PubMed Update August 2013

16 papers today – this is getting to be a big job. Naloxone, fentanyl, methadone, stars, pain, Central Asia, primary care, injection facilities, personal stories …

1) Notes from the field: acetyl fentanyl overdose fatalities – rhode island, march-may 2013.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2013 Aug 30;62(34):703-4.

Comment: The evidence of synthetic fentanyl was difficult to detect and concerning to many as heralding a possible repeat of the 2006/2007 fentanyl-tainted heroin overdose outbreak.

2) Methadone induced sensorineural hearing loss.

Saifan C, Glass D, Barakat I, El-Sayegh S.

Case Rep Med. 2013;2013:242730. doi: 10.1155/2013/242730. Epub 2013 Jul 29.

Comment: In this case the patient was restarted on methadone and the sensorineural hearing loss was permanent.

3) Opioids compared to placebo or other treatments for chronic low-back pain.

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

Cochrane Database Syst Rev. 2013 Aug 27;8:CD004959. doi:

Comment: There are no quality data to support long-term management of non-cancer pain with opioids.

4) Cory monteith dies of a heroin overdose at age 31.

Willens JS.

Pain Manag Nurs. 2013 Sep;14(3):125. doi: 10.1016/j.pmn.2013.07.004. No abstract available.

Comment: The Glee star.

5) Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran.

Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A.

Clin Toxicol (Phila). 2013 Aug 23. [Epub ahead of print]

Comment: Accidental poisonings among family in Iran for (insufficiently-labeled) take-home methadone syrup.

6) The epidemiology and management of adult poisonings admitted to the short-stay ward of a large Scottish emergency department.

Teo A, Cooper J.

Scott Med J. 2013 Aug;58(3):149-53. doi: 10.1177/0036933013496951.

Comment: I’m unable to access this paper. It’s a review of overdose events at a Scottish hospital; 4% were administered naloxone.

7) Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach.

Gilbert L, Primbetova S, Nikitin D, Hunt T, Terlikbayeva A, Momenghalibaf A, Ruziev M, El-Bassel N.

Drug Alcohol Depend. 2013 Aug 13. doi:pii: S0376-8716(13)00282-2.

Comment: A really interesting approach to thinking about HIV and drug overdose mortality, through the lens of syndemics – a hot topic in public health – and risk environments. With the bonus of an important review of data from several Central Asian states.

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

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

Acta Histochem. 2013 Aug 13. doi:pii: S0065-1281(13)00145-1.

Comment: Interesting analysis comparing heroin overdose patients to controls, although I’m unclear it’s direct relationship to the pathologic processes of overdose.

9) Associations Between Injection Risk and Community Disadvantage Among Suburban Injection Drug Users in Southwestern Connecticut, USA.

Heimer R, Barbour R, Palacios WR, Nichols LG, Grau LE.

AIDS Behav. 2013 Aug 7. [Epub ahead of print]

Comment: Intriguing paper on rural heroin use.

10) Non-Fatal Opioid Overdose and Major Depression among Street-Recruited Young Heroin Users.

Chahua M, Sordo L, Barrio G, Domingo-Salvany A, Brugal MT, Molist G, de la Fuente L, Bravo MJ.

Eur Addict Res. 2013 Aug 1;20(1):1-7. [Epub ahead of print]

Comment: There haven’t been many overdose studies out of Spain. Nice to see this.

11) Reducing the health consequences of opioid addiction in primary care.

Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD.

Am J Med. 2013 Jul;126(7):565-71. doi: 10.1016/j.amjmed.2012.11.031. Epub 2013 May 8. Review.

Comment: Kudos to the authors for getting out to primary care providers information on simple harm reduction practices that can be employed in clinical settings.

12) Opioid antagonists for pain.

Taylor R Jr, Pergolizzi JV Jr, Porreca F, Raffa RB.

Expert Opin Investig Drugs. 2013 Apr;22(4):517-25. doi: 10.1517/13543784.2013.778973. Review.

Comment: Fascinating paper on the analgesic properties of opioid ANTagonists.

13) Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?

Jozaghi E, Andresen MM.

Harm Reduct J. 2013 Feb 16;10:1. doi: 10.1186/1477-7517-10-1.

Comment: A discussion including the benefits of supervised injection facilities in reducing overdose deaths, sharing of injection equipment, public drug use, and utilization of emergency medical services.

14) Fentanyl-associated fatalities among illicit drug users in Wayne County, Michigan (July 2005-May 2006).

Algren DA, Monteilh CP, Punja M, Schier JG, Belson M, Hepler BR, Schmidt CJ, Miller CE, Patel M, Paulozzi LJ, Straetemans M, Rubin C.

J Med Toxicol. 2013 Mar;9(1):106-15. doi: 10.1007/s13181-012-0285-4.

Comment: A review of pathological details related to the tragic 2005-2007 fentanyl-tainted heroin outbreak.

15) ‘I saved a life’: a heroin addict’s reflections on managing an overdose using ‘take home naloxone’.

George S, Boulay S, Begley D.

BMJ Case Rep. 2010 Sep 7;2010. doi:pii: bcr0520102986.

Comment: A rare example in the medical literature, this paper includes several paragraphs of direct patient perspective on administering naloxone. Read the free full-text from BMJ.

16) Clinical safety of 1500 mg oral naltrexone overdose.

Reece AS.

BMJ Case Rep. 2010 Sep 7;2010. doi:pii: bcr0420102871. 10.1136/bcr.04.2010.2871. Review.

Comment: The hepatotoxicity concerns with naltrexone were based on doses of around 2 grams, which would be considered massive today.