1) Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS.

J Stud Alcohol Drugs. 2016 Sep;77(5):774-81.

Comments: Really interesting results with regard to methamphetamine – co-use of methamphetamine increased overdose risk in San Diego but not Tijuana, suggesting that risk may have been behavioral rather than pharmacologic.

2) 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.

Comments: Review of naloxone literature with an eye toward how it influences nursing.

3) Prescription opioids prior to injection drug use: Comparisons and public health implications.

Al-Tayyib AA, Koester S, Riggs P.

Addict Behav. 2016 Aug 19. pii: S0306-4603(16)30296-9. doi: 10.1016/j.addbeh.2016.08.016. [Epub ahead of print]

Comments: Those who initiated injection with prescription opioids were higher risk than those who started with heroin in the Denver Colorado’s NHBS cohort.

4) Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention.

Kirane H, Ketteringham M, Bereket S, Dima R, Basta A, Mendoza S, Hansen H.

J Subst Abuse Treat. 2016 Oct;69:44-9. doi: 10.1016/j.jsat.2016.07.005. Epub 2016 Jul 18.

Comments: Investigators asked patients and providers how they thought things *would* change if they gave/received naloxone kits and found quite a few thought use would increase. In contrast, looking at what “did” happen suggests the opposite (see next month’s PubMed Update).

5) Application of human factors engineering (HFE) to the design of a naloxone auto-injector for the treatment of opioid emergencies.

Raffa RB, Taylor R Jr, Pergolizzi JV Jr, Nalamachu S, Edwards ES, Edwards ET.

Drug Deliv Transl Res. 2016 Aug 25. [Epub ahead of print]

Comments: This is a paper about the naloxone auto-injector.

6) The paradox of decreasing nonmedical opioid analgesic use and increasing abuse or dependence – An assessment of demographic and substance use trends, United States, 2003-2014.

Jones CM.

Addict Behav. 2016 Aug 17. pii: S0306-4603(16)30306-9. doi: 10.1016/j.addbeh.2016.08.027. [Epub ahead of print]

Comments: We are not nearly out of the woods yet.

7) Increases in Fentanyl-Related Overdose Deaths – Florida and Ohio, 2013-2015.

Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, Halpin J, Zibbell J, McCarty CL, DeFiore-Hyrmer J, DiOrio M, Goldberger BA.

MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):844-9. doi: 10.15585/mmwr.mm6533a3.

Comments: Ugh.

8) Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid-Involved OverdoseDeaths – 27 States, 2013-2014.

Gladden RM, Martinez P, Seth P.

MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):837-43. doi: 10.15585/mmwr.mm6533a2.

Comments: Ugh.

9) OPAL: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain. Trial protocol.

Lin CW, McLachlan AJ, Latimer J, Day RO, Billot L, Koes BW, Maher CG.

BMJ Open. 2016 Aug 24;6(8):e011278. doi: 10.1136/bmjopen-2016-011278.

Comments: Interesting study protocol. Worthwhile effort.

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

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

Clin Toxicol (Phila). 2016 Aug 23:1-5. [Epub ahead of print]

Comments: U-47700 can be detected in serum and the demethylated metabolites in urine.

11) Talking about screening, brief intervention, and referral to treatment for adolescents: An upstream intervention to address the heroin and prescription opioid epidemic.

Harris BR.

Prev Med. 2016 Aug 18. pii: S0091-7435(16)30227-4. doi: 10.1016/j.ypmed.2016.08.022. [Epub ahead of print]

Comments: SBIRT for adolescents. I’m mixed on this as SBIRT hasn’t fared so well in recent studies.

12) Development of a Proto-Typology of Opiate Overdose Onset.

Neale J, Bradford J, Strang J.

Addiction. 2016 Aug 20. doi: 10.1111/add.13589. [Epub ahead of print]

Comments: Totally fascinating and much needed work to elucidate different typologies of overdose.

13) Non-accidental non-fatal poisonings attended by emergency ambulance crews: an observational study of data sources and epidemiology.

John A, Okolie C, Porter A, Moore C, Thomas G, Whitfield R, Oretti R, Snooks H.

BMJ Open. 2016 Aug 18;6(8):e011049. doi: 10.1136/bmjopen-2016-011049.

Comments: Review of ambulance calls for poisoning in Wales.

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

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

J Addict Med. 2016 Aug 11. [Epub ahead of print]

Comments: A discussion of a case. Can’t access.

15) NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale.

Lee JD, Nunes EV, Mpa PN, Bailey GL, Brigham GS, Cohen AJ, Fishman M, Ling W, Lindblad R, Shmueli-Blumberg D, Stablein D, May J, Salazar D, Liu D, Rotrosen J.

Contemp Clin Trials. 2016 Aug 10. pii: S1551-7144(16)30202-6. doi: 10.1016/j.cct.2016.08.004. [Epub ahead of print]

Comments: Title says it all.

16) Commentary on Darke & Duflou (2016): Heroin-related deaths-identifying a window for intervention.

Tas B, McDonald R.

Addiction. 2016 Sep;111(9):1614-5. doi: 10.1111/add.13467. No abstract available.

Comments: Really interesting commentary addressing multiple possible implications of the cited article, which was discussed in a prior PubMed Update.

17) Addiction classics: Heroin overdose.

Darke S.

Addiction. 2016 Aug 10. doi: 10.1111/add.13516. [Epub ahead of print] Review.

Comments: Thanks to the author for reminding us where the current thinking about overdose emerged – since the 1970s there have been investigators proposing the tenets that currently serve as the foundation for our understanding of the field.

18) The Opioid Crisis and the Physician’s Role in Contributing to its Resolution: Step One–Prevention of Overdoses.

Wolfe S, Bouffard DL, Modesto-LoweE V.

Conn Med. 2016 Jun-Jul;80(6):325-34. Review.

Comments: Can’t access the paper, but appears to review for primary care providers the role of overdose prevention education and naloxone.

19) Recognition and response to opioid overdose deaths-New Mexico, 2012.

Levy B, Spelke B, Paulozzi LJ, Bell JM, Nolte KB, Lathrop S, Sugerman DE, Landen M.

Drug Alcohol Depend. 2016 Aug 3. pii: S0376-8716(16)30208-3. doi: 10.1016/j.drugalcdep.2016.07.011. [Epub ahead of print]

Comments: Interesting comparison of heroin to other opioid (OPR) deaths. OPR deaths were more likely to have multiple co-morbidities and prescribed polypharmacy. OPR detahs were just as likely to be witnessed (71.8% for OPR vs 74.5% for heroin), although more likely to be described as “abnormal drowsiness” and “snoring” for OPR than heroin. EMS was just as likely to be called to the scene and naloxone was half as likely to be given by paramedics for OPR vs heroin deaths. Drug paraphernalia or signs of injection were less likely in OPR deaths.

20) An autopsy case of acetyl fentanyl intoxication caused by insufflation of ‘designer drugs’.

Takase I, Koizumi T, Fujimoto I, Yanai A, Fujimiya T.

Leg Med (Tokyo). 2016 Jul;21:38-44. doi: 10.1016/j.legalmed.2016.05.006. Epub 2016 May 18.

Comments: Snored for 12 hours before being attended to.

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

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

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

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

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

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

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

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

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

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

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

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

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

Darke S, Farrell M.

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

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

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

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

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

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

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

Tait RJ, Lenton S.

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

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

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

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

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

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

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

Bennett T, Holloway K, Bird SM.

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

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

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

Handley SA, Flanagan RJ.

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

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

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

Stavseth LS, Kunøe N, Tanum L.

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

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