1) High buprenorphine-related mortality is persistent in Finland.

Kriikku P, Häkkinen M, Ojanperä I.

Forensic Sci Int. 2018 Aug 17;291:76-82. doi: 10.1016/j.forsciint.2018.08.010. [Epub ahead of print]

Comments: This is an interesting topic. Finland seems to have a lot of buprenorphine injection, in the absence of much other injection opioid use. There is also high levels of alcohol and benzodiazepine use and that is the context of the deaths.

2) A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality.

Weiner SG, Price CN, Atalay AJ, Harry EM, Pabo EA, Patel R, Suzuki J, Anderson S, Ashley SW, Kachalia A.

Jt Comm J Qual Patient Saf. 2018 Aug 28. pii: S1553-7250(18)30088-6. doi: 10.1016/j.jcjq.2018.07.003. [Epub ahead of print]

Comments: Metrics of opioid prescribing declined with no change in overdose.

3) Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016-June 2017.

Mattson CL, O’Donnell J, Kariisa M, Seth P, Scholl L, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2018 Aug 31;67(34):945-951. doi: 10.15585/mmwr.mm6734a2.

Comments: This is an amazing piece that finallystarts to flesh out the basic epidemiology of overdose in the post-heroin world. Conducting enhanced surveillance of opioid overdose deaths in 11 cities, they identified 17.4% were from opioid analgesics only, 18.5% for both analgesics and illicit opioids, and 58.7% for illicit opioids only – rates varied substantially by region/state. 10% had been released from an institutional setting in the month before death (mostly hospital for prescription-only and mostly jail/prison for illicit-only, with a mix for combined deaths). There was evidence of injection in 49.2% of illicit-only deaths and 6.6% of prescription opioid-only deaths. Bystanders were present in 41.6% of prescription-only, 44.0% of illicit-only, and 45.0% of combined deaths. Naloxone was administered by 0.8%, 4.3%, and 4.4% of cases, respectively. As in prior studies, prescription-only were more likely to contain benzodiazepines whereas illicit-only deaths were more likely to have cocaine or methamphetamine, with combined deaths a blend of those two categories. Prescription-only deaths were evenly split between male and femaile, whereas other categories were nearly three-quarters male. These results are long-awaited and critical to beginning to understand fundamental elements of the evolving opioid crisis. Kudos to the CDC for this.

4) Addressing the Fentanyl Analog Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood.

Skov-Skov Bergh M, Bogen IL, Wilson SR, Øiestad ÅML.

Ther Drug Monit. 2018 Aug 27. doi: 10.1097/FTD.0000000000000564. [Epub ahead of print]

Comments: Method to look for both fentanyl/analogs and naloxone.

5) Opioid Analgesics in Georgia Medicaid: Trends in Potential Inappropriate Prescribing Practices by Demographic Characteristics, 2009-2014.

Jayawardhana J, Abraham AJ, Perri M.

J Manag Care Spec Pharm. 2018 Sep;24(9):886-894. doi: 10.18553/jmcp.2018.24.9.886.

Comments: Patients in “missing race” category are at high risk … ok that’s a strange outcome.

6) Opioid toxicity with underlying tumour lysis syndrome in a patient with CMML: a diagnostic and therapeutic challenge.

Vig S, Mishra S, Rustagi K, Bhan S.

BMJ Case Rep. 2018 Aug 27;2018. pii: bcr-2018-225646. doi: 10.1136/bcr-2018-225646.

Comments: Interesting case of opioid overdose induced by kidney failure caused by tumor lysis syndrome.

7) Identifying Missed Clinical Opportunities in Delivery of Overdose Prevention and Naloxone Prescription to Adolescents Using Opioids.

Wilson JD, Berk J, Adger H, Feldman L.

J Adolesc Health. 2018 Aug;63(2):245-248. doi: 10.1016/j.jadohealth.2018.05.011.

Comments: Pediatricians, opioids, and naloxone.

8) Government Patent Use to Address the Rising Cost of Naloxone: 28 U.S.C. § 1498 and Evzio.

Wang A, Kesselheim AS.

J Law Med Ethics. 2018 Jun;46(2):472-484. doi: 10.1177/1073110518782954.

Comments: Interesting approach to deal with out of control pharmaceutical pricing.

9) Our Ethical Obligation to Treat Opioid Use Disorder in Prisons: A Patient and Physician’s Perspective.

Bone C, Eysenbach L, Bell K, Barry DT.

J Law Med Ethics. 2018 Jun;46(2):268-271. doi: 10.1177/1073110518782933.

Comments: Yes.

10) Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths – United States, 2007-2012.

Harduar Morano L, Steege AL, Luckhaupt SE.

MMWR Morb Mortal Wkly Rep. 2018 Aug 24;67(33):925-930. doi: 10.15585/mmwr.mm6733a3.

Comments: Construction, extraction, and healthcare industries – fascinating.

11) Using Publicly Available Data to Understand the Opioid Overdose Epidemic: Geospatial Distribution of Discarded Needles in Boston, Massachusetts.

Bearnot B, Pearson JF, Rodriguez JA.

Am J Public Health. 2018 Aug 23:e1-e3. doi: 10.2105/AJPH.2018.304583. [Epub ahead of print]

Comments: These analyses are interesting and need to be carefully done.

12) Supervised Injectable Opioid Treatment for the Management of Opioid Dependence.

Bell J, Belackova V, Lintzeris N.

Drugs. 2018 Aug 21. doi: 10.1007/s40265-018-0962-y. [Epub ahead of print] Review.

Comments: Interesting review of supervised opioid injection for treatment of opioid use disorder – another intervention that is often limited by politics.

13) Naloxone distribution and possession following a large-scale naloxone program.

Madah-Amiri D, Gjersing L, Clausen T.

Addiction. 2018 Aug 20. doi: 10.1111/add.14425. [Epub ahead of print]

Comments: The longer a naloxone program is around the more likely people are to carry naloxone. Actually an interesting conclusion – as time and intensity of programming may lead to a culture of overdose prevention in a given locality.

14) Comparison between buprenorphine provider availability and opioid deaths among US counties.

Jones CW, Christman Z, Smith CM, Safferman MR, Salzman M, Baston K, Haroz R.

J Subst Abuse Treat. 2018 Oct;93:19-25. doi: 10.1016/j.jsat.2018.07.008. Epub 2018 Jul 20.

Comments: Lots of variability in access that doesn’t always correspond to need.

15) A Randomized Usability Assessment of Simulated Naloxone Administration by Community Members.

Eggleston W, Sullivan RW, Pacelli L, Podolak C, Keenan M, Wojcik S.

Addiction. 2018 Aug 14. doi: 10.1111/add.14416. [Epub ahead of print]

Comments: Study showing the obvious: lay people not comfortable with needles can more easily administer the FDA-approved nasal spray than vial and syringe intramuscular. For people who inject drugs, the less costly vial and syringe allows for far broader reach of programming.

16) The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible.

Carroll JJ, Rich JD, Green TC.

J Addict Med. 2018 Aug 7. doi: 10.1097/ADM.0000000000000436. [Epub ahead of print]

Comments: The main reasons for use are managing withdrawal and opioid use disorder. 12% of those reporting diverted buprenorphine use reported that they had used it to get high.

17) Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy.

Harrison TK, Kornfeld H, Aggarwal AK, Lembke A.

Anesthesiol Clin. 2018 Sep;36(3):345-359. doi: 10.1016/j.anclin.2018.04.002. Epub 2018 Jul 11. Review.

Comments: There are some messed up guidelines out there that suggest stopping buprenorphine when admitted / heading to surgery – this is almost always a bad idea. People do much, much better with regard to pain when kept on buprenorphine.

18) Change and variability in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993-2007.

Tempalski B, Cleland CM, Williams LD, Cooper HLF, Friedman SR.

Subst Abuse Treat Prev Policy. 2018 Aug 9;13(1):28. doi: 10.1186/s13011-018-0165-2.

Comments: Not enough.

19) On the front lines of the opioid epidemic: Rescue by naloxone.

Skolnick P.

Eur J Pharmacol. 2018 Sep 15;835:147-153. doi: 10.1016/j.ejphar.2018.08.004. Epub 2018 Aug 7.

Comments: Nasal naloxone works well at the higher concentrations.

20) Naloxone Administration Frequency During Emergency Medical Service Events – United States, 2012-2016.

Cash RE, Kinsman J, Crowe RP, Rivard MK, Faul M, Panchal AR.

MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):850-853. doi: 10.15585/mmwr.mm6731a2.

Comments: Exciting to see the work coming out of the expanded surveillance and research efforts.

21) 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.

Comments: Protocol for study exploring adverse outcomes during and after methadone and buprenorphine treatment.

22) The impact of medically supervised injection centres on drug-related harms: A meta-analysis.

May T, Bennett T, Holloway K.

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

Comments: This paper is weird. They ask a slew of questions with often one or two observational papers for each question. Strange for a meta-analysis… Also, the paper the list as showing no decrease in overdose mortality is a dead link – appears it was a report posted but nothing ever published and not publicly available. The group that did the report also since published a paper showing a dramatic decrease in ambulance callouts for overdose with the facility.

23) 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 Sep;290:219-226. doi: 10.1016/j.forsciint.2018.07.009. Epub 2018 Jul 19.

Comments: Heroin seized in Victoria had a median effective dose of heroin of 12.0mg; 8% had 1.5-2 doses and 6% had over a double dose. The “effective dose” approach has some logic.

24) Development and implementation of procedures for outpatient naloxone prescribing 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]

Comments: Pharmacy, nursing, and physician collaboration.

25) 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. [Epub ahead of print]

Comments: Teaching students how to recognize overdose and administer naloxone.

26) 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: Yes.

1) Wearable Biosensors to Evaluate Recurrent Opioid Toxicity After Naloxone Administration: A Hilbert Transform Approach.

Chintha KK, Indic P, Chapman B, Boyer EW, Carreiro S.

Proc Annu Hawaii Int Conf Syst Sci. 2018 Jan;2018:3247-3252. Epub 2018 Jan 3.

Comment: Unable to access. Abstract indicates that authors studied 11 participants to identify physiologic signs that naloxone effect was wearing off.

2) Using medical examiner case narratives to improve opioid overdose surveillance.

Hurstak E, Rowe C, Turner C, Behar E, Cabugao R, Lemos NP, Coffin P.

Int J Drug Policy. 2018 Jan 17;54:35-42. doi: 10.1016/j.drugpo.2017.12.017. [Epub ahead of print]

Comment: Opioid overdose surveillance is remarkably limited in its ability to explain the issue. This paper involved manual review of medical examiner case narratives in an attempt to identify consistently reported elements that could help us establish the populations at highest risk for death. This issue arose in the early 2000s, when opioid overdose deaths transitioned from heroin to prescription opioids – was it the same population, just using different substances? Was it a new population? How much of a mix was it? This paper looked at evidence of drug injection as a marker for a “heroin use” population versus non-injection, which may represent a distinct risk population.

3) Drug involvement in fatal overdoses.

Ruhm CJ.

SSM Popul Health. 2017 Jan 31;3:219-226. doi: 10.1016/j.ssmph.2017.01.009. eCollection 2017 Dec.

Comment: Recounts the transition to heroin as causal opioid and reminds us of the importance of polydrug involvement – a critical issue that has proven notoriously challenging to study.

4) Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs.

Rafful C, Orozco R, Rangel G, Davidson P, Werb D, Beletsky L, Strathdee SA.

Addiction. 2018 Jan 14. doi: 10.1111/add.14159. [Epub ahead of print]

Comment: Heroin users with recent involuntary treatment were nearly twice as likely to overdose.

5) Promising roles for pharmacists in addressing the U.S. opioid crisis.

Compton WM, Jones CM, Stein JB, Wargo EM.

Res Social Adm Pharm. 2017 Dec 31. pii: S1551-7411(17)30977-4. doi: 10.1016/j.sapharm.2017.12.009. [Epub ahead of print]

Comment: As addiction medicine truly becomes part of the medical system, the role for pharmacists – as well as other health professionals – becomes paramount.

6) Opioid drug poisonings in Ohio adolescents and young adults, 2002-2014.

Caupp S, Steffan J, Shi J, Wheeler KK, Spiller HA, Casavant MJ, Xiang H.

Clin Toxicol (Phila). 2018 Jan 11:1-8. doi: 10.1080/15563650.2018.1424889. [Epub ahead of print]

Comment: Demographics from the poison center.

7) Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy.

Glanz JM, Narwaney KJ, Mueller SR, Gardner EM, Calcaterra SL, Xu S, Breslin K, Binswanger IA.

J Gen Intern Med. 2018 Jan 29. doi: 10.1007/s11606-017-4288-3. [Epub ahead of print]

Comment: Nice work by this team. They developed a model of overdose risk among people prescribed opioids longterm and validated it. The validation was not as good as expected, as it seems the validation population was higher risk for overdose, so the model didn’t pick up all the at-risk people. It’s also not clear that this model would transfer to other settings where the demographics of opioid use and overdose are quite different (e.g. they found that patients aged 55-65 were at lowest risk, whereas we see the opposite in San Francisco). The authors also note the important caveat that most people with the model characteristics (on long-acting opioids, tobacco use, mental health diagnoses, substance use disorders, and age via a quadratic equation) do not experience overdose, so this model should not be used to target reduced prescribing. Most interesting perhaps, opioid dose did NOT make it into their model, which points to the fallacy of focusing on that outcome as the goal of opioid stewardship efforts. Finally, the authors suggest that this model could be used to target naloxone prescription; I would suggest that this model may be a minimum guideline, although this may not account for overdose in the immediate social circle of the patient (naloxone may be used by a patient on someone else who suffers an overdose, whether a family member or friend who uses opioids or someone who accidentally or intentionally accesses the patient’s medication).

8) Drug Overdose Deaths in the United States, 1999-2016.

Hedegaard H, Warner M, Miniño AM.

NCHS Data Brief. 2017 Dec;(294):1-8.

Comment: Over 63,600 deaths in 2016, a further 21% more than 2015, and highest in West Virginia, Ohio, New Hampshire, DC, and Pennsylvania.

9) Naloxone dosage for opioid reversal: current evidence and clinical implications.

Rzasa Lynn R, Galinkin JL.

Ther Adv Drug Saf. 2018 Jan;9(1):63-88. doi: 10.1177/2042098617744161. Epub 2017 Dec 13. Review.

Comment: The naloxone dose controversy. It’s pretty clear that medical personnel should use the lowest dose they can to get effect. Lay use is more complex because it has to be simpler. The jerry-rigged nasal devise is pretty clearly insufficient for the fentanyl crisis. The other devices – from 0.4mg IM to 4mg nasal – seem to mostly work pretty consistently. Another reason for difficult resuscitations in the fentanyl era is that fentanyl overdoses may result in rapid cessation of respiration. In contrast to a heroin overdose, whereby when the witness wakes up from a ‘nod’ their friend has slowly declining respirations but still has a pulse, in the event of a fentanyl overdose the victim may have already progressed to cardiac arrest – which requires advanced medical management.

10) Diagnosis of Heroin Overdose in an 8-Year-Old Boy: Reliable Contribution of Toxicological Investigations.

Soichot M, Julliand S, Filatriau J, Hurbain A, Bourgogne E, Mihoubi A, Gourlain H, Delhotal-Landes B.

J Anal Toxicol. 2017 Dec 28. doi: 10.1093/jat/bkx111. [Epub ahead of print]

Comment: Advanced toxicology identified findings consistent with heroin exposure.

11) Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large U.S. EMS System.

Grover JM, Alabdrabalnabi T, Patel MD, Bachman MW, Platts-Mills TF, Cabanas JG, Williams JG.

Prehosp Emerg Care. 2018 Jan 3:1-9. doi: 10.1080/10903127.2017.1387628. [Epub ahead of print]

Comment: Sensitivity of EMS naloxone administration for overdose was 57% and positive predictive value 60%. Unfortunately big data is failing us again – we need boots on the ground.

12) Prescription Opioid Dependence in Western New York: Using Data Analytics to Find an Answer to the Opioid Epidemic.

Sinha S, Burstein GR, Leonard KE, Murphy TF, Elkin PL.

Stud Health Technol Inform. 2017;245:594-598.

Comment: It’s a lot of work to glean good data from electronic medical records.

13) Increasing diversion of methadone in Vancouver, Canada, 2005-2015.

Reddon H, Ho J, DeBeck K, Milloy MJ, Liu Y, Dong H, Ahamad K, Wood E, Kerr T, Hayashi K.

J Subst Abuse Treat. 2018 Feb;85:10-16. doi: 10.1016/j.jsat.2017.11.010. Epub 2017 Nov 28.

Comment: The abstract seems to suggest that the increasing availability of diverted methadone is from agonist treatment, although couldn’t much of it be related to prescribing for pain, as is the case in the US?

14) Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency.

Wallace B, Barber K, Pauly BB.

Int J Drug Policy. 2017 Dec 28;53:83-89. doi: 10.1016/j.drugpo.2017.12.011. [Epub ahead of print]

Comment: Suggests that partial implementation of harm reduction strategies, without full engagement, carries risks.

15) Prescribing Opioid Replacement Therapy in U.S. Correctional Settings.

Farahmand P, Modesto-Lowe V, Chaplin MM.

J Am Acad Psychiatry Law. 2017 Dec;45(4):472-477.

Comment: A good idea, as the authors argue.

16) Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

Davidson PJ, Lopez AM, Kral AH.

Int J Drug Policy. 2017 Dec 23;53:37-44. doi: 10.1016/j.drugpo.2017.12.005. [Epub ahead of print]

Comment: The benefit of being underground is that you’re not constrained by political / institutional factors. There are coincident risks as well.

17) Intranasal and Intramuscular Naloxone for Opioid Overdose in the Pre-Hospital Setting: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet].

Peprah K, Frey N.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Mar 16.

Comment: Limited to absent data.

18) Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study.

Goldman-Hasbun J, DeBeck K, Buxton JA, Nosova E, Wood E, Kerr T.

Harm Reduct J. 2017 Dec 22;14(1):79. doi: 10.1186/s12954-017-0206-6.

Comment: People become more aware of naloxone the longer and more widespread its availability – the limited knowledge in this study is, I suspect, mostly related to the relatively late uptake of take-home naloxone in Canada.

19) Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities.

McCarty D, Priest KC, Korthuis PT.

Annu Rev Public Health. 2017 Dec 22. doi: 10.1146/annurev-publhealth-040617-013526. [Epub ahead of print]

Comment: Review of current strategies in prescribing opioids and managing OUD.

20) Managing opioid overdose in pregnancy with take-home naloxone.

Blandthorn J, Bowman E, Leung L, Bonomo Y, Dietze P.

Aust N Z J Obstet Gynaecol. 2017 Dec 22. doi: 10.1111/ajo.12761. [Epub ahead of print]

Comment: Mostly the same, but there are a couple of important additional pieces to remember. First, you always need to tilt / place visibly pregnant women in emergency situations on their left side – this takes pressure off of the blood supply to the fetus. Second, you should titrate the naloxone a bit more cautiously as precipitated withdrawal could be dangerous to the fetus; that being said, maternal respiratory arrest is clearly more hazardous.

21) Opioid, Overdose.

Schiller EY, Mechanic OJ.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-.
2017 Nov 28.

Comment: A basic description.

22) Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users.

Molist G, Brugal MT, Barrio G, Mesías B, Bosque-Prous M, Parés-Badell O, de la Fuente L; Spanish Working Group for the Study of Mortality among Drug Users.

Int J Drug Policy. 2017 Dec 18;53:8-16. doi: 10.1016/j.drugpo.2017.11.011. [Epub ahead of print]

Comment: Heroin and cocaine users have greatly elevated risk of mortality. Interestingly, and consistent with decades of research, death from overdose declined with age rather than rising.

23) Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

Dasgupta N, Beletsky L, Ciccarone D.

Am J Public Health. 2017 Dec 21:e1-e5. doi: 10.2105/AJPH.2017.304187. [Epub ahead of print]

Comment: This is one of my favorite papers in a long time. It is inspired, deeply moving, and beautifully crafted. There is so much more to this than reducing opioid prescribing, providing opioid use disorder treatment, handing out naloxone, etc. This issue involves economic and social abandonment, and so much more.

24) ED Treatment of Opioid Addiction: An Opportunity to Lead.

Martin A, Mitchell A.

Acad Emerg Med. 2017 Dec 21. doi: 10.1111/acem.13367. [Epub ahead of print]

Comment: Great!

25) Abuse-deterrent opioids: an update on current approaches and considerations.

Pergolizzi JV Jr, Raffa RB, Taylor R Jr, Vacalis S.

Curr Med Res Opin. 2017 Dec 21:1-42. doi: 10.1080/03007995.2017.1419171. [Epub ahead of print]

Comment: Industry-funded promotion of novel formulations of opioids.

26) Clinical Update: The Risk of Opioid Toxicity and Naloxone Use in Operational K9s.

Palmer LE, Gautier A.

J Spec Oper Med. 2017 Winter;17(4):86-92.

Comment: I can’t access this. Naloxone is effective in canines, as well as other animals to the best of my knowledge. Exposure risks, in contrast, are being greatly exaggerated in media of late.

27) Effects of naloxone distribution alone or in combination with addiction treatment with or without pre-exposure prophylaxis for HIV prevention in people who inject drugs: a cost-effectiveness modelling study.

Uyei J, Fiellin DA, Buchelli M, Rodriguez-Santana R, Braithwaite RS.

Lancet Public Health. 2017 Mar;2(3):e133-e140. doi: 10.1016/S2468-2667(17)30006-3. Epub 2017 Feb 10. Erratum in: Lancet Public Health. 2017 Apr;2(4):e165.

Comment: Added to naloxone distribution modeling with substance use disorder treatment referral and pre-exposure prophylaxis for HIV – an effort to merge management of syndemics as we see in practice, which can be really helpful for programmatic planning. The results appear reasonable, although I disagree with some of the model parameter estimates (e.g. overdose risk is modeled as 7.7% per year and constant – this leads to outcome estimates that are not reflected in epidemiologic data which suggests a declining overdose risk with age / some people overdose more than others).

28) A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

Maguire MA, Pavlakos RN, Mehta BH, Schmuhl KK, Beatty SJ.

Curr Pharm Teach Learn. 2018 Jan – Feb;10(1):72-77. doi: 10.1016/j.cptl.2017.09.007. Epub 2017 Oct 6.

Comment: That’s cool, and a great way to engage the profession longterm.

29) A content review of online naloxone Continuing Education courses for pharmacists in states with standing orders.

Carpenter DM, Roberts CA, Westrick SC, Ferreri SP, Kennelty KA, Look KA, Abraham O, Wilson C.

Res Social Adm Pharm. 2017 Nov 21. pii: S1551-7411(17)30649-6. doi: 10.1016/j.sapharm.2017.11.011. [Epub ahead of print]

Comment: Talking with patients about naloxone requires a bit of subtlety.

30) A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013.

Marotta PL, McCullagh CA.

Eur J Epidemiol. 2017 Dec 12. doi: 10.1007/s10654-017-0342-z. [Epub ahead of print]

Comment: Implementation of methadone, buprenorphine, and those treatments for incarcerated populations were associate with less drug-related death.

31) Identifying gaps in the implementation of naloxone programs for laypersons in the United States.

Lambdin BH, Zibbell J, Wheeler E, Kral AH.

Int J Drug Policy. 2017 Dec 9;52:52-55. doi: 10.1016/j.drugpo.2017.11.017. [Epub ahead of print]

Comment: 8% of counties had naloxone programs, including only 13% of counties with the highest overdose rates.

32) Comparison of Two Naloxone Regimens in Addicted Methadone-Overdosed Patients, a Clinical Trial Study.

Khosravi N, Zamani N, Hassanian-Moghaddam H, Ostadi A, Rahimi M, Kabir A.

Curr Clin Pharmacol. 2017 Dec 11. doi: 10.2174/1574884713666171212112540. [Epub ahead of print]

Comment: Tintanelli is 0.1mg every 2-3 minutes. Goldfrank is escalating doses every 2-3 minutes. Goldfrank reverses faster but results in more complications due to rapid reversal.

33) Back to the core: A network approach to bolster harm reduction among persons who inject drugs.

Bouchard M, Hashimi S, Tsai K, Lampkin H, Jozaghi E.

Int J Drug Policy. 2017 Dec 8;51:95-104. doi: 10.1016/j.drugpo.2017.10.006. [Epub ahead of print]

Comment: Network interventions make a lot of sense, and are really challenging to design / test.

34) An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study.

Katzman JG, Takeda MY, Bhatt SR, Moya Balasch M, Greenberg N, Yonas H.

J Addict Med. 2017 Dec 7. doi: 10.1097/ADM.0000000000000374. [Epub ahead of print]

Comment: Given naloxone to patients on agonist maintenance treatment leads to reversals in their immediate social networks.

35) Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon.

Ghaddar A, Abbas Z, Haddad R.

Harm Reduct J. 2017 Dec 8;14(1):78. doi: 10.1186/s12954-017-0204-8.

Comment: Treating opioid use disorder with proven medications works in Lebanon as well.

36) Rethinking Naloxone: Overdose drug is only one part of the cycle of narcotic abuse.

Richmond NJ.

JEMS. 2017 Feb;42(2):63. No abstract available.

Comment: Can’t access and no abstract.

37) Housing and overdose: an opportunity for the scale-up of overdose prevention interventions?

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

Harm Reduct J. 2017 Dec 6;14(1):77. doi: 10.1186/s12954-017-0203-9.

Comment: Important target for overdose prevention.

38) Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine.

Krawczyk N, Picher CE, Feder KA, Saloner B.

Health Aff (Millwood). 2017 Dec;36(12):2046-2053. doi: 10.1377/hlthaff.2017.0890.

Comment: Why aren’t we using the proven treatments for opioid use disorder? This is like not providing anti-hyperglycemic agents for a diabetic individual.

39) Opiate use disorders and overdose: Medical students’ experiences, satisfaction with learning, and attitudes toward community naloxone provision.

Tobin H, Klimas J, Barry T, Egan M, Bury G.

Addict Behav. 2017 Nov 22. pii: S0306-4603(17)30436-7. doi: 10.1016/j.addbeh.2017.11.028. [Epub ahead of print]

Comment: There is always a need for more education on this topic.

40) Factors associated with naloxone administration in an opioid dependent sample.

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

J Subst Abuse Treat. 2018 Jan;84:17-20. doi: 10.1016/j.jsat.2017.10.008. Epub 2017 Oct 18.

Comment: Interesting analysis of people entering opioid detox. Only heroin users (i.e. no prescription opioid users) had administered naloxone and few African Americans had done so.

41) Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse.

Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.

PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.

Comment: Vaccines have long been a goal of some for substance use disorders. There remain many challenges.

42) Case 37-2017. A 36-Year-Old Man with Unintentional Opioid Overdose.

Raja AS, Miller ES, Flores EJ, Wakeman SE, Eng G.

N Engl J Med. 2017 Nov 30;377(22):2181-2188. doi: 10.1056/NEJMcpc1710563. Comment: Exciting to see the NEJM taking a deep dive into a patient with an opioid use disorder!

43) Elderly Man in Respiratory Arrest.

Mackle T, Rhine D.

Ann Emerg Med. 2017 Oct;70(4):599-604. doi: 10.1016/j.annemergmed.2017.04.035. No abstract available.

Comment: Gastric perforation due to resuscitation. Complications of well-intentioned medical interventions … suck.

44) Detection of Carfentanil by LC-MS-MS and Reports of Associated Fatalities in the USA.

Shanks KG, Behonick GS.

J Anal Toxicol. 2017 Jul 1;41(6):466-472. doi: 10.1093/jat/bkx042.

Comment: Go low.

45) Naloxone Access and Use for Suspected Opioid Overdoses.

Ann Emerg Med. 2017 Jul;70(1):112-113. doi: 10.1016/j.annemergmed.2017.03.031. No abstract available.

Comment:  The American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the American College of Medical Toxicology (ACMT) affirm naloxone access for all emergency responders and lay persons by prescription, as well as the ability for pharmacists to furnish without prescription.

46) Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine.

Dempsey SK, Poklis JL, Sweat K, Cumpston K, Wolf CE.

J Anal Toxicol. 2017 Jul 1;41(6):547-550. doi: 10.1093/jat/bkx034.

Comment: A tricyclic antidepressant approved in Europe (not in the US) overdose that responded to naloxone … authors presume that this was managing the tricyclic overdose although one might wonder if there was an undetected synthetic opioid on board.

Consumption spaces

47) Changes in public order after the opening of an overdose monitoring facility for people who inject drugs.

León C, Cardoso LJP, Johnston S, Mackin S, Bock B, Gaeta JM.

Int J Drug Policy. 2017 Dec 30;53:90-95. doi: 10.1016/j.drugpo.2017.12.009. [Epub ahead of print]

Comment: There were fewer people on the streets oversedated.

48) Perceptions about supervised injection facilities among people who inject drugs in Philadelphia.

Harris RE, Richardson J, Frasso R, Anderson ED.

Int J Drug Policy. 2017 Dec 10;52:56-61. doi: 10.1016/j.drugpo.2017.11.005. [Epub ahead of print]

Comment: Again, people who use drugs support a safe consumption space.

OxyContin reformulation

49) The effect of a potentially tamper-resistant oxycodone formulation on opioid use and harm: main findings of the National Opioid Medications Abuse Deterrence (NOMAD) study.

Larance B, Dobbins T, Peacock A, Ali R, Bruno R, Lintzeris N, Farrell M, Degenhardt L.

Lancet Psychiatry. 2018 Jan 10. pii: S2215-0366(18)30003-8. doi: 10.1016/S2215-0366(18)30003-8. [Epub ahead of print]

Comment: “This formulation of controlled-release oxycodone reduced tampering with pharmaceutical opioids among people who inject drugs, but did not affect population-level opioid use or harm.”

50) The impact of OxyContin reformulation at the Sydney Medically Supervised Injecting Centre: Pros and cons.

Jauncey M, Livingston M, Salmon AM, Dietze P.

Int J Drug Policy. 2017 Dec 18;53:17-22. doi: 10.1016/j.drugpo.2017.11.025. [Epub ahead of print]

Comment: More on the unintended consequence of OxyContin reformulation.

Fentanyl papers

51) The Rapid Escalation of Fentanyl in Illicit Drug Evidence in Allegheny County, Pennsylvania, 2010-2016.

Creppage KE, Yohannan J, Williams K, Buchanich JM, Songer TJ, Wisniewski SR, Fabio A.

Public Health Rep. 2018 Jan 1:33354917753119. doi: 10.1177/0033354917753119. [Epub ahead of print]

Comment: Per title.

52) Newly Emerging Drugs of Abuse and Their Detection Methods: An ACLPS Critical Review.

Liu L, Wheeler SE, Venkataramanan R, Rymer JA, Pizon AF, Lynch MJ, Tamama K.

Am J Clin Pathol. 2018 Jan 29;149(2):105-116. doi: 10.1093/ajcp/aqx138.

Comment: New standard for untargeted drug identification.

53) Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: A cross-sectional urine toxicology screening study.

Hayashi K, Milloy MJ, Lysyshyn M, DeBeck K, Nosova E, Wood E, Kerr T.

Drug Alcohol Depend. 2017 Dec 5;183:1-6. doi: 10.1016/j.drugalcdep.2017.10.020. [Epub ahead of print]

Comment: Lots of fentanyl exposure.

54) Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD.

Mars SG, Ondocsin J, Ciccarone D.

J Psychoactive Drugs. 2017 Dec 6:1-10. doi: 10.1080/02791072.2017.1394508. [Epub ahead of print]

Comment: Critical ethnography.

55) Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin.

Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.

Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30. Review.

Comment: Way more complicated than just pain meds.

56) Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn.

Shoff EN, Zaney ME, Kahl JH, Hime GW, Boland DM.

J Anal Toxicol. 2017 Jul 1;41(6):484-492. doi: 10.1093/jat/bkx041.

Comment: Another paper on identifying fentanyl analogs.

57) Fatalities Involving Carfentanil and Furanyl Fentanyl: Two Case Reports.

Swanson DM, Hair LS, Strauch Rivers SR, Smyth BC, Brogan SC, Ventoso AD, Vaccaro SL, Pearson JM.

J Anal Toxicol. 2017 Jul 1;41(6):498-502. doi: 10.1093/jat/bkx037.

Comment: And another!

There’s some sophisticated work here – innovative epidemiology, interventions, and reviews of overdose. We’ve come a long way from the 1990s, but clearly not quickly enough for the dynamic urgency of this issue.

1) Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse.

Raleigh MD, Peterson SJ, Laudenbach M, Baruffaldi F, Carroll FI, Comer SD, Navarro HA, Langston TL, Runyon SP, Winston S, Pravetoni M, Pentel PR.

PLoS One. 2017 Dec 1;12(12):e0184876. doi: 10.1371/journal.pone.0184876. eCollection 2017.

Comments: Interesting approach and data.

2) Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin.

Pergolizzi JV Jr, LeQuang JA, Taylor R Jr, Raffa RB; NEMA Research Group.

Postgrad Med. 2018 Jan;130(1):1-8. doi: 10.1080/00325481.2018.1407618. Epub 2017 Nov 30.

Comments: Yeah … this is really complicated.

3) Hypoglycemia and Sudden Death During Treatment With Methadone for Opiate Detoxification.

Plescia CJ, Manu P.

Am J Ther. 2017 Nov 14. doi: 10.1097/MJT.0000000000000692. [Epub ahead of print]

Comments: This is an iatrogenic methadone and benzodiazepine overdose during simultaneous alcohol and opioid detoxification.

4) Revisiting Naloxone: A different take on overdose guidelines from Lee County, Fla.

Hamel MG.

JEMS. 2016 Nov;41(11):46-8. No abstract available.

Comments: No abstract. Can’t access.

5) Naloxone Conundrum: Reduce risk in managing the opioid overdose patient.

Wirth SR.

JEMS. 2016 Nov;41(11):14-5. No abstract available.

Comments: Same journal, again no abstract, and can’t access.

6) Evaluation of the Southern Harm Reduction Coalition for HIV Prevention: Advocacy Accomplishments.

Story CR; Members of the Southern Harm Reduction Coalition, Kao WK, Currin J, Brown C, Charles V.

Health Promot Pract. 2017 Nov 1:1524839917742850. doi: 10.1177/1524839917742850. [Epub ahead of print]

Comments: Paper on the advocacy efforts for harm reduction.

7) Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus.

Dematteis M, Auriacombe M, D’Agnone O, Somaini L, Szerman N, Littlewood R, Alam F, Alho H, Benyamina A, Bobes J, Daulouede JP, Leonardi C, Maremmani I, Torrens M, Walcher S, Soyka M.

Expert Opin Pharmacother. 2017 Dec;18(18):1987-1999. doi: 10.1080/14656566.2017.1409722. Epub 2017 Dec 3.

Comments: We have good medications. Use them.

8) Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review.

Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O’Reilly C, Grusing S, Daya M.

Ann Intern Med. 2017 Dec 19;167(12):867-875. doi: 10.7326/M17-2224. Epub 2017 Nov 28.

Comments: As with many systematic reviews, there are insufficient data to really answer the questions. Open access.

9) Attitudes, Beliefs, Practices, and Concerns Among Clinicians Prescribing Opioids in a Large Academic Institution.

Ebbert JO, Philpot LM, Clements CM, Lovely JK, Nicholson WT, Jenkins SM, Lamer TJ, Gazelka HM.

Pain Med. 2017 Jun 15. doi: 10.1093/pm/pnx140. [Epub ahead of print]

Comments: This is a unique survey at Mayo Clinic in Minnesota. Kudos to the authors. Most providers weren’t comfortable with the care they provided. Few (2%) routinely prescribed naloxone. Many weren’t registered with the PDMP. We’re kind of in a mess.

10) Payer Policy Behavior Towards Opioid Pharmacotherapy Treatment in Ohio.

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

J Addict Med. 2017 Nov 15. doi: 10.1097/ADM.0000000000000369. [Epub ahead of print]

Comments: Everyone pays for opioids for pain but treating opioid use disorder is not paid for unless paired with behavioral therapy and duration of treatment is limited. These are not evidence-based decisions. There are strong data that buprenorphine treatment are effective with or without behavioral therapy. And stopping treatment is always associated with increased mortality. How about we put a limit on the duration of insulin for diabetes?

11) Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington.

Glick SN, Burt R, Kummer K, Tinsley J, Banta-Green CJ, Golden MR.

Drug Alcohol Depend. 2017 Nov 16;182:86-92. doi: 10.1016/j.drugalcdep.2017.10.011. [Epub ahead of print]

Comments: The opioid epidemic is also a stimulant issue.

12) Witnessed overdoses and naloxone use among visitors to Rikers Island jails trained in overdose rescue.

Huxley-Reicher Z, Maldjian L, Winkelstein E, Siegler A, Paone D, Tuazon E, Nolan ML, Jordan A, MacDonald R, Kunins HV.

Addict Behav. 2017 Nov 16. pii: S0306-4603(17)30437-9. doi: 10.1016/j.addbeh.2017.11.029. [Epub ahead of print]

Comments: Great results from an innovative program to reach those at risk for overdose. Impressive work from NYC!

13) PHArmacists’ perspective oN the Take hOme naloxone prograM (The PHANTOM Study).

Edwards J, Bates D, Edwards B, Ghosh S, Yarema M.

Can Pharm J (Ott). 2017 Jul 7;150(4):259-268. doi: 10.1177/1715163517711960. eCollection 2017 Jul-Aug.

Comments: Pharmacists in Alberta highly supportive of screening patients and providing naloxone.

14) Overdose prevention training with naloxone distribution in a prison in Oslo, Norway: a preliminary study.

Petterson AG, Madah-Amiri D.

Harm Reduct J. 2017 Nov 21;14(1):74. doi: 10.1186/s12954-017-0200-z.

Comments: Training in naloxone prior to release was associated with improved knowledge.

15) Increasing Prescription Opioid and Heroin Overdose Mortality in the United States, 1999-2014: An Age-Period-Cohort Analysis.

Huang X, Keyes KM, Li G.

Am J Public Health. 2018 Jan;108(1):131-136. doi: 10.2105/AJPH.2017.304142. Epub 2017 Nov 21.

Comments: Fascinating results. Two cohorts are involved. Baby boomers 1947 through 1964 have elevated rates of prescription opioid as well as heroin overdose death. A second cohort, born 1979-1992, is at elevated risk of heroin overdose death. I can’t access full article unfortunately.

16) ‘I have it just in case’ – Naloxone access and changes in opioid use behaviours.

Heavey SC, Chang YP, Vest BM, Collins RL, Wieczorek W, Homish GG.

Int J Drug Policy. 2017 Nov 17;51:27-35. doi: 10.1016/j.drugpo.2017.09.015. [Epub ahead of print]

Comments: This is a qualitative study (N=20) at a residential treatment center (presumably in Buffalo NY where authors are based). Authors report that some respondents reported behaviors related to naloxone that may put them at higher risk. The is the first research to suggest this finding. The examples they provide, however, are not entirely concordant with the purported themes, with the exception of one example in which a respondent reported using something that he thought was fentanyl because there was someone with naloxone present in case it was in fact fentanyl. The other examples include: a person who overdosed three days in a row and was reversed by paramedics each time which is described as “opioid use after naloxone”, and “naloxone behaviors that may increase overdose mortality risk” which include mistaking an overdose for a nod (this doesn’t seem relevant to naloxone) and people who tend to use alone (again, unclear how this is related to naloxone). Finally, conducting this study in a residential treatment center brings extensive biases that affect how people (re)interpret their own history.

17) Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015.

Curtin SC, Tejada-Vera B, Warmer M.

NCHS Data Brief. 2017 Aug;(282):1-8.

Comments: Wow. Increased heroin deaths among kids. This suggests that we are dealing with increased opioid use, not just increased risk with the shift to heroin and emergence of fentanyl.

18) Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.

Lee JD, Nunes EV Jr, Novo P, Bachrach K, Bailey GL, Bhatt S, Farkas S, Fishman M, Gauthier P, Hodgkins CC, King J, Lindblad R, Liu D, Matthews AG, May J, Peavy KM, Ross S, Salazar D, Schkolnik P, Shmueli-Blumberg D, Stablein D, Subramaniam G, Rotrosen J.

Lancet. 2017 Nov 14. pii: S0140-6736(17)32812-X. doi: 10.1016/S0140-6736(17)32812-X. [Epub ahead of print]

Comments: In randomized-controlled trials, we care about the intent-to-treat analysis. The per-protocol analysis is a distant second that doesn’t usually get a place of prominence in the abstract of a major paper, making this abstract unusual. Moreover, describing the intent-to-treat findings as “it is harder to initiate patients” is very unusual. The most important finding from this study is, of course, that those assigned to XR-NTX had higher rates of relapse and more opioid-positive urines – and this should be the conclusion by traditional RCT standards. While the authors are likely correct that this finding is because it is harder (and presumably more dangerous) to induct people onto XR-NTX, from a clinical perspective this makes XR-NTX inferior to buprenorphine. That does not mean it’s not valuable, but it does mean that relying exclusively on it is inconsistent with quality care. I really hope they are following people longer than 24 weeks, given that this is a lifelong disease and, while buprenorphine is usually provided longterm, XR-NTX is rarely provided for more than 6 months. Of note, there are several author COIs related to Alkermes which I consider relevant given the unusual presentation of intent-to-treat results.

19) Is naloxone the best antidote to reverse tramadol-induced neuro-respiratory toxicity in overdose? An experimental investigation in the rat.

Lagard C, Malissin I, Indja W, Risède P, Chevillard L, Mégarbane B.

Clin Toxicol (Phila). 2017 Nov 17:1-7. doi: 10.1080/15563650.2017.1401080. [Epub ahead of print]

Comments: Works, but increases seizure risk.

20) Extracorporeal membrane oxygenation used successfully in a near fatal case of opioid-induced acute respiratory distress syndrome.

Greenberg K, Kohl B.

Am J Emerg Med. 2017 Nov 8. pii: S0735-6757(17)30928-2. doi: 10.1016/j.ajem.2017.11.020. [Epub ahead of print]

Comments: ARDS is a nasty lung disease that is difficult to ventilate, with a high mortality rate.

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

Mack KA, Jones CM, Ballesteros MF.

Am J Transplant. 2017 Dec;17(12):3241-3252. doi: 10.1111/ajt.14555.

Comments: Why is this in a transplantation journal? Also, an earlier paper in this review suggests that youth opioid use has picked up since the end of the study period for this article.

22) Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase I healthy volunteer study.

McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, Strang J.

Addiction. 2017 Nov 16. doi: 10.1111/add.14033. [Epub ahead of print]

Comments: 2mg IN similar to 0.4mg IM … as one would expect!

23) Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial.

Molfenter T, Knudsen HK, Brown R, Jacobson N, Horst J, Van Etten M, Kim JS, Haram E, Collier E, Starr S, Toy A, Madden L.

Implement Sci. 2017 Nov 15;12(1):135. doi: 10.1186/s13012-017-0665-x.

Comments: Description of an impending implementation science study to increase provision of addiction treatment for opioid use disorder.

24) Reversal of Opioid-Induced Toxicity.

Ostwal SP, Salins N, Deodhar J.

Indian J Palliat Care. 2017 Oct-Dec;23(4):484-486. doi: 10.4103/IJPC.IJPC_117_17.

Comments: Case report of a person on palliative opioids successfully reversed with naloxone.

25) Epidemiologic incidence of rhabdomyolysis in opioid overdose in ICU of poisoning center in Iran, 2014.

Khoshideh B, Arefi M, Ghorbani M, Akbarpour S, Taghizadeh F.

Epidemiol Health. 2017 Nov 8. doi: 10.4178/epih.e2017050. [Epub ahead of print]

Comments: Rhabdomyolysis is a disease produced by breakdown of muscle cells, resulting in buildup of creatine kinase which is toxic to the kidneys. Usually it occurs when someone is “down” for a prolonged period (i.e. unconscious on the floor), resulting in pressure on muscles. Sometimes we see it with extreme exposure to stimulants, such as cocaine or methamphetamine, with excessive tensing of muscles for prolonged periods. We also see it as a rare side effect of statin exposure, and several other causes.

26) Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose.

Freeman LK, Bourque S, Etches N, Goodison K, O’Gorman C, Rittenbach K, Sikora CA, Yarema M.

Can J Public Health. 2017 Nov 9;108(4):e398-e402. doi: 10.17269/cjph.108.5989.

Comments: 9572 kits distributed and 472 reversals reported in Alberta’s 953 naloxone sites in 2016.

27) Availability of naloxone in Canadian pharmacies: a population-based survey.

Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN.

CMAJ Open. 2017 Nov 8;5(4):E779-E784. doi: 10.9778/cmajo.20170123.

Comments: Half of pharmacies had naloxone available in British Columbia, one-third in Maritimes, a quarter in Ontario and central and northern Canada; 0.9% in Quebec.

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

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

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

Comments: I’m still stuck on “this sucks.”

29) Is systematic training in opioid overdose prevention effective?

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

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

Comments: 40% of people who inject opioids that received naloxone used it to reverse an overdose.

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

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

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

Comments: Motivational interviewing-based intervention among naloxone recipients resulted in substantial reduction in occurrence of subsequent overdose events.

31) Drug related deaths in Scotland double in 10 years.

Iacobucci G.

BMJ. 2017 Aug 21;358:j3941. doi: 10.1136/bmj.j3941. No abstract available.

Comments: Ugh. Overdose death is way more complicated than a simple reversal agent. There are clearly economic and social elements to the epidemic we are facing today.

32) Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Moore PQ, Weber J, Cina S, Aks S.

Am J Emerg Med. 2017 Nov;35(11):1706-1708. doi: 10.1016/j.ajem.2017.05.003. Epub 2017 May 8.

Comments: We are still a long way from effectively utilizing clinical data systems.

33) Deadly chemistry.

McLaughlin K.

Science. 2017 Mar 31;355(6332):1364-1366. doi: 10.1126/science.355.6332.1364. No abstract available.

Comments: Fentanyl and analogues.

34) Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD.

Addict Sci Clin Pract. 2017 Feb 28;12(1):7. doi: 10.1186/s13722-017-0072-2.

Comments: Home induction works well, even in low resource settings.

35) A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence.

Chetty M, Kenworthy JJ, Langham S, Walker A, Dunlop WC.

Addict Sci Clin Pract. 2017 Feb 24;12(1):6. doi: 10.1186/s13722-017-0071-3. Review.

Comments: 18 models in total, with widely varying approaches and quality, a tiny number given the impact of opioid use disorder and treatment.

36) Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study.

Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD.

Harm Reduct J. 2017 Feb 20;14(1):13. doi: 10.1186/s12954-017-0139-0.

Comments: >60%

37) The impact of benzodiazepine use in patients enrolled in opioid agonist therapy in Northern and rural Ontario.

Franklyn AM, Eibl JK, Gauthier G, Pellegrini D, Lightfoot NE, Marsh DC.

Harm Reduct J. 2017 Jan 26;14(1):6. doi: 10.1186/s12954-017-0134-5. Erratum in: Harm Reduct J. 2017 Mar 28;14 (1):15.

Comments: Benzodiazepine use complicated opioid use disorder treatment, for sure. One of the questions is why? Is it comorbid use disorder? Is it anxiety? Depression?

38) Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know.

Kerensky T, Walley AY.

Addict Sci Clin Pract. 2017 Jan 7;12(1):4. doi: 10.1186/s13722-016-0068-3. Review.

Comments: Nice review of key issues related to naloxone provision.

108 articles in four months. The fentanyl ones are all at the end in a special section, as are the injection facility ones. The rest you will have to parse through. Okay, that’s it – I feel myself turning into a pumpkin.

1) A mapping review of take-home naloxone for people released from correctional settings.

Horton M, McDonald R, Green TC, Nielsen S, Strang J, Degenhardt L, Larney S.

Int J Drug Policy. 2017 May 30;46:7-16. doi: 10.1016/j.drugpo.2017.05.015. [Epub ahead of print]

Comment: Naloxone pre-release is totally doable, but outcome studies have run into some challenges.

2) Buprenorphine implants in medical treatment of opioid addiction.

Chavoustie S, Frost M, Snyder O, Owen J, Darwish M, Dammerman R, Sanjurjo V.

Expert Rev Clin Pharmacol. 2017 Jun 2. doi: 10.1080/17512433.2017.1336434. [Epub ahead of print]

Comment: Looking forward to this. It should overcome a lot of the misinformed resistance.

3) The societal cost of heroin use disorder in the United States.

Jiang R, Lee I, Lee TA, Pickard AS.

PLoS One. 2017 May 30;12(5):e0177323. doi: 10.1371/journal.pone.0177323. eCollection 2017.

Comment: I haven’t read this in depth, but find it a bit disturbing. It always seems a bit off in economic models when you “charge” people for incarcerating them.

4) DNA Methylation Profiling of Human Prefrontal Cortex Neurons in Heroin Users Shows Significant Difference between Genomic Contexts of Hyper- and Hypomethylation and a Younger Epigenetic Age.

Kozlenkov A, Jaffe AE, Timashpolsky A, Apontes P, Rudchenko S, Barbu M, Byne W, Hurd YL, Horvath S, Dracheva S.

Genes (Basel). 2017 May 30;8(6). pii: E152. doi: 10.3390/genes8060152.

Comment: Possible heroin-associated changes in the prefrontal cortex.

5) Overdose Education and Naloxone Distribution for Veterans with Opioid Use Disorder: Results from a Pilot Initiative.

Chang G, Davids M, Kershaw A.

J Addict Dis. 2017 May 26:0. doi: 10.1080/10550887.2017.1333331. [Epub ahead of print]

Comment: 89% of outpatient and 63% of inpatient veterans accepted take-home naloxone.

6) A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program.

Piper BJ, Desrosiers CE, Fisher HC, McCall KL, Nichols SD.

Pharmacotherapy. 2017 May 19. doi: 10.1002/phar.1952. [Epub ahead of print]

Comment: A registry of drug arrests including type of drug.

7) Frequency and severity of non-fatal opioid overdoses among clients attending the Sydney Medically Supervised Injecting Centre.

Roxburgh A, Darke S, Salmon AM, Dobbins T, Jauncey M.

Drug Alcohol Depend. 2017 May 17;176:126-132. doi: 10.1016/j.drugalcdep.2017.02.027. [Epub ahead of print]

Comment: Great data. 12.7 overdose events per 1,000 heroin injections; 4.1 oxycodone overdoses per 1,000 injections. Another confirmation that injecting prescribed opioids is safer than heroin / street drugs, and thus possibly explaining at least part of the increase in overdose death while we pull back on opioid prescribing.

8) Use of naloxone nasal spray 4 mg in the community setting: a survey of use by community organizations.

Avetian GK, Fiuty P, Mazzella S, Koppa D, Heye V, Hebbar P.

Curr Med Res Opin. 2017 May 23:1-9. doi: 10.1080/03007995.2017.1334637. [Epub ahead of print]

Comment: Some good initial field data on the 4mg nasal spray. We were worried about precipitated withdrawal, but the results seem to be pretty similar to the other doses. 98.8% survived and 2 of the 3 deaths were thought to be already dead when naloxone was administered (there was no further info for the third case). 14% had withdrawal, 10% had retching/vomiting type symptoms, and 9% were angry. Interestingly, given the “high” dose and exposure of this product, a second dose was used 33% of the time, with >=3 doses in 2.4% of cases. As we know, it is difficult to wait for naloxone to start to work, and many of the second doses are administered in a panic rather than due to lack of effect of the first dose.

9) Rapid widespread distribution of intranasal naloxone for overdose prevention.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2017 Apr 1;173:17-23. doi: 10.1016/j.drugalcdep.2016.12.013. Epub 2017 Jan 28.

Comment: Government-supported program gets the product out fast.

10) Increases in prescription opioid injection abuse among treatment admissions in the United States, 2004-2013.

Jones CM, Christensen A, Gladden RM.

Drug Alcohol Depend. 2017 May 16;176:89-95. doi: 10.1016/j.drugalcdep.2017.03.011. [Epub ahead of print]

Comment: When you look at the years in Figure 1, once again the biggest change centers around 2010, a key year in all of the opioid trend graphs.

11) Update on Barriers to Pharmacotherapy for Opioid Use Disorders.

Sharma A, Kelly SM, Mitchell SG, Gryczynski J, O’Grady KE, Schwartz RP.

Curr Psychiatry Rep. 2017 Jun;19(6):35. doi: 10.1007/s11920-017-0783-9. Review.

Comment: Financial, regulatory, geographic, attitudinal, and logistic.

12) Telling our stories: heroin-assisted treatment and SNAP activism in the Downtown Eastside of Vancouver.

Boyd S, Murray D; SNAP, MacPherson D.

Harm Reduct J. 2017 May 18;14(1):27. doi: 10.1186/s12954-017-0152-3.

Comment: Some powerful activism in Vancouver.

13) Safety profile of injectable hydromorphone and diacetylmorphine for long-term severe opioid use disorder.

Oviedo-Joekes E, Brissette S, MacDonald S, Guh D, Marchand K, Jutha S, Harrison S, Janmohamed A, Zhang DZ, Anis AH, Krausz M, Marsh DC, Schechter MT.

Drug Alcohol Depend. 2017 May 10;176:55-62. doi: 10.1016/j.drugalcdep.2017.02.021. [Epub ahead of print]

Comment: Generally, in a chronic disease that requires ongoing management and can be extremely morbid, we accept with open arms any treatment that has at least some benefit.

14) Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review.

Elzey MJ, Barden SM, Edwards ES.

Pain Physician. 2016 May;19(4):215-28. Review.

Comment: We need to study non-fatal overdose more.

15) Comparison of a New Intranasal Naloxone Formulation to Intramuscular Naloxone: Results from Hypothesis-generating Small Clinical Studies.

Gufford BT, Ainslie GR, White JR Jr, Layton ME, Padowski JM, Pollack GM, Paine MF.

Clin Transl Sci. 2017 May 15. doi: 10.1111/cts.12473. [Epub ahead of print]

Comment: Interesting data comparing the products; overall 2mg IN and 2mg IM naloxone were pretty similar.

16) Risk to heroin users of polydrug use of pregabalin or gabapentin.

Lyndon A, Audrey S, Wells C, Burnell ES, Ingle S, Hill R, Hickman M, Henderson G.

Addiction. 2017 May 10. doi: 10.1111/add.13843. [Epub ahead of print]

Comment: Interesting. Initially I suspected that the association of increased prescribing of gabapentins and increased opioid overdose mortality was a nature of the growing population of opioid dependent persons, but the authors present some interview data and animal data suggesting that these agents lessen the tolerance to the respiratory depressive effects of opioids. Is this yet another combination we should try to avoid clinically? We are running out of options.

17) Medical providers’ knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings.

Winograd RP, Davis CS, Niculete M, Oliva E, Martielli RP.

Subst Abus. 2017 Apr-Jun;38(2):135-140. doi: 10.1080/08897077.2017.1303424.

Comment: I find it so weird that a physician would say that prescribing naloxone would increase opioid use. I doubt any would say the same about prescribing or recommending insulin, glucagon, epinephrine pens, or fire extinguishers.

18) Multiple Naloxone Administrations Among Emergency Medical Service Providers is Increasing.

Faul M, Lurie P, Kinsman JM, Dailey MW, Crabaugh C, Sasser SM.

Prehosp Emerg Care. 2017 May 8:1-8. doi: 10.1080/10903127.2017.1315203. [Epub ahead of print]

Comment: Pretty good analysis.

19) Beliefs about the consequences of using benzodiazepines among persons with opioid use disorder.

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

J Subst Abuse Treat. 2017 Jun;77:67-71. doi: 10.1016/j.jsat.2017.03.002. Epub 2017 Mar 9.

Comment: Benzo users generally know that they are risky.

20) Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis.

Jordan AE, Blackburn NA, Des Jarlais DC, Hagan H.

J Subst Abuse Treat. 2017 Jun;77:31-37. doi: 10.1016/j.jsat.2017.03.007. Epub 2017 Mar 12.

Comment: Increased through the 2000s.

21) Treatment of opioid overdose: a brief review of naloxone pharmacology and delivery.

Hendley TM, Hersh EV, Moore PA, Stahl B, Saraghi M.

Gen Dent. 2017 May-Jun;65(3):18-21. No abstract available.

Comment: Can’t access.

22) Drug users’ experiences of witnessing overdoses: what do they know and what do they need to know?

Best D, Man LH, Gossop M, Noble A, Strang J.

Drug Alcohol Rev. 2000 Dec;19(4):407-412. doi: 10.1080/713659420.

Comment: Drug users are interested in overdose prevention…

23) Correction: Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal.

Ann Intern Med. 2017 May 2;166(9):687. doi: 10.7326/M17-0652. No abstract available.

Comment: This is a small correction in one of the appendix tables from the Coffin cost-effectiveness paper. There was an error in Appendix Table 3, where the total number of overdose events was overcounted. The correction is in the online table only:

24) Naloxone rescheduling in Australia: Processes, implementation and challenges with supply of naloxone as a ‘pharmacist only’ over-the-counter medicine.

Pricolo A, Nielsen S.

Drug Alcohol Rev. 2017 Apr 27. doi: 10.1111/dar.12547. [Epub ahead of print]

Comment: Overcomes the standing order barrier that the U.S. has.

25) Supervised dosing with a long-acting opioid medication in the management of opioid dependence.

Saulle R, Vecchi S, Gowing L.

Cochrane Database Syst Rev. 2017 Apr 27;4:CD011983. doi: 10.1002/14651858.CD011983.pub2. Review.

Comment: Not much data comparing supervised to unsupervised dosing.

26) Pharmacokinetics after a single dose of naloxone administered as a nasal spray in healthy volunteers.

Vanky E, Hellmundt L, Bondesson U, Eksborg S, Lundeberg S.

Acta Anaesthesiol Scand. 2017 Jul;61(6):636-640. doi: 10.1111/aas.12898. Epub 2017 Apr 25.

Comment: Using a 0.4mg/mL formulation intranasally (which nobody uses), uptake was fast and concentration highly variable.

27) Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

Wiessing L, Ferri M, Běláčková V, Carrieri P, Friedman SR, Folch C, Dolan K, Galvin B, Vickerman P, Lazarus JV, Mravčík V, Kretzschmar M, Sypsa V, Sarasa-Renedo A, Uusküla A, Paraskevis D, Mendão L, Rossi D, van Gelder N, Mitcheson L, Paoli L, Gomez CD, Milhet M, Dascalu N, Knight J, Hay G, Kalamara E, Simon R; EUBEST working group, Comiskey C, Rossi C, Griffiths P.

Harm Reduct J. 2017 Apr 22;14(1):19. doi: 10.1186/s12954-017-0141-6.

Comment: Really cool set of best practice indicators.

28) Pharmacokinetics of concentrated naloxone nasal spray over first 30 minutes post-dosing: analysis of suitability for opioid overdose reversal.

Mundin G, McDonald R, Smith K, Harris S, Strang J.

Addiction. 2017 Apr 21. doi: 10.1111/add.13849. [Epub ahead of print]

Comment: Concentrated nasal naloxone pk data.

29) Expanding access to naloxone for family members: The Massachusetts experience.

Bagley SM, Forman LS, Ruiz S, Cranston K, Walley AY.

Drug Alcohol Rev. 2017 Apr 20. doi: 10.1111/dar.12551. [Epub ahead of print]

Comment: Good experience.

30) Peripartum Anesthetic Management of the Opioid-tolerant or Buprenorphine/Suboxone-dependent Patient.

Pan A, Zakowski M.

Clin Obstet Gynecol. 2017 Jun;60(2):447-458. doi: 10.1097/GRF.0000000000000288.

Comment: As above.

31) Assessing causality in drug policy analyses: How useful are the Bradford Hill criteria in analysing take-home naloxone programs?

Olsen A, McDonald D, Lenton S, Dietze PM.

Drug Alcohol Rev. 2017 Apr 18. doi: 10.1111/dar.12523. [Epub ahead of print]

Comment: There’s more than Bradford Hill criteria supporting naloxone. Very little we do in medicine has RCT data.

32) Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations.

Nadpara PA, Joyce AR, Murrelle EL, Carroll NW, Carroll NV, Barnard M, Zedler BK.

Pain Med. 2017 Apr 13. doi: 10.1093/pm/pnx038. [Epub ahead of print]

Comment: Risk factors were similar in the two populations, including substance use disorder, depression, other mental health disorders, organ dysfunction, higher doses, fentanyl/morphine/methadone, and other psychoactive medications.

33) Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015.

Stopka TJ, Donahue A, Hutcheson M, Green TC.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S34-S44. doi: 10.1016/j.japh.2016.12.077. Epub 2017 Feb 8.

Comment: 45% of surveyed pharmacies stocked naloxone.

34) Underestimated impact of novel psychoactive substances: laboratory confirmation of recreational drug toxicity in Oslo, Norway.

Vallersnes OM, Persett PS, Øiestad EL, Karinen R, Heyerdahl F, Hovda KE.

Clin Toxicol (Phila). 2017 Apr 13:1-9. doi: 10.1080/15563650.2017.1312002. [Epub ahead of print]

Comment: There are drug fads, but there are core drugs that dominate the scene and tend to stick around.

35) Naloxone Administration for Opioid Overdose Reversal in the Prehospital Setting: Implications for Pharmacists.

Weaver L, Palombi L, Bastianelli KM.

J Pharm Pract. 2017 Jan 1:897190017702304. doi: 10.1177/0897190017702304. [Epub ahead of print]

Comment: Information on naloxone formulations for pharmacists.

36) Scotland’s national naloxone program: The prison experience.

Horsburgh K, McAuley A.

Drug Alcohol Rev. 2017 Apr 10. doi: 10.1111/dar.12542. [Epub ahead of print]

Comment: Implementation challenges.

37) How Would You Manage Opioid Use in These Three Patients?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Alford DP, Cohen ML, Reynolds EE.

Ann Intern Med. 2017 Apr 4;166(7):506-513. doi: 10.7326/M17-0287.

Comment: Case review for clinicians.

38) Institutional Substance Use Disorder Intervention Improves General Internist Preparedness, Attitudes, and Clinical Practice.

Wakeman SE, Kanter GP, Donelan K.

J Addict Med. 2017 Apr 3. doi: 10.1097/ADM.0000000000000314. [Epub ahead of print]

Comment: Not so long ago, a physician was on their own in treating diabetes.
They had a ton of medications, so the situation was better than for most substance use disorders. But they didn’t have nutritionists and other services to round off care and ensure patients were well taken care of; it was tough and often dissatisfying. Now they have more wraparound services. Do it for substance use disorders and you get a similar improvement in satisfaction all around.

39) Proceedings from Bridging Health Disparities to Address the Opioid Epidemic: A Symposium at the Warren Alpert Medical School of Brown University.

Dumenco L, Monteiro K, Mello M, Collins S, Operario D, Scanlan K, Dollase R, George P.

R I Med J (2013). 2017 Apr 3;100(4):16-18.

Comment: Addressing the Rhode Island crisis.

40) When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications.

Rech MA, Barbas B, Chaney W, Greenhalgh E, Turck C.

Ann Emerg Med. 2017 Mar 25. pii: S0196-0644(17)30194-4. doi: 10.1016/j.annemergmed.2017.02.015.

Comment: Naloxone, fentanyl, and midazolam are often used intranasal in emergency settings.

41) Buprenorphine physician supply: Relationship with state-level prescription opioid mortality.

Knudsen HK, Havens JR, Lofwall MR, Studts JL, Walsh SL.

Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S55-S64. doi: 10.1016/j.drugalcdep.2016.08.642.

Comment: these ecologic studies are hard to interpret.

42) Randomized controlled trial of a computerized opioid overdose education intervention.

Dunn KE, Yepez-Laubach C, Nuzzo PA, Fingerhood M, Kelly A, Berman S, Bigelow GE.

Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S39-S47. doi: 10.1016/j.drugalcdep.2016.12.003.

Comment: Interesting data from an online training

43) Development of a targeted naloxone coprescribing program in a primary care practice.

Wilson CG, Rodriguez F, Carrington AC, Fagan EB.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S130-S134. doi: 10.1016/j.japh.2016.12.076. Epub 2017 Feb 9.

Comment: Chart review identified a large number of patients eligible for naloxone and only about 3% had the medication on their med list.

44) Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies – United States, 2007-2014.

Faul M, Bohm M, Alexander C.

MMWR Morb Mortal Wkly Rep. 2017 Mar 31;66(12):320-323. doi: 10.15585/mmwr.mm6612a2.

Comment: As we shifted away from methadone for pain, there were fewer methadone deaths. I’m think deck chairs, Titanic …

45) Use of Intranasal Naloxone by Basic Life Support Providers.

Weiner SG, Mitchell PM, Temin ES, Langlois BK, Dyer KS.

Prehosp Emerg Care. 2017 May-Jun;21(3):322-326. doi: 10.1080/10903127.2017.1282562. Epub 2017 Feb 6.

Comment: BLS naloxone is a good thing.

46) Knowledge of Opioid Overdose and Attitudes to Supply of Take-Home Naloxone Among People with Chronic Noncancer Pain Prescribed Opioids.

Nielsen S, Peacock A, Lintzeris N, Bruno R, Larance B, Degenhardt L.

Pain Med. 2017 Mar 13. doi: 10.1093/pm/pnx021. [Epub ahead of print]

Comment: 14% had experienced overdose symptoms They liked the idea of naloxone but didn’t know much about overdose.

47) Physician Dispensing of Oxycodone and Other Commonly Used Opioids, 2000-2015, United States.

Mack KA, Jones CM, McClure RJ.

Pain Med. 2017 Mar 15. doi: 10.1093/pm/pnx007. [Epub ahead of print]

Comment: Radical shifts in direct dispensing of opioids, particularly in Florida. Wow.

48) Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico.

Meacham MC, Roesch SC, Strathdee SA, Lindsay S, Gonzalez-Zuniga P, Gaines TL.

Drug Alcohol Rev. 2017 Mar 24. doi: 10.1111/dar.12524. [Epub ahead of print]

Comment: Polydrug use (and polyroute) and HIV & overdose risk.

49) Revisiting the ‘paradigm shift’ in opioid use: Developments and implications 10 years later.

Fischer B, Rehm J.

Drug Alcohol Rev. 2017 Mar 23. doi: 10.1111/dar.12539. [Epub ahead of print]

Comment: This is an interesting one. The authors describe the situation well. The interesting part, however, is that they write “little did we know” how bad it was going to get. Well … the piece they refer to was written by them in 2009 (Thinking the unthinkable: could the increasing misuse of prescription opioids among street drug users offer benefits for public health? Public Health. 2009). In that same issue, I wrote a companion piece in which I disagreed with their thesis that overprescribing opioids could be a good thing and emphasized the need to respond to the overdose epidemic (Balancing the costs and benefits of opioid analgesics in the United States. Public Health. 2009). My point is that, certainly by 2009, we did know.

50) No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone.

Jones JD, Campbell A, Metz VE, Comer SD.

Addict Behav. 2017 Mar 9;71:104-106. doi: 10.1016/j.addbeh.2017.03.008. [Epub ahead of print]

Comment: The best study to-date demonstrating the lack of risk compensation associated with naloxone provision.

51) Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern.

Al-Tayyib A, Koester S, Langegger S, Raville L.

Subst Use Misuse. 2017 Mar 21:1-8. doi: 10.1080/10826084.2016.1271432. [Epub ahead of print]

Comment: Methamphetamine has largely replaced cocaine as the stimulant injected alongside heroin in much of the U.S. There are suggestions that the apparent role of cocaine in contributing to heroin overdose may also apply to methamphetamine.

52) Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study.

Abrahamsson T, Berge J, Öjehagen A, Håkansson A.

Drug Alcohol Depend. 2017 Feb 28;174:58-64. doi: 10.1016/j.drugalcdep.2017.01.013. [Epub ahead of print]

Comment: Sedating drugs are associated with mortality in methadone patients. It’s important to ask, however, the mechanism of this. Those in need of these medications may simply be at higher risk of death. In the absence of randomized trial data, it is hard to rule out such a confounder – see paper #16 however, which gets pretty close.

53) The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy.

Faulkner-Gurstein R.

Soc Sci Med. 2017 Mar 9;180:20-27. doi: 10.1016/j.socscimed.2017.03.013. [Epub ahead of print]

Comment: The utilization of the context of drug use as an opportunity for intervention.

54) Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings.

Brinkley-Rubinstein L, Cloud DH, Davis C, Zaller N, Delany-Brumsey A, Pope L, Martino S, Bouvier B, Rich J.

Int J Prison Health. 2017 Mar 13;13(1):25-31. doi: 10.1108/IJPH-08-2016-0039.

Comment: Yup.

55) Body pushing, prescription drugs and hospital admission.

Byard RW, Kenneally M.

Forensic Sci Med Pathol. 2017 Mar 15. doi: 10.1007/s12024-017-9855-8. [Epub ahead of print]

Comment: Authors suggest that the patient intended to overdose and get admitted to a secure psychiatric facility, with pills stored in the rectum for use while in the facility, but died by accident.

56) Medicalizing the Opioid Epidemic in the U.S. in the Era of Health Care Reform.

Smith DE.

J Psychoactive Drugs. 2017 Mar 15:1-7. doi: 10.1080/02791072.2017.1295334. [Epub ahead of print]

Comment: Challenges.

57) Naloxone for Outpatients at Risk of Opioid Overdose #328.

Chwistek M, Wolf M.

J Palliat Med. 2017 Mar 15. doi: 10.1089/jpm.2017.0087. [Epub ahead of print] No abstract available.

Comment: A summary of co-prescribing for palliative care providers.

58) Primary care management of opioid use disorders: Abstinence, methadone, or buprenorphine-naloxone?

Srivastava A, Kahan M, Nader M.

Can Fam Physician. 2017 Mar;63(3):200-205. Review.

Comment: Agonist treatment is more effective.

59) Pharmacy-based statewide naloxone distribution: A novel “top-down, bottom-up” approach.

Morton KJ, Harrand B, Floyd CC, Schaefer C, Acosta J, Logan BC, Clark K.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S99-S106.e5. doi: 10.1016/j.japh.2017.01.017.

Comment: Great program they describe, but not clear if the claims for naloxone were related to direct provision from pharmacy or an increase in prescriptions from physicians and mid-level providers. Also the increase in provision was co-incident with the availability of the new nasal naloxone that made provision easier.

60) Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration’s national program.

Oliva EM, Christopher ML, Wells D, Bounthavong M, Harvey M, Himstreet J, Emmendorfer T, Valentino M, Franchi M, Goodman F, Trafton JA; Veterans Health Administration Opioid Overdose Education and Naloxone Distribution National Support and Development Workgroup..

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S168-S179.e4. doi: 10.1016/j.japh.2017.01.022.

Comment: 39,000 VA patients got naloxone by the end of 2016. Seriously impressive work by those who coordinated the project and the many VA providers.

61) Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone.

Duvivier H, Gustafson S, Greutman M, Jangchup T, Harden AK, Reinhard A, Warshany K.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S135-S140. doi: 10.1016/j.japh.2017.01.005.

Comment: More on pharmacists and opioid safety/naloxone.

62) Overdose Education and Naloxone Distribution Program Attendees: Who Attends, What Do They Know, and How Do They Feel?

Heavey SC, Burstein G, Moore C, Homish GG.

J Public Health Manag Pract. 2017 Mar 1. doi: 10.1097/PHH.0000000000000538. [Epub ahead of print]

Comment: Can only access abstract, but looks like they did surveys and follow ups for trainees in a naloxone program in Erie County NY. They found that a lot of trainees were family rather than drug users themselves.

63) Drug Overdose Deaths in the United States, 1999-2015.

Hedegaard H, Warner M, Minino AM.

NCHS Data Brief. 2017 Feb;(273):1-8.

Comment: Deaths from stimulants and all classes of opioids, with the exception of methadone, have been increasing since 2010.

64) Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision.

Barry T, Klimas J, Tobin H, Egan M, Bury G.

Br J Gen Pract. 2017 Apr;67(657):e267-e273. doi: 10.3399/bjgp17X689857. Epub 2017 Feb 28.

Comment: In Ireland, 75% of general practitioners had patients who used illicit opioids, 25% provided methadone treatment, and two-thirds supported increased access to naloxone.

65) Public sector low threshold office-based buprenorphine treatment: outcomes at year 7.

Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD.

Addict Sci Clin Pract. 2017 Feb 28;12(1):7. doi: 10.1186/s13722-017-0072-2.

Comment: Home inductions with buprenorphine lead to similar outcomes as in-clinic efforts. This is a big deal as in-clinic inductions are a barrier to broadening the base of providers willing to address the – largely iatrogenic – opioid epidemic.

66) Mortality trends among heroin users treated between 1975 and 2013 in Northern Italy: Results of a longitudinal study.

Pavarin RM, Fioritti A, Sanchini S.

J Subst Abuse Treat. 2017 Feb 23. pii: S0740-5472(16)30376-2. doi: 10.1016/j.jsat.2017.02.009. [Epub ahead of print]

Comment: HIV, overdose, and liver disease. The age range in which heroin users die at the most increased rate relative to the general population is 25-34 years.

67) Implementing an overdose education and naloxone distribution program in a health system.

Devries J, Rafie S, Polston G.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S154-S160. doi: 10.1016/j.japh.2017.01.002. Epub 2017 Feb 21.

Comment: UC San Diego, implemented electronic health record alert, saw an increase from 4.5 to 46 naloxone prescriptions per month.

68) Overdose Risk in Young Children of Women Prescribed Opioids.

Finkelstein Y, Macdonald EM, Gonzalez A, Sivilotti ML, Mamdani MM, Juurlink DN; Canadian DrugSafety And Effectiveness Research Network (CDSERN)..

Pediatrics. 2017 Mar;139(3). pii: e20162887. doi: 10.1542/peds.2016-2887. Epub 2017 Feb 20.

Comment: If you have opioids in the house, you should have naloxone there too.

69) [Misuse and dependence on prescription opioids: Prevention, identification and treatment].

Rolland B, Bouhassira D, Authier N, Auriacombe M, Martinez V, Polomeni P, Brousse G, Schwan R, Lack P, Bachellier J, Rostaing S, Bendimerad P, Vergne-Salle P, Dematteis M, Perrot S.

Rev Med Interne. 2017 Feb 14. pii: S0248-8663(17)30021-8. doi: 10.1016/j.revmed.2016.12.024. [Epub ahead of print] French.

Comment: Just as complicated in French as in English.

70) Implementing take-home naloxone in an urban community pharmacy.

Akers JL, Hansen RN, Oftebro RD.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S161-S167. doi: 10.1016/j.japh.2017.01.006. Epub 2017 Feb 13.

Comment: Process outcomes.

71) Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12.

Hsu DJ, McCarthy EP, Stevens JP, Mukamal KJ.

Addiction. 2017 Feb 13. doi: 10.1111/add.13795. [Epub ahead of print]

Comment: Rising.

72) Strategies and policies to address the opioid epidemic: A case study of Ohio.

Penm J, MacKinnon NJ, Boone JM, Ciaccia A, McNamee C, Winstanley EL.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S148-S153. doi: 10.1016/j.japh.2017.01.001. Epub 2017 Feb 8.

Comment: Challenges.

73) A nationwide pharmacy chain responds to the opioid epidemic.

Shafer E, Bergeron N, Smith-Ray R, Robson C, O’Koren R.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S123-S129. doi: 10.1016/j.japh.2016.12.075. Epub 2017 Feb 3.

Comment: Drug disposal, naloxone, patient education.

74) Epidemiology of naloxone use for opioid overdose in a tertiary care medical center.

Rudd-Barnard G, Pangarkar S, Moaleji N, Glassman P.

J Pain. 2016 Apr;17(4S):S11. doi: 10.1016/j.jpain.2016.01.044. Epub 2016 Mar 24. No abstract available.

Comment: Some largely inpatient data on naloxone use.

75) Development and delivery of a pharmacist training program to increase naloxone access in Kentucky.

Palmer E, Hart S, Freeman PR.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S118-S122. doi: 10.1016/j.japh.2016.12.071. Epub 2017 Feb 1.

Comment: Increased number of pharmacists that have gotten certified to dispense naloxone under a physician protocol.

76) Does exposure to opioid substitution treatment in prison reduce the risk of death after release? A national prospective observational study in England.

Marsden J, Stillwell G, Jones H, Cooper A, Eastwood B, Farrell M, Lowden T, Maddalena N, Metcalfe C, Shaw J, Hickman M.

Addiction. 2017 Feb 4. doi: 10.1111/add.13779. [Epub ahead of print]

Comment: Wow! Prison agonist treatment was associated with 75% reduction in all-cause death and 85% reduction in drug overdose death in the first month out of prison.

77) An interprofessional education workshop to develop health professional student opioid misuse knowledge, attitudes, and skills.

Monteiro K, Dumenco L, Collins S, Bratberg J, MacDonnell C, Jacobson A, Dollase R, George P.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S113-S117. doi: 10.1016/j.japh.2016.12.069. Epub 2017 Jan 31.

Comment: I’ve always felt that health professionals respond better to any disease where they learn interventions to treat it.

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

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

Clin Toxicol (Phila). 2017 Feb;55(2):81-87. doi: 10.1080/15563650.2016.1253846. Epub 2016 Nov 16. Review.

Comment: No.

79) The authors reply regarding “Do heroin overdose patients require observation after receiving naloxone?”

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

Clin Toxicol (Phila). 2017 Apr;55(4):309-310. doi: 10.1080/15563650.2017.1284337. Epub 2017 Feb 3. No abstract available.

Comment: Authors defend their conclusion that people who respond to naloxone given for presumed heroin overdose can safely refuse transport if there is no sign of returning opioid toxicity after an hour.

80) The Opioid Epidemic: What Does it Mean for Nurses?

Leahy LG.

J Psychosoc Nurs Ment Health Serv. 2017 Jan 1;55(1):18-23. doi: 10.3928/02793695-20170119-03.\

Comment: Medications to treat opioid use disorder.

81) A case of massive methadone overdose presented with refractory hypoglycemia.

Li AT, Chu FK.

Clin Toxicol (Phila). 2017 Mar;55(3):233. doi: 10.1080/15563650.2016.1277236. Epub 2017 Jan 24. No abstract available.

Comment: Fascinating. I love these case reports.

82) Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity.

Isbister GK, Heppell SP, Page CB, Ryan NM.

Clin Toxicol (Phila). 2017 Mar;55(3):187-192. doi: 10.1080/15563650.2016.1277234. Epub 2017 Jan 20.

Comment: Again, case reports are fascinating.

83) Prescription drug abuse – A timely update.

Monheit B, Pietrzak D, Hocking S.

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

Comment: Review for Australian physicians.

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

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

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

Comment: Process outcomes.

85) Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

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

Acad Emerg Med. 2017 Apr;24(4):475-483. doi: 10.1111/acem.13121. Epub 2017 Mar 17.

Comment: ICD codes for opioid poisoning only identified 25% of opioid overdose events identified by clinical chart review, and naloxone administration didn’t help to refine that. Such a bummer that DAWN isn’t around anymore, because we just can’t get good enough substance use-related data from coding / big data – we need manual reviews.

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

Toce MS, Burns MM, O’Donnell KA.

Clin Toxicol (Phila). 2017 Jan;55(1):12-17. doi: 10.1080/15563650.2016.1244337. Epub 2016 Oct 19.

Comment: Most develop signs of toxicity within 8 hours of exposure.

87) President’s message: Food and Drug Administration approved naloxone and continued use of improvised nasal naloxone: What is a treatment advocate and educator to do?

Morrone WR.

J Addict Dis. 2016 Oct-Dec;35(4):339-345. No abstract available.

Comment: Can’t access.

88) Caring for patients with opioid use disorder in the hospital.

Donroe JH, Holt SR, Tetrault JM.

CMAJ. 2016 Dec 6;188(17-18):1232-1239. Epub 2016 Sep 19. Review. No abstract available.

Comment: We have treatments! Use them.

89) Five minutes with . . . Steve Rolles, drug policy analyst.

Gulland A.

BMJ. 2016 Sep 14;354:i4930. doi: 10.1136/bmj.i4930. No abstract available.

Comment: Focus on public health.

90) Combating Opioid Overdose With Public Access to Naloxone.

Mitchell KD, Higgins LJ.

J Addict Nurs. 2016 Jul-Sep;27(3):160-79. doi: 10.1097/JAN.0000000000000132. Review.

Comment: Can’t access.

91) A case of U-47700 overdose with laboratory confirmation and metabolite identification.

Jones MJ, Hernandez BS, Janis GC, Stellpflug SJ.

Clin Toxicol (Phila). 2017 Jan;55(1):55-59. doi: 10.1080/15563650.2016.1209767. Epub 2016 Aug 23. Erratum in: Clin Toxicol (Phila). 2017 Jan;55(1):76.

Comment: Responded to naloxone in the field.

92) Will Adding Methadone to Controlled Substance Monitoring Programs Help Psychiatrists Prevent Prescription Drug Overdoses?

DiPrinzio D, Sethi R.

Prim Care Companion CNS Disord. 2016 Apr 7;18(2). doi: 10.4088/PCC.15l01871. eCollection 2016. No abstract available.

Comment: Authors argue that methadone used in opioid use disorder treatment should show up in prescription drug monitoring programs. As an individual clinician, that would be helpful for me. However, the stigma around opioid use disorder treatment is still massive.

93) The pharma-fever that almost got away.

Zhang XC, Siket M, Binder W.

R I Med J (2013). 2016 Jul 1;99(7):29-31. No abstract available.

Comment: Can’t access.

94) Opioid Use Disorders.

Sharma B, Bruner A, Barnett G, Fishman M.

Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87. doi: 10.1016/j.chc.2016.03.002. Epub 2016 Apr 9. Review.

Comment: A review.

95) Weighing the Risks and Benefits of Chronic Opioid Therapy.

Lembke A, Humphreys K, Newmark J.

Am Fam Physician. 2016 Jun 15;93(12):982-90.

Comment: Again, this is so complicated.

96) Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme.

Tjagvad C, Skurtveit S, Linnet K, Andersen LV, Christoffersen DJ, Clausen T.

Eur Addict Res. 2016;22(5):249-58. doi: 10.1159/000446429. Epub 2016 Jun 1.

Comment: This is difficult to tease out, as liberal methadone can reach the highest risk persons, who would also have a higher risk of death.

Fentanyl:

97) Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Moore PQ, Weber J, Cina S, Aks S.

Am J Emerg Med. 2017 May 8. pii: S0735-6757(17)30367-4. doi: 10.1016/j.ajem.2017.05.003. [Epub ahead of print]

Comment: Other studies have found these data to have real limitations, but in general they should pick up on large trends. The other issue is that lay naloxone responders may not call EMS after a successful reversal, so a community with excellent naloxone coverage may not experience EMS upticks in the context of a small outbreak.

98) Characteristics of Fentanyl Overdose – Massachusetts, 2014-2016.

Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, Ruiz S, Babakhanlou-Chase H, Chan M, Callis BP, Kuramoto-Crawford J, Nields HM, Walley AY.

MMWR Morb Mortal Wkly Rep. 2017 Apr 14;66(14):382-386. doi: 10.15585/mmwr.mm6614a2.

Comment: Just read it. It’s too important to summarize.

99) Fentanyl laced heroin and its contribution to a spike in heroin overdose in Miami-Dade County.

Bode AD, Singh M, Andrews J, Kapur GD, Baez AA.

Am J Emerg Med. 2017 Feb 28. pii: S0735-6757(17)30158-4. doi: 10.1016/j.ajem.2017.02.043. [Epub ahead of print] No abstract available.

Comment: Authors report increased opioid overdose and a greater increase in naloxone, arguing that this means the increase was likely driven by fentanyl. I’m not sure I buy this analysis, in part because of some basic math errors (e.g. “The greatest increase in OOD was observed during the month of September with 65 cases in 2015 and 266 cases in 2016 (182% [sic – should read 326%]) (Fig. 1a/Table 1). The number of naloxone vials used from July–September rose from 212 in 2015 to 1221 in 2016, a 476% increase (Table 2a).” The analysis also doesn’t account for the number of naloxone doses actually used on individual cases (not all naloxone administrations are coded as overdose events).

100) Increase in Drug Overdose Deaths Involving Fentanyl-Rhode Island, January 2012-March 2014.

Mercado MC, Sumner SA, Spelke MB, Bohm MK, Sugerman DE, Stanley C.

Pain Med. 2017 Mar 6. doi: 10.1093/pm/pnx015. [Epub ahead of print]

Comment: Ugh.

101) Addressing the Fentanyl Threat to Public Health.

Frank RG, Pollack HA.

N Engl J Med. 2017 Feb 16;376(7):605-607. doi: 10.1056/NEJMp1615145. No abstract available.

Comment: Nope, still don’t like street use of fentanyl.

102) High Concomitant Misuse of Fentanyl in Subjects on Opioid Maintenance Treatment.

Krause D, Plörer D, Koller G, Martin G, Winter C, Adam R, Canolli M, Al-Iassin J, Musselmann R, Walcher S, Schäfer F, Pogarell O.

Subst Use Misuse. 2017 Apr 16;52(5):639-645. doi: 10.1080/10826084.2016.1246571. Epub 2017 Feb 3.

Comment: Interesting – high rates of fentanyl use in a population of users in Munich, Germany.

103) Multiple Fentanyl Overdoses – New Haven, Connecticut, June 23, 2016.

Tomassoni AJ, Hawk KF, Jubanyik K, Nogee DP, Durant T, Lynch KL, Patel R, Dinh D, Ulrich A, D’Onofrio G.

MMWR Morb Mortal Wkly Rep. 2017 Feb 3;66(4):107-111. doi: 10.15585/mm6604a4.

Comment: Again, just read it.

104) Illicit Fentanyl-Related Fatalities in Florida: Toxicological Findings.

Lee D, Chronister CW, Broussard WA, Utley-Bobak SR, Schultz DL, Vega RS, Goldberger BA.

J Anal Toxicol. 2016 Oct;40(8):588-594.

Comment: Lots of it.

105) Fentanyl misuse.

Ruzycki S, Yarema M.

CMAJ. 2016 Jun 14;188(9):673. doi: 10.1503/cmaj.151378. Epub 2016 Apr 18. No abstract available.

Comment: Brief overview.

Injection Facilities

106) Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility.

Irwin A, Jozaghi E, Weir BW, Allen ST, Lindsay A, Sherman SG.

Harm Reduct J. 2017 May 12;14(1):29. doi: 10.1186/s12954-017-0153-2.

Comment: The data support these facilities as an important element of the overdose response.

107) Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study.

Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD.

Harm Reduct J. 2017 Feb 20;14(1):13. doi: 10.1186/s12954-017-0139-0.

Comment: The opioid users who could most benfit from an injection facility are the most likely to want to use an injection facility.

108) Another Senseless Death – The Case for Supervised Injection Facilities.

Wakeman SE.

N Engl J Med. 2017 Mar 16;376(11):1011-1013. doi: 10.1056/NEJMp1613651. No abstract available.

Comment: See title.