geocoding work is always intriguing.

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

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

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

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

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

Haggerty LC, Gatewood SS, Goode JKR.

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

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

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

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

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

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

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

Cicero TJ, Kasper ZA, Ellis MS.

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

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

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

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

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

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

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

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

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

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

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

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

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

Comment: Increasing use.

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

Fraser S, Farrugia A, Dwyer R.

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

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

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

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

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

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

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

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

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

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

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

Wakeman SE, Barnett ML.

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

Comment: Nice article! Good read.

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

Saloner B, Stoller KB, Alexander GC.

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

Comment: Yes, please.

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

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

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

Comment: Fentanyl review.

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

Rubin R.

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

Comment: Review of addressing OUD in the emergency department.

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

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

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

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

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

Paul L.

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

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

Kansagra SM, Cohen MK.

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

26 naloxone papers:

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

Verdier M, Routsolias JC, Aks SE.

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

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

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

McAuley A, Munro A, Taylor A.

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

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

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

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

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

Comments: Peers are hugely important in service provision.

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

Ouyang S, Moore T.

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

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

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

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

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

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

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

Behar E, Bagnulo R, Coffin PO.

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

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

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

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

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

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

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

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

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

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

9) An overview of take-home naloxone programs in Australia.

Dwyer R, Olsen A, Fowlie C, Gough C, van Beek I, Jauncey M, Lintzeris N, Oh G, Dicka J, Fry CL, Hayllar J, Lenton S.

Drug Alcohol Rev. 2018 May;37(4):440-449. doi: 10.1111/dar.12812.

Comments: Peer programs!

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

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

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

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

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

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

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

Comments: Smaller kits more likely to be carried.

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

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

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

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

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

Ryan SA, Dunne RB.

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

Comments: Intranasal works well.

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

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

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

Comments: Pilot naloxone prescribing in France.

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

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

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

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

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

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

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

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

17) Prescribing naloxone for opioid overdose intervention.

Dunne RB.

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

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

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

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

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

Comments: Home health approach to training on overdose response.

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

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

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

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

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

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

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

Comments: Intranasal naloxone was 0.75 as bioavailable as intramuscular.

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

Pauly JB, Vartan CM, Brooks AT.

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

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

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

Seger DL, Loden JK.

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

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

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

Keane C, Egan JE, Hawk M.

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

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

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

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

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

Comments: EMTs can be trained to administer naloxone.

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

Dunn KE, Barrett FS, Bigelow GE.

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

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

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

Yates D, Frey T, Montgomery JC.

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

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

Plus 6 papers on naloxone and Good Samaritan laws:

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

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

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

Comments: As title says.

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

Gertner AK, Domino ME, Davis CS.

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

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

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

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

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

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

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

Nguyen H, Parker BR.

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

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

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

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

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

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

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

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

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

Comments: See title.

And 6 papers on pharmacies and naloxone/opioids:

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

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

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

Comments:  Bigger pharmacies and chains stocked naloxone more.

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

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

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

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

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

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

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

Comments: How pharmacists can help.

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

Tewell R, Edgerton L, Kyle E.

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

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

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

Toderika Y, Williams S.

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

Comments: As above!

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

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

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

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

9 papers on fentanyl:

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

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

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

Comments: Reviewing emerging presence of fentanyl in Poland.

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

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

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

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

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

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

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

Comments: Not really, but we are desparate.

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

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

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

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

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

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

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

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

44) Efficacious Vaccine against Heroin Contaminated with Fentanyl.

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

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

Comments: Interesting idea.

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

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

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

Comments: Fentanyl deaths became predominant.

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

Dismukes LC.

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

Comments: Describes a focus on the dark net.

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

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

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

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

13 papers on medications for opioid use disorder:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ward EN, Quaye AN, Wilens TE.

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

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

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

Gust SW, McCormally J.

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

Comments: International research on OUD treatment and overdose prevention.

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

Hadland SE, Park TW, Bagley SM.

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

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

55) Buprenorphine Therapy for Opioid Use Disorder.

Zoorob R, Kowalchuk A, Mejia de Grubb M.

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

Comments: A review of above.

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

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

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

Comments: Programmatic data review.

57) Pharmacogenetics of Opioid Use Disorder Treatment.

Crist RC, Clarke TK, Berrettini WH.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

62) Substance use and homelessness among emergency department patients.

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

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

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

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

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

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

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

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

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

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

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

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

Pedigo JR, Seifert CF.

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

Comments: More opioid overdose ED visits.

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

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

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

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

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

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

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

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

7 surveillance-esque papers:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Up and up.

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

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

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

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

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

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

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

Comments: We really need a major effort on surveillance.

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

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

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

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

And lots (35) more!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Palamar JJ, Le A, Mateu-Gelabert P.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

83) Risk factors for opioid overdose among hospitalized patients.

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

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

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

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

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

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

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

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

Mars SG, Ondocsin J, Ciccarone D.

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

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

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

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

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

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

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

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

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

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

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

Castillo T.

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

Comments: What’s happening in North Carolina.

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

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

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

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

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

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

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

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

91)Addressing the growing opioid and heroin abuse epidemic: a call for medical school curricula.

Ratycz MC, Papadimos TJ, Vanderbilt AA.

Med Educ Online. 2018 Dec;23(1):1466574. doi: 10.1080/10872981.2018.1466574.

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

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

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

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

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

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

Mendoza S, Rivera AS, Hansen HB.

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

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

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

McBain R, Rose AJ, LaRochelle MR.

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

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

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

Chouinard S, Prasad A, Brown R.

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

Comments: A lot of education is needed.

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

Amjad W, Qureshi WT, Farooq AU.

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

Comments: I have no way to access.

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

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

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

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

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

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

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

Comments: Online training in naloxone is certainly sufficient.

99) America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis.

Ostling PS, Davidson KS, Anyama BO, Helander EM, Wyche MQ, Kaye AD.

Curr Pain Headache Rep. 2018 Apr 4;22(5):32. doi: 10.1007/s11916-018-0685-5. Review.

Comments: Review of issues related to opioid crisis.

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

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

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

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

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

Holloway K, Hills R, May T.

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

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

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

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

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

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

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

Peglow SL, Binswanger IA.

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

Comments: Review of overdose prevention plans.

104) Opioid use and harms associated with a sustained-release tapentadol formulation: a postmarketing study protocol.

Peacock A, Larance B, Farrell M, Cairns R, Buckley N, Degenhardt L.

BMJ Open. 2018 Mar 23;8(3):e020006. doi: 10.1136/bmjopen-2017-020006.

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

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

Madras BK.

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

Comments: As title says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Support for safer consumptions spaces in Scotland.

Onward!

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

Salerno JE, Weiss LS, Salcido DD.

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

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

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

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

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

Comments: More fentanyl around is associated with more deaths.

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

Kinsman JM, Robinson K.

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

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

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

Huhn AS, Garcia-Romeu AP, Dunn KE.

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

Comments: Online naloxone education.

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

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

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

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

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

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

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

Comments: Lots of pharmacists not aware.

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

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

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

Comments: Yes.

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

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

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

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

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

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

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

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

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

Perlman DC, Jordan AE.

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

Comments: A look at the multiple issues.

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

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

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

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

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

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

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

Comments: Strong associations between opioid use and trauma history.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Public drug use.

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

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

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

Comments: Pharmacist student education on overdose and naloxone.

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

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

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

Comments: Resident education increased prescribing.

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

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

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

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

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

Nielsen S, Larney S, Farrell M.

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

Comments: Comments on intranasal naloxone.

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

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

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

Comments: Fentanyl test strips are in high demand.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments: Big reductions in crisis-driven service utilization.

27) Assessment of potential opioid toxicity and response to naloxone by rapid response teams at an urban Melbourne hospital.

Gunasekaran B, Weil J, Whelan T, Santamaria J, Boughey M.

Intern Med J. 2018 Feb;48(2):198-200. doi: 10.1111/imj.13692.

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

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

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

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

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

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

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

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

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

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

Moses TEH, Lundahl LH, Greenwald MK.

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

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

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

Toderika Y, Williams S.

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

Comments: Pharmacists’ role.

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

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

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

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

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

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

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

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

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

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

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

Comments: We still have a lot to learn.

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

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

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

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

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

Wakeman SE.

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

Comments: No different from other healthcare.

1) Using Group Visits to Provide Overdose Education and Distribute Naloxone to High-Risk Primary Care Patients.

Bair MJ.

Pain Med. 2017 Nov 1. doi: 10.1093/pm/pnx279. [Epub ahead of print] No abstract available.

Comment: Described in the title, this is a commentary on a quasi-experimental study in Veterans’ Administration clinics.

2) Group Visits for Overdose Education and Naloxone Distribution in Primary Care: A Pilot Quality Improvement Initiative.

Spelman JF, Peglow S, Schwartz AR, Burgo-Black L, McNamara K, Becker WC.

Pain Med. 2017 Oct 16. doi: 10.1093/pm/pnx243. [Epub ahead of print]

Comment: The paper discussed in the above commentary.

3) Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France.

Roux P, Rojas Castro D, Ndiaye K, Briand Madrid L, Laporte V, Mora M, Maradan G, Morel S, Spire B, Carrieri P.

Subst Abuse Treat Prev Policy. 2017 Nov 2;12(1):46. doi: 10.1186/s13011-017-0131-4.

Comment: If oral therapy did not work, some people would accept supervised IV buprenorphine treatment.

4) Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 – 10 States, July-December 2016.

O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2017 Nov 3;66(43):1197-1202. doi: 10.15585/mmwr.mm6643e1.

Comment: >10% of deaths involved fentanyl and analogues.

5) Trends in Hospitalization for Opioid Overdose among Rural Compared to Urban Residents of the United States, 2007-2014.

Mosher H, Zhou Y, Thurman AL, Sarrazin MV, Ohl ME.

J Hosp Med. 2017 Nov;12(11):925-929. doi: 10.12788/jhm.2793.

Comment: Can’t access full article, but this seems to compare overdose hospitalizations between urban and rural sites and urban and rural residents.

6) Is systematic training in opioid overdose prevention effective?

Espelt A, Bosque-Prous M, Folch C, Sarasa-Renedo A, Majó X, Casabona J, Brugal MT; REDAN Group.

PLoS One. 2017 Oct 31;12(10):e0186833. doi: 10.1371/journal.pone.0186833. eCollection 2017.

Comment: Yes. Improved knowledge and a possible slight decline in regional fatal overdoses.

7) Heroin Contaminated with Fentanyl Dramatically Enhances Brain Hypoxia and Induces Brain Hypothermia.

Solis E Jr, Cameron-Burr KT, Kiyatkin EA.

eNeuro. 2017 Oct 30;4(5). pii: ENEURO.0323-17.2017. doi: 10.1523/ENEURO.0323-17.2017. eCollection 2017 Sep-Oct.

Comment: As the title says.

8) A Survey of Prescribers’ Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program.

Peckham AM, Niculete ME, Steinberg H, Boggs DL.

J Public Health Manag Pract. 2017 Oct 27. doi: 10.1097/PHH.0000000000000668. [Epub ahead of print]

Comment: Providers still need individualized training for this.

9) Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review.

Lewis CR, Vo HT, Fishman M.

Subst Abuse Rehabil. 2017 Oct 11;8:79-95. doi: 10.2147/SAR.S101700. eCollection 2017. Review.

Comment: Progress has been made but we have a long way to go.

10) Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial.

Coffin PO, Santos GM, Matheson T, Behar E, Rowe C, Rubin T, Silvis J, Vittinghoff E.

PLoS One. 2017 Oct 19;12(10):e0183354. doi: 10.1371/journal.pone.0183354. eCollection 2017.

Comment: Talking about overdose regularly can reduce overdose events…

11) Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas – United States.

Mack KA, Jones CM, Ballesteros MF.

MMWR Surveill Summ. 2017 Oct 20;66(19):1-12. doi: 10.15585/mmwr.ss6619a1.

Comment: Not as simple as we’ve been told.

12) The US Opioid Crisis: Current Federal and State Legal Issues.

Soelberg CD, Brown RE Jr, Du Vivier D, Meyer JE, Ramachandran BK.

Anesth Analg. 2017 Nov;125(5):1675-1681. doi: 10.1213/ANE.0000000000002403. Review.

Comment: Legal and policy approaches.

13) Increasing availability of illicit and prescription opioids among people who inject drugs in a Canadian setting, 2010-2014.

Ho J, DeBeck K, Milloy MJ, Dong H, Wood E, Kerr T, Hayashi K.

Am J Drug Alcohol Abuse. 2017 Oct 19:1-10. doi: 10.1080/00952990.2017.1376678. [Epub ahead of print]

Comment: As title says, and in some contrast to the U.S. experience in which prescription opioid availability began to decline after 2010.

14) Imaging Sex Differences in Regional Brain Metabolism during Acute Opioid Withdrawal.

Santoro GC, Carrion J, Dewey SL.

J Alcohol Drug Depend. 2017 Apr;5(2). pii: 262. doi: 10.4172/2329-6488.1000262. Epub 2017 Apr 6.

Comment: Differences between men and women may help to explain different responsiveness to opioid use disorder treatment.

15) Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”.

Salama A, Levin Y, Jha P, Alweis R.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):222-226. doi: 10.1080/20009666.2017.1351290. eCollection 2017 Oct.

Comment: Yikes.

16) Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU.

Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, Jean E.

J Community Hosp Intern Med Perspect. 2017 Sep 19;7(4):202-207. doi: 10.1080/20009666.2017.1356189. eCollection 2017 Oct.

Comment: This was a study of ICU admissions for acute drug poisoning in a single facility in NYC over 6 months from late 2015 to early 2016. The 65 patients accounted for 19% of all ICU admissions during the period; 8 signed out AMA while in the ICU and 5 patients died. The most common drugs positive on serumor urine testing were alcohol (35%), opioids (33%), cocaine (24%), methadone (22%), benzodiazepines (18%), and marijuana (16%). Among the 35% with negative screens, causes of the admission including tylenol, ethylene gycol, isopropyl alcohol, bleach, NSAIDS, and antidepressants. Mean cost of ICU care was $16k.

I don’t see a report on length of stay or on disposition (i.e. did they go home, to skilled nursing, were they vegetative, etc.).

17) Naloxone Counseling for Harm Reduction and Patient Engagement.

Han JK, Hill LG, Koenig ME, Das N.

Fam Med. 2017 Oct;49(9):730-733.

Comment: Family health providers providing naloxone kits.

18) National trends and outcomes of cardiac arrest in opioid overdose.

Sakhuja A, Sztajnkrycer M, Vallabhajosyula S, Cheungpasitporn W, Patch R 3rd, Jentzer J.

Resuscitation. 2017 Oct 14;121:84-89. doi: 10.1016/j.resuscitation.2017.10.010. [Epub ahead of print]

Comment: Interesting. Mortality in the hospital for drug poisoning 1.5%: heroin overdose 4.4% (61.8% if arrived in cardiac arrest), prescription opioid overdose 2.3% (58.3% for cardiac arrest), non-opioid 1.2% (54.7% for cardiac arrest). Authors report increasing rate of cardiac arrest presentations for heroin overdose from 2000-2013, and most presentations are for prescription opioids. Trying to tease this apart is a bit tricky. Does this mean heroin overdoses are getting more dangerous? If the data went to 2015 or 2016 the answer would likely be yes, due to fentanyl, but earlier years didn’t see much of that so I don’t think this is explained by fentanyl. Were more heroin overdoses being managed in the field, either by lay persons or paramedics with more lenient transport policies, and thus not presenting to the hospital unless they had serious complications?

19) Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature.

Butler DC, Shanks K, Behonick GS, Smith D, Presnell SE, Tormos LM.

J Anal Toxicol. 2017 Sep 28:1-6. doi: 10.1093/jat/bkx083. [Epub ahead of print]

Comment: Hard to detect.

20) Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists.

Knipper E, Banta-Green CJ, Jimenez N.

Paediatr Anaesth. 2017 Nov;27(11):1070-1076. doi: 10.1111/pan.13225. Review.

Comment: Discussion of disordered opioid use by pediatric patients.

21) Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses.

Larance B, Degenhardt L, Peacock A, Gisev N, Mattick R, Colledge S, Campbell G.

Drug Alcohol Rev. 2017 Oct 12. doi: 10.1111/dar.12617. [Epub ahead of print]

Comment: Not much harm yet and interest in developing policies and practices to prevent them.

22) Basic and Advanced EMS Providers Are Equally Effective in Naloxone Administration for Opioid Overdose in Northern New England.

Gulec N, Lahey J, Suozzi JC, Sholl M, MacLean CD, Wolfson DL.

Prehosp Emerg Care. 2017 Oct 12:1-7. doi: 10.1080/10903127.2017.1371262. [Epub ahead of print]

Comment: It’s a remarkably safe and straightforward drug.

23) Use of on-site detoxification services co-located with a supervised injection facility.

Gaddis A, Kennedy MC, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T.

J Subst Abuse Treat. 2017 Nov;82:1-6. doi: 10.1016/j.jsat.2017.08.003. Epub 2017 Aug 8.

Comment: Insite has a detox service. 11% of Insite attendees utilized it in a 2 year period. A recent overdose roughly doubled the chances that a participant would access the service (adjusted odds ratio 1.90).

24) Acute eosinophilic pneumonia secondary to heroin inhalation.

Eyüpoğlu D, Ortaç Ersoy E, Rollas K, Topeli A.

Tuberk Toraks. 2017 Jun;65(2):154-156. doi: 10.5578/tt.10438.

Comment: Treated with steroids.

25) Patterns of substance use and mortality risk in a cohort of “hard-to-reach” polysubstance users.

Gjersing L, Bretteville-Jensen AL.

Addiction. 2017 Oct 7. doi: 10.1111/add.14053. [Epub ahead of print]

Comment: 6% reported an overdose in the preceding 30 days. Crude mortality was 2.52/100py, 57% of which was due to overdose. A past-four week overdose quadrupled the risk of death and agonist treatment halved mortality. Using a latent class analysis among those not in agonist treatment, polysubstance injectors and somewhat frequent injectors were the most likely to die.

26) Combatting the opioid epidemic: Baltimore’s experience and lessons learned.

Wen LS, Warren KE.

J Public Health (Oxf). 2017 Jul 19:1-5. doi: 10.1093/pubmed/fdx093. [Epub ahead of print]

Comment: Summary of actions in Baltimore

27) Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers.

Dahlem CHG, King L, Anderson G, Marr A, Waddell JE, Scalera M.

Public Health Nurs. 2017 Oct 6. doi: 10.1111/phn.12365. [Epub ahead of print]

Comment: Description of naloxone use by law enforcement.

28) Opioid crisis at the Jersey Shore-special report.

Dudley LS, Konomos D, Robbins V, Qiu L, Bauter R, Merlin MA.

J Public Health (Oxf). 2017 Aug 31:1-6. doi: 10.1093/pubmed/fdx106. [Epub ahead of print]

Comment: Jersey Shore overdoses seen by advanced EMS. 312 cases. 212 got first naloxone by lay person, police, or other BLS provider. Of those 5.2% died. Of those who got first naloxone dose by paramedics, 19.3% died.

29) A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose.

Griswold MK, Chai PR, Krotulski AJ, Friscia M, Chapman BP, Varma N, Boyer EW, Logan BK, Babu KM.

J Med Toxicol. 2017 Oct 2. doi: 10.1007/s13181-017-0632-6. [Epub ahead of print]

Comment: Oral fluid testing.

30) The Opioid Epidemic: Crisis and Solutions.

Skolnick P.

Annu Rev Pharmacol Toxicol. 2017 Oct 2. doi: 10.1146/annurev-pharmtox-010617-052534. [Epub ahead of print]

Comment: Discussion of need for alternative pharmacotherapies for pain.

31) Take-home naloxone provision cuts opioid overdose deaths.

Thompson J.

Practitioner. 2016 Nov;260(1798):7. No abstract available.

Comment: Letter. Can’t access.

32) Fentanyl and the Evolving Opioid Epidemic: What Strategies Should Policy Makers Consider?

Barry CL.

Psychiatr Serv. 2017 Oct 2:appips201700235. doi: 10.1176/appi.ps.201700235. [Epub ahead of print]

Comment: Several harm reduction approaches discussed.

33) Who is Overdosing? An Updated Picture of Overdose Deaths From 2008 to 2015.

Eigner G, Henriksen B, Huynh P, Murphy D, Brubaker C, Sanders J, McMahan D.

Health Serv Res Manag Epidemiol. 2017 Sep 8;4:2333392817727424. doi: 10.1177/2333392817727424. eCollection 2017 Jan-Dec.

Comment: Opioid deaths in Allen County, Indiana.

34) Heroin-Related Compartment Syndrome: An Increasing Problem for Acute Care Surgeons.

Benns M, Miller K, Harbrecht B, Bozeman M, Nash N.

Am Surg. 2017 Sep 1;83(9):962-965.

Comment: Unable to access, but I assume this is in Kentucky. Heroin is now the second most common etiology for compartment syndrome. Compartment syndrome is basically when there is so much swelling in a part of the body that blood can no longer flow to that region.

35) Concurrent Use of Opioids and Benzodiazepines: Evaluation of Prescription Drug Monitoring by a United States Laboratory.

McClure FL, Niles JK, Kaufman HW, Gudin J.

J Addict Med. 2017 Sep 28. doi: 10.1097/ADM.0000000000000354. [Epub ahead of print]

Comment: Among people who were prescribed either an opioid or a benzodiazepine and who were urine tox tested, 25% had the other drug class – half of those cases were not prescribed the other class of drugs. 19% of specimens testing positive for prescribed opioids also had non-prescribed benzodiazepines and 15% of specimens testing positive for prescribed benzodiazepines also had non-prescribed opioids. These data are a bit confusing as many are presented as specimen data rather than patient data; clearly a person who is tested frequently is more likely to have non-prescribed use and results would be similar within-person.

36) The Curious (Dis)Connection between the Opioid Epidemic and Crime.

Szalavitz M, Rigg KK.

Subst Use Misuse. 2017 Sep 27:1-5. doi: 10.1080/10826084.2017.1376685. [Epub ahead of print]

Comment: “That trend—towards viewing addiction as a medical, rather than a moral problem—has also been given a tremendous boost by the media focus on opioid addiction as a white problem.”

37) Community use of naloxone for opioid overdose.

Jauncey ME, Nielsen S.

Aust Prescr. 2017 Aug;40(4):137-140. doi: 10.18773/austprescr.2017.043. Epub 2017 Aug 1. Review. No abstract available.

Comment: Pharmacy review.

38) Modifiable risk factors for external cause mortality after release from prison: a nested case-control study.

Spittal MJ, Forsyth S, Borschmann R, Young JT, Kinner SA.

Epidemiol Psychiatr Sci. 2017 Sep 25:1-10. doi: 10.1017/S2045796017000506. [Epub ahead of print]

Comment: Use of opioids in the community more than doubles the risk of death on prison release.

39) Methods for delivering the UK’s multi-centre prison-based naloxone-on-release pilot randomised trial (N-ALIVE): Europe’s largest prison-based randomised controlled trial.

Meade AM, Bird SM, Strang J, Pepple T, Nichols LL, Mascarenhas M, Choo L, Parmar MKB.

Drug Alcohol Rev. 2017 Sep 21. doi: 10.1111/dar.12592. [Epub ahead of print]

Comment: Feasibility of RCT in prison.

40) Opioid Overdose Outbreak – West Virginia, August 2016.

Massey J, Kilkenny M, Batdorf S, Sanders SK, Ellison D, Halpin J, Gladden RM, Bixler D, Haddy L, Gupta R.

MMWR Morb Mortal Wkly Rep. 2017 Sep 22;66(37):975-980. doi: 10.15585/mmwr.mm6637a3.

Comment: 20 overdoses in 2 days in a town in West Virginia, lots of fentanyl products.

41) A Case of Opioid Overdose and Subsequent Death After Medically Supervised Withdrawal: The Problematic Role of Rapid Tapers for Opioid Use Disorder.

Chang DC, Klimas J, Wood E, Fairbairn N.

J Addict Med. 2017 Sep 19. doi: 10.1097/ADM.0000000000000359. [Epub ahead of print]

Comment: Are we still surprised by this? Detox is extremely dangerous.

42) Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments.

Lacroix L, Thurgur L, Orkin AM, Perry JJ, Stiell IG.

CJEM. 2017 Sep 18:1-7. doi: 10.1017/cem.2017.390. [Epub ahead of print]

Comment: 86% of ED docs were willing to prescribe naloxone. That’s substantial.

43) Advances in the delivery of buprenorphine for opioid dependence.

Rosenthal RN, Goradia VV.

Drug Des Devel Ther. 2017 Aug 28;11:2493-2505. doi: 10.2147/DDDT.S72543. eCollection 2017. Review.

Comment: Patches, injections, and implants, oh my.

44) Deaths from Opioid Overdosing: Implications of Coroners’ Inquest Reports 2008-2012 and Annual Rise in Opioid Prescription Rates: A Population-Based Cohort Study.

Shipton EE, Shipton AJ, Williman JA, Shipton EA.

Pain Ther. 2017 Sep 8. doi: 10.1007/s40122-017-0080-7. [Epub ahead of print]

Comment: A 33% increase in opioid death from 2001 to 2012 in New Zealand.

45) Treating Acute Pain in the Opiate-Dependent Patient.

Dever C.

J Trauma Nurs. 2017 Sep/Oct;24(5):292-299. doi: 10.1097/JTN.0000000000000309.

Comment: Per title, can’t access.

46) Mobile Technology to Increase HIV/HCV Testing and Overdose Prevention/Response among People Who Inject Drugs.

Aronson ID, Bennett A, Marsch LA, Bania TC.

Front Public Health. 2017 Aug 23;5:217. doi: 10.3389/fpubh.2017.00217. eCollection 2017.

Comment: Combining HIV, HCV, and overdose into a tablet.

47) Association between public injecting and drug-related harm among HIV-positive people who use injection drugs in a Canadian setting: A longitudinal analysis.

Ickowicz S, Wood E, Dong H, Nguyen P, Small W, Kerr T, Montaner JSG, Milloy MJ.

Drug Alcohol Depend. 2017 Aug 10;180:33-38. doi: 10.1016/j.drugalcdep.2017.07.016. [Epub ahead of print]

Comment: Public injecting was associated with detectable HIV viral load, incarceration, and daily injection. Overdose was more likely in bivariate but not adjusted analyses.

48) Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region – United States, 2006-2015.

O’Donnell JK, Gladden RM, Seth P.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):897-903. doi: 10.15585/mmwr.mm6634a2.

Comment: Mortality increased throughout the nation, least in the West and most in the Northeast

49) Overdose Deaths Related to Fentanyl and Its Analogs – Ohio, January-February 2017.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore IE, Harshbarger KE, Antonides HM, Carlson RR.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):904-908. doi: 10.15585/mmwr.mm6634a3.

Comment: Fentanyl and related products overtaking

50) Medication-Assisted Treatment and Opioid Use Before and After Overdose in Pennsylvania Medicaid.

Frazier W, Cochran G, Lo-Ciganic WH, Gellad WF, Gordon AJ, Chang CH, Donohue JM.

JAMA. 2017 Aug 22;318(8):750-752. doi: 10.1001/jama.2017.7818. No abstract available.

Comment: Slight increase in pharmacotherapy for opioid use disorder after overdose event

51) Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015.

Nolan S, Buxton J, Dobrer S, Dong H, Hayashi K, Milloy MJ, Kerr T, Montaner J, Wood E.

Public Health Rep. 2017 Sep/Oct;132(5):563-569. doi: 10.1177/0033354917717230. Epub 2017 Jul 27.

Comment: 22% of people who inject drugs had take-home naloxone.

1) Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies.

Hawk KF, Vaca FE, D’Onofrio G.

Yale J Biol Med. 2015 Sep 3;88(3):235-245. eCollection 2015 Sep. Review.

Comment: Can’t access full article. Appears to be a review of harm reduction strategies for opioid overdose prevention.

2) Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update.

Brady KT, McCauley JL, Back SE.

Am J Psychiatry. 2015 Sep 4:appiajp201515020262. [Epub ahead of print]

Comment: Appropriately draws attention to the problem now faced in the United States: we are cutting back on opioid prescribing to try to limit further opioid dependence, but effectively abandoning many of the people who are already dependent.

3) Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series.

DeVido J, Connery H, Hill KP.

J Opioid Manag. 2015 Jul-Aug;11(4):363-6. doi: 10.5055/jom.2015.0285.

Comment: Two case reports of sleep-disordered breathing among buprenorphine patients suggesting that buprenorphine may contribute to sleep apnea.

4) Buprenorphine infrequently found in fatal overdose in New York City.

Paone D, Tuazon E, Stajic M, Sampson B, Allen B, Mantha S, Kunins H.

Drug Alcohol Depend. 2015 Aug 15. pii: S0376-8716(15)01598-7. doi: 10.1016/j.drugalcdep.2015.08.007. [Epub ahead of print]

Comment: Actually, none of the decedents tested positive for buprenorphine – very few (2) were found to have positive toxicology for norbuprenorphine, a metabolite demonstrating recent – but not recent enough to be causal – consumption of buprenorphine. This is not surprising since it’s tough to overdose on buprenorphine. Nice work.

5) Risk Factors for Mortality and Endotracheal Intubation after Methadone Intoxication.

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

Basic Clin Pharmacol Toxicol. 2015 Aug 24. doi: 10.1111/bcpt.12476. [Epub ahead of print]

Comment: Lower consciousness/respirations once in the emergency room were associated with increased likelihood of being intubated and/or dying from methadone overdose. This is interesting in the context of previous papers included on this blog that demonstrate lower likelihood of such outcomes when naloxone is administered in the field. Is it time to think of naloxone as an automated electronic defibrillator?

6) The characteristics of a cohort who tamper with prescribed and diverted opioid medications.

Larance B, Lintzeris N, Bruno R, Peacock A, Cama E, Ali R, Kihas I, Hordern A, White N, Degenhardt L.

J Subst Abuse Treat. 2015 Jun 24. pii: S0740-5472(15)00137-3. doi: 10.1016/j.jsat.2015.06.001. [Epub ahead of print]

Comment: This is a complex population. Although risk outcomes appear closer to those of someone who uses heroin than those of someone prescribed opioids, the clinical characteristics overlap substantially with the latter group.

7) Capsule Commentary on Binswanger et al., Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff.

Jackson JL.

J Gen Intern Med. 2015 Aug 19. [Epub ahead of print] No abstract available.

Comment: Summarizes the Bingswanger paper and that’s about it.

8) Factors associated with illicit methadone injecting in a Canadian setting.

Tucker D, Milloy MJ, Hayashi K, Nguyen P, Kerr T, Wood E.

Am J Addict. 2015 Sep;24(6):532-7. doi: 10.1111/ajad.12257. Epub 2015 Aug 18.

Comment: Really high-risk people inject methadone.

9) Gender differences in mortality among treated opioid dependent patients.

Evans E, Kelleghan A, Li L, Min J, Huang D, Urada D, Hser YI, Nosyk B.

Drug Alcohol Depend. 2015 Jul 17. pii: S0376-8716(15)00381-6. doi: 10.1016/j.drugalcdep.2015.07.010. [Epub ahead of print]

Comment: Some findings from a longitudinal study that I find hard to interpret and potentially specious.

10) Clinical and Forensic Diagnosis of Very Recent Heroin Intake by 6-acetylmorphine Immunoassay Test and LC-MS/MS Analysis in Urine and Blood.

Borriello R, Carfora A, Cassandro P, Petrella R.

Ann Clin Lab Sci. 2015 Jul;45(4):414-8.

Comment: The 6-MAM assay is pretty good.

11) Intravenous Heroin-Associated Delayed Spongiform Leukoencephalopathy: Case Report and Reviews of the Literature.

Pirompanich P, Chankrachang S.

J Med Assoc Thai. 2015 Jul;98(7):703-8.

Comment: We’ve reviewed heroin-associated spongiform leukoencephalopathy before on this blog. This is another case identified in a heroin injector – instead of smoker – and review of the literature. Interestingly, this case was identified after an overdose.

12) Intermittent versus Persistent Wolff-Parkinson-White Syndrome in Children: Electrophysiologic Properties and Clinical Outcomes.

Kiger ME, McCanta AC, Tong S, Schaffer M, Runciman M, Collins KK.

Pacing Clin Electrophysiol. 2015 Aug 8. doi: 10.1111/pace.12732. [Epub ahead of print]

Comment: There are some questions about the role of cardiac disease on overdose risk – this is pretty clearly the case for cocaine but not well understood for opioids. This report on WPW patients (WPW is an electrical conduction disease of the heart that affects repolarization of cardiac tissue and can result in potentially fatal arrhythmias in otherwise healthy people) refers briefly to a WPW patient who had to be resuscitated after methadone overdose. No further details unfortunately.

13) Orienting patients to greater opioid safety: models of community pharmacy-basednaloxone.

Green TC, Dauria EF, Bratberg J, Davis CS, Walley AY.

Harm Reduct J. 2015 Aug 6;12:25. doi: 10.1186/s12954-015-0058-x.

Comment: Two models of pharmacy provision of naloxone. Exciting work in New England.

14) Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers.

LaBelle CT, Han SC, Bergeron A, Samet JH.

J Subst Abuse Treat. 2015 Jun 26. pii: S0740-5472(15)00146-4. doi: 10.1016/j.jsat.2015.06.010. [Epub ahead of print]

Comment: Describes an effort to expand buprenorphine treatment availability in Massachusetts.

15) Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011.

Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S.

Arch Iran Med. 2014 Aug;17(8):534-8. doi: 014178/AIM.003.

Comment: Interesting that pesticides match opioids as the two leading causes of poisoning death.

16) DOH issues emergency regulations on expanding use of Narcan to prevent opioidoverdose deaths.

R I Med J (2013). 2014 Apr;97(4):49. No abstract available.

Comment: We should exercise caution in our use of the term “Narcan” in the future as the brand was purchased by the manufacturers of a nasal device that is likely to be approved in the near future. Promoting one brand over another is poor form in public health and academic venues.

1. Patterns and correlates of non-fatal heroin overdose at 11-year follow-up: Findings from the Australian Treatment Outcome Study.

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

Drug Alcohol Depend. 2014 Sep 16. [Epub ahead of print]

Comment: This study (the ATOS) and the team of investigators have produced some of the most powerful and useful data in substance use research. Once again they have delved into heroin overdose by following treatment patients 11 years out. At least 10.2% of the cohort had died by that time and an additional 9.4% were unaccounted for. Among the 70.1% interviewed, 67.5% had overdosed, 24.4% had experienced five or more overdoses (again suggesting that there are “overdosers” out there who are at very elevated risk of the event). In the past year before the follow-up visit, 4.9% had overdosed (11.8% of those who had used heroin in that period), 95.2% of whom had overdosed previously. Those who overdosed were more likely to report higher levels of non-heroin opiate use, as well as benzodiazepine, cocaine, and methamphetamine use.

2. A new naloxone auto-injection device to treat opioid overdose.

Simonson W.

Geriatr Nurs. 2014 Sep-Oct;35(5):381-2.

Comment: A review of the role of take-home naloxone in the form of the new autoinjector.

3. Increases in heroin overdose deaths – 28 States, 2010 to 2012.

Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A, Gabella B, Hume B, Huntamer T, Kariisa M, Largo TW, Miles J, Newmyer A, Nitcheva D, Perez BE, Proescholdbell SK, Sabel JC, Skiba J, Slavova S, Stone K, Tharp JM, Wendling T, Wright D, Zehner AM.

MMWR Morb Mortal Wkly Rep. 2014 Oct 3;63(39):849-54.

Comment: This report demonstrates declining prescription opioid deaths (-6.6%), but heroin deaths increased so much (+101.7%) that the data actually demonstrate an overall increase in opioid overdose mortality from 2010 to 2012 (+4.3%). There is disagreement as to what is driving the increase in heroin use and overdose. Is it an inevitable consequence of increased availability of opioids? Or is it the result of growing restrictions on access to those opioids? Clearly there are elements of both, leaving us with conflicting duties when it comes to managing those already reliant upon prescription opioids. Western medical ethics is clear on this point: our patient is the person we treat, who may have been harmed by the very same prescribing behavior we are now trying to change and who may be further harmed by those changes. If we truly believe that this epidemic is “iatrogenic” (i.e. caused by medical care, akin to a surgeon leaving scissors in an abdomen), then we have to be extremely cautious and thoughtful in fixing the problem and we can never abandon the patient.

4. Working together: Expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond.

Lenton S, Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C.

Drug Alcohol Rev. 2014 Oct 1. doi: 10.1111/dar.12198. [Epub ahead of print]

Comment: It’s taken an incredibly long time for take-home naloxone to reach Australia, especially given how innovative that country has been with respect to managing drug policy and overdose.

5. Responding to opioid overdose in Rhode Island: where the medical community has gone and where we need to go.

Green TC, Bratberg J, Dauria EF, Rich JD.

R I Med J (2013). 2014 Oct 1;97(10):29-33.

Comment: The first of three articles in this post from Rhode Island, US, which has been facing a surge in opioid overdose deaths and has been responding with expanded naloxone treatment availability. This and the next two articles are free at:http://rimed.org/rimedicaljournal-2014-10.asp.

6. Emergency department naloxone distribution: a rhode island department of health, recovery community, and emergency department partnership to reduce opioid overdosedeaths.

Samuels E.

R I Med J (2013). 2014 Oct 1;97(10):38-9.

Comment: A brief summary of an ED-based naloxone prescription program in Rhode Island, US. I like the emerging use of the term “naloxone rescue kit.”

7. The rhode island community responds to opioid overdose deaths.

Bowman S, Engelman A, Koziol J, Mahoney L, Maxwell C, McKenzie M.

R I Med J (2013). 2014 Oct 1;97(10):34-7.

Comment: A third article on the response in Rhode Island.

8. Emergency hospitalizations for unsupervised prescription medication ingestions by young children.

Lovegrove MC, Mathew J, Hampp C, Governale L, Wysowski DK, Budnitz DS.

Pediatrics. 2014 Oct;134(4):e1009-16. doi: 10.1542/peds.2014-0840. Epub 2014 Sep 15.

Comment: From 2007-2011 in the US, there were 9,490 hospitalizations among children <6 years of age, 17.6% of which involved opioids. Interestingly, buprenorphine was the most frequent opioid. There are some limitations to this study, including the absence of non-oral ingestions and the lack of narrative detail for the cases.

9. Emergency Medical Services NaloxoneAccess: A National Systematic Legal Review.

Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW.

Acad Emerg Med. 2014 Oct;21(10):1173-1177.

Comment: Most states don’t allow basic life support-trained emergency medical responders to administer naloxone.

10. Supply of buprenorphine waivered physicians: The influence of state policies.

Stein BD, Gordon AJ, Dick AW, Burns RM, Pacula RL, Farmer CM, Leslie DL, Sorbero M.

J Subst Abuse Treat. 2014 Aug 2.

Comment: 43% of US counties have no buprenorphine treatment providers. Hello?

11. Fatal Methadone Toxicity: Potential Role of CYP3A4 Genetic Polymorphism.

Richards-Waugh LL, Primerano DA, Dementieva Y, Kraner JC, Rankin GO.

J Anal Toxicol. 2014 Oct;38(8):541-7.

Comment: There’s much to be learned about risks for opioid overdose mortality. This study evaluated the role of CYP450 isoform known as CYP3A4, involved in hepatic metabolism. Some people are slow metabolizers – single nucleotide polymorphisms (aka common “mutations”) rs2242480 and rs2740574 were more common in methadone-only deaths but not in methadone+benzodiazepine deaths, suggesting that these genetic variations may play a role in overdose risk.

12. Prescription histories and dose strengths associated with overdose deaths.

Hirsch A, Proescholdbell SK, Bronson W, Dasgupta N.

Pain Med. 2014 Jul;15(7):1187-95.

Comment: The majority of prescription opioid overdose decedents had filled a prescription for that opioid within 60 days of their death. This has to be an argument for co-prescribing naloxone.

13. Patterns of DrugUse, Risky Behavior, and Health Status Among Persons Who Inject Drugs Living in San Diego, California: A Latent Class Analysis.

Roth AM, Armenta RA, Wagner KD, Roesch SC, Bluthenthal RN, Cuevas-Mota J, Garfein RS.

Subst Use Misuse. 2014 Oct 14. [Epub ahead of print]

Comment: Opioid overdose and HCV appear to be associated in this analysis. This is an interesting area of work. We are quickly learning that people who witness overdoses – and thus people most likely to use naloxone to reverse an overdose – are very high risk persons themselves. This makes logical sense but can make interpreting risk data among naloxone recipients quite challenging.

14. Prognostic factors in acute methadone toxicity: a 5-year study.

Aghabiklooei A, Edalatparvar M, Zamani N, Mostafazadeh B.

J Toxicol. 2014;2014:341826. doi: 10.1155/2014/341826. Epub 2014 Aug 12.

Comment: Fascinating study out of Iran. Methadone overdose cases ultimately died from renal failure related to rhabdomyolysis. This likely means that overdose cases were “down” for a while, where the pressure of their bodies on the ground/floor resulted in muscle breakdown, causing release of muscle metabolites that damaged the kidneys. Although they were revived (at least somewhat), the kidney damage from that downtime was ultimately fatal.

15. A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Larney S, Gowing L, Mattick RP, Farrell M, Hall W, Degenhardt L.

Drug Alcohol Rev. 2014 Mar;33(2):115-28. doi: 10.1111/dar.12095. Epub 2013 Dec 3. Review.

Comment: Authors contend that long-acting naltrexone formulations for opioid dependence should be limited to clinical trials only. The depot injection of naltrexone was approved in the US for this indication in 2012 based on a study conducted in Russia. While oral naltrexone clearly should not be used for opioid dependence – as there is a very high overdose death rate after discontinuation of treatment – the long-acting formulations may overcome that by allowing for a slower “tapering” off of the medication when treatment is discontinued. There are several studies in process or planning in the US which should provide more useful data to guide us on the safety of this therapy.

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

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

BMC Fam Pract. 2014 Jan 15;15:12. doi: 10.1186/1471-2296-15-12.

Comment: A survey of primary care providers in Scotland (with a fairly low response rate of 55% that biases the results) found limited awareness of the concept of prescribing naloxone.

17. A quantitative and qualitative evaluation of the British Columbia Take Home Naloxoneprogram.

Oluwajenyo Banjo MPHc, Tzemis D, Al-Qutub D, Amlani A, Kesselring S, Buxton JA.

CMAJ Open. 2014 Jul 22;2(3):E153-61. doi: 10.9778/cmajo.20140008. eCollection 2014 Jul.

Comment: In the first 20 months, take-home naloxone in British Columbia opened in 40 sites, trained 1,318 participants, distributed 836 kits and reported 85 reversed overdose events. They ran into issues with finding providers willing to prescribe, recruiting some high-risk populations (like pain patients), and getting convincing participants it was safe to call emergency medical services.

18. Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons.

Weisberg DF, Becker WC, Fiellin DA, Stannard C.

Int J Drug Policy. 2014 Jul 30.

Comment: An interesting comparison of the US and UK in opioid prescribing and the risks for resultant opioid use disorder and overdose epidemics. Authors suggest that limited use of benzodiazepines and ready access to methadone may be helping to buffer the UK from the effects of opioid prescribing seen in the US.

19. Characteristics of mexican and mexican american adolescents in treatment for “cheese” heroin use.

Walker R, Maxwell JC, Adinoff B, Carmody T, Coton CE, Tirado CF.

J Ethn Subst Abuse. 2014;13(3):258-72. doi: 10.1080/15332640.2014.883582.

Comment: 74% of Hispanic adolescents in treatment for “cheese heroin” dependence reported a prior overdose (70% of females, 80% of males).

20. Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services.

Klimas J, O’Reilly M, Egan M, Tobin H, Bury G.

Am J Emerg Med. 2014 Jul 31.

Comment: Ambulances in Dublin Ireland attended 469 opioid overdoses, 2.8% of which were fatal and 26% of which were among persons who had been attended to for at least one prior overdose. These are useful data for understanding the epidemiology of EMS-attended overdose cases.

21 and 22. Pitfalls of intranasal naloxone

Zuckerman M, Weisberg SN, Boyer EW.

Prehosp Emerg Care. 2014 Oct-Dec;18(4):550-4

Intranasal Naloxone for Opioid Overdose Reversal.

Davis CS, Banta-Green CJ, Coffin P, Dailey MW, Walley AY.

Prehosp Emerg Care. 2014 Aug 25. [Epub ahead of print].

Comment: The lead article is a case report of an overdose that didn’t respond to initial paramedic-administered intranasal naloxone and an unrelated opinion piece critiquing both intranasal and take-home naloxone. There are randomized trials of intranasal naloxone and high-quality observational studies of take-home naloxone that are useful in this discussion – this article constitutes neither. The response letter pointing out these and other concerns has an entire page of disclosures because the lead article authors and journal editor determined that federal research funding is a conflict of interest. The disclosures are worth a read.

23. High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users.

Frank D, Mateu-Gelabert P, Guarino H, Bennett A, Wendel T, Jessell L, Teper A.

Int J Drug Policy. 2014 Jul 31.

Comment: Qualitative interviews among young prescription opioid users in New York City identified substantial experiences with personal and witnessed overdose and little to no connection with the networks and services that provide overdose prevention services.

24. Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden.

Richert T.

Int J Drug Policy. 2014 Jul 21.

Comment: Qualitative interviews with heroin users in Sweden identifies concerns with responding to overdose (in a setting without naloxone access) including police harassment and not wanting to disturb a high.

25. Quality Assessment of Acute Inpatient Pain Management in an Academic Health Center.

Lin RJ, Reid MC, Chused AE, Evans AT.

Am J Hosp Palliat Care. 2014 Aug 8. pii: 1049909114546545. [Epub ahead of print]

Comment: Authors reviewed pain management in a New York City hospital. Over 6 months, they found 5 cases of naloxone administration for an in-hospital opioid overdose related to prescribed opioids.

26. Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data.

Seaman EL, Levy MJ, Lee Jenkins J, Godar CC, Seaman KG.

Prehosp Disaster Med. 2014 Aug 4:1-5. [Epub ahead of print]

Comment: Younger adolescents use prescription drugs, older adolescents use illicit drugs.

27. Time for universal provision of take-home naloxone.

Crocker-Buque T, Lovitt C.

Lancet. 2014 Jul 26;384(9940):308. doi: 10.1016/S0140-6736(14)61240-X. No abstract available.

Comment: A letter calling for lay naloxone in the UK.

28. Naloxone auto-injector gains FDA approval.

Knopf A.

Behav Healthc. 2014 May-Jun;34(3):48-9. No abstract available.

Comment: Unable to access.

29. A multifactorial intervention for hospital opioid management.

Akce M, Suneja A, Genord C, Singal B, Hopper JA.

J Opioid Manag. 2014 Sep-Oct;10(5):337-44. doi: 10.5055/jom.2014.0223.

Comment: Can’t access full article. An educational intervention among hospital residents had no impact on pain. Naloxone use was an outcome but is not reported in the abstract.

30. Swift recovery of severe acute hypoxemic respiratory failure under non-invasive ventilation.

Pichot C, Petitjeans F, Ghignone M, Quintin L.

Anaesthesiol Intensive Ther. 2014 Oct 27. doi: 10.5603/AIT.a2014.0053. [Epub ahead of print]

Comment: Interesting successful case report of non-invasive ventilation in an opioid overdose with severe respiratory failure.

31. Safety studies of post-surgical buprenorphinetherapy for mice.

Traul KA, Romero JB, Brayton C, DeTolla L, Forbes-McBean N, Halquist MS, Karnes HT, Sarabia-Estrada R, Tomlinson MJ, Tyler BM, Ye X, Zadnik P, Guarnieri M.

Lab Anim. 2014 Oct 10. pii: 0023677214554216. [Epub ahead of print]

Comment: Can’t access full article. The abstract is confusing to me, but it appears to involve efforts to improve analgesia for lab mice through use of buprenorphine. Unlike human studies, investigators here conducted intentional overdoses.

32. Body packing: a review of general background, clinical and imaging aspects.

Berger FH, Nieboer KH, Goh GS, Pinto A, Scaglione M.

Radiol Med. 2014 Oct 10. [Epub ahead of print]

Comment: Lots of badness can result from this.

1) The Whole Is Just the Sum of Its Parts: Limited Polydrug Use Among the “Big Three” Expensive Drugs in the United States.

Caulkins JP, Everingham S, Kilmer B, Midgette G.

Curr Drug Abuse Rev. 2013 Dec 5. [Epub ahead of print]

Comments: Somewhat surprising data suggesting relatively separate markets for heroin, cocaine and methamphetamine.

2) A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Larney S, Gowing L, Mattick RP, Farrell M, Hall W, Degenhardt L.

Drug Alcohol Rev. 2013 Dec 3. doi: 10.1111/dar.12095. [Epub ahead of print]

Comments: A systematic review concluding that the data for naltrexone implants for opioid dependence are insufficient for use outside of clinical trials.

3)  Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009.

Bohnert AS, Ilgen MA, Trafton JA, Kerns RD, Eisenberg A, Ganoczy D, Blow FC.

Clin J Pain. 2013 Nov 25. [Epub ahead of print]

Comments: What happened with opioid analgesic overdose deaths in the United States also happened in among veterans receiving care in the Veterans’ Administration.

4) The Dueling Obligations of Opioid Stewardship.

Coffin P, Banta-Green C.

Ann Intern Med. 2013 Dec 10. doi: 10.7326/M13-2781. [Epub ahead of print] No abstract available.

Comments: Commentary on the reliance on opioids and minimizing the potential harms of stewardship efforts.

5) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2013 Nov 25. [Epub ahead of print] No abstract available.

Comments: This is really a news report in CMAJ about Canada’s BC naloxone program.

6) Preventing deaths from rising opioid overdose in the US – the promise of naloxoneantidote in community-based naloxone take-home programs.

Straus MM, Ghitza UE, Tai B.

Subst Abuse Rehabil. 2013 Sep 2;2013(4). doi: 10.2147/SAR.S47463.

Comments: Good review of major initiatives to respond to increasing rates of opioid overdose mortality in the United States, including take-back programs, prescription drug monitoring programs, and naloxone distribution.

7) Drug-induced deaths – United States, 1999-2010.

Mack KA; National Center for Injury Prevention and Control, CDC.

MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-3.

Comments: Review of drug-related deaths of the past decade.

8) From oxycodone to heroin: Two cases of transitioning opioid use in young Australians.

Dertadian GC, Maher L.

Drug Alcohol Rev. 2013 Nov 21. doi: 10.1111/dar.12093. [Epub ahead of print]

Comments: Interesting case reports of transitions from oral prescription opioid consumption to illicit opioid injection. Unable to access for details.

9) Common causes of poisoning: etiology, diagnosis and treatment.

Müller D, Desel H.

Dtsch Arztebl Int. 2013 Oct;110(41):690-9; quiz 700. doi: 10.3238/arztebl.2013.0690. Epub 2013 Oct 11.

Comments: Interesting analysis of all acute poisonings in the German poison control center over 26 years.

10) Opiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A Study on Gender Differences.

Origer A, Lopes da Costa S, Baumann M.

Eur Addict Res. 2013 Oct 31;20(2):87-93. [Epub ahead of print]

Comments: Interesting gender-based analysis suggesting that women may be at higher risk earlier in their drug use careers.

11) Safe methadone induction and stabilization: report of an expert panel.

Baxter LE Sr, Campbell A, Deshields M, Levounis P, Martin JA, McNicholas L, Payte JT, Salsitz EA, Taylor T, Wilford BB.

J Addict Med. 2013 Nov-Dec;7(6):377-86. doi: 10.1097/01.ADM.0000435321.39251.d7.

Comments: Guidelines addressing methadone starting dose, dose escalation, and concomitant medications/drugs.

12) 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.

Comments: No overdoses.

13) [Distribution of naloxone to prevent death from heroin overdose. Study of opioid dependent patients’ attitudes to be part of the antidote program].

Håkansson A, Vedin A, Wallin C, Kral AH.

Lakartidningen. 2013 Jul 17-Aug 6;110(29-31):1340-2. Swedish. No abstract available.

Comments: Unable to access, but it would be fascinating to see the Swedish response to lay naloxone.

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

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

Clin Toxicol (Phila). 2013 Sep-Oct;51(8):777-82. doi: 10.3109/15563650.2013.830732. Epub 2013 Aug 23.

Comments:

15) Project Lazarus: an innovative community response to prescription drug overdose.

Brason FW 2nd, Roe C, Dasgupta N.

N C Med J. 2013 May-Jun;74(3):259-61. No abstract available.

Comments: Unable to access.

16) Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.

Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM.

Can J Public Health. 2013 Apr 18;104(3):e200-4.

Comments: Report from the first 8 months of naloxone trainings in Toronto!

17) The pathogenetic role of adulterants in 5 cases of drug addicts with a fatal outcome.

Barbera N, Busardò FP, Indorato F, Romano G.

Forensic Sci Int. 2013 Apr 10;227(1-3):74-6. doi: 10.1016/j.forsciint.2012.08.041. Epub 2012 Sep 20.

Comments: Fascinating paper on the role of dextromethorphan, built upon evidence that dextromethorphan – an NMDA-recepter antagonist – decreases the expiratory phase of respiration and magnifies the respiratory depression induced by morphine. While adulterants may be more important than we’ve previously realized, how does one translate that to overdose prevention in the field?

18) Deadly heroin or the death of heroin – overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Horvath M, Dunay G, Csonka R, Keller E.

Neuropsychopharmacol Hung. 2013 Dec;15(4):253-9.

Comments: Very exciting to see a review of drug overdose deaths in Budapest, Hungary. The number of deaths is remarkably low, with just 464 deaths in 18 years (299 opioid-related). Surprisingly 58% of the deaths were heroin alone, a finding the authors suggest means that use patterns are distinct in Budapest.

19) [Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

Cui N, Cao XB, Wang CH, Luo W, Pang L, Rou KM, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Oct;34(10):961-3. Chinese.

Comments: Interesting analysis from China with the suggestion that adherence to methadone maintenance reduces overdose mortality.

20) Survey of naloxone legal status in opioid overdose prevention and treatment.

Hewlett L, Wermeling DP.

J Opioid Manag. 2013 Sep-Oct;9(5):369-77. doi: 10.5055/jom.2013.0179.

Comments: Review of naloxone access laws in the United States. There was so much activity in 2013, that this article is already a bit out of date!

21) Mortality among Methadone Maintenance Clients in China: A Six-Year Cohort Study.

Cao X, Wu Z, Li L, Pang L, Rou K, Wang C, Luo W, Yin W, Li J, McGoogan JM; National Methadone Maintenance Treatment Program Working Group.

PLoS One. 2013 Dec 12;8(12):e82476. doi: 10.1371/journal.pone.0082476.

Comments: Overdose was the leading cause of death among methadone patients, four times more likely among those with HIV, and longer time in methadone treatment reduced overdose mortality risk.

22) Associations among Pain, Non-Medical Prescription Opioid Use, and Drug Overdose History.

Bonar EE, Ilgen MA, Walton M, Bohnert AS.

Am J Addict. 2014 Jan;23(1):41-7. doi: 10.1111/j.1521-0391.2013.12055.x. Epub 2013 Jun 14.

Comments: Analysis among substance users at a treatment center of pain, non-medical prescription opioid use, and overdose.

23) 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: This is a fascinating analysis that I’ve been waiting to see (AJPH does tend to take a while to publish!). However, what happened in NYC with opioid overdose may or may not be reflective of what happened in other areas of the country. NYC saw a clear increase in overdose on Staten Island, among those using prescription opioids, while heroin deaths were decreasing citywide. Staten Island then had an increase in heroin deaths as many transitioned to heroin and there were no services in place to limit the harms of heroin. In other areas there is less of a clear trend.

24) 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-Dec;37(9):629-35. doi: 10.1093/jat/bkt085.

Comments: Again demonstrating the limited utility of drug concentration in opioid overdose deaths.

25) Naltrexone in the treatment of opioid-dependent pregnant women: the case for a considered and measured approach to research.

Jones HE, Chisolm MS, Jansson LM, Terplan M.

Addiction. 2013 Feb;108(2):233-47. doi: 10.1111/j.1360-0443.2012.03811.x. Epub 2012 Apr 4. Review.

Comments: The research field of obstetrics is generally way behind the rest of medicine. Because we are so concerned over the health of pregnant women and the well-being of the embryos and fetuses they carry, we tend to rely on decades of experience and new approaches progress glacially. As the authors point out, given the numerous potential downsides of naltrexone for opioid dependence, we are not near the point of recommending this therapy for pregnant women at this time – or even researching it directly.