PubMed Update December 2018

33 new papers in December 2018. Lots of focus on naloxone, as well as some interesting pieces on national policy and the unintended consequences of the opioid stewardship initiatives. A bit late with this one, so expect January shortly!

1) Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History.

Abbasi AB, Salisbury-Afshar E, Jovanov D, Berberet C, Arunkumar P, Aks SE, Layden JE, Pho MT.

J Urban Health. 2019 Jan 3. doi: 10.1007/s11524-018-00329-x. [Epub ahead of print]

Comment: We’ve been losing people to overdose for much longer than the overprescribing issue. Hopefully the type of work this paper represents will help support a longterm emphasis on overdose prevention. About 1 in 3 decedents had not received any opioid prescription in the past 6 years. These individuals were more likely to be racial/ethnic minorities and urban, and less likely to have contact with the healthcare system or receive buprenorphine treatment.

2) Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017.

Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G.

MMWR Morb Mortal Wkly Rep. 2018 Jan 4;67(5152):1419-1427. doi: 10.15585/mmwr.mm675152e1.

Comment: Yup, things kept getting worse through 2017. Most people suspect that 2017 was a peak, that 2018 will be a (statistical) plateau, and that numbers may start to improve but we have a long way to go.

3) Wound Botulism Outbreak Among Persons Who Use Black Tar Heroin – San Diego County, California, 2017-2018.

Peak CM, Rosen H, Kamali A, Poe A, Shahkarami M, Kimura AC, Jain S, McDonald E.

MMWR Morb Mortal Wkly Rep. 2019 Jan 4;67(5152):1415-1418. doi: 10.15585/mmwr.mm675152a3.

Comment: Wound botulism cases tend to come in clusters, suggesting that it is batches of black tar heroin contaminated with botulism (rather than, for example, injection practices exposing people to environmental botulism). This manuscript came up because of what the similarity in symptoms between botulism and several other conditions, including intoxication and poisoning.

4) Testing hair for fentanyl exposure: a method to inform harm reduction behavior among individuals who use heroin.

Palamar JJ, Salomone A, Bigiarini R, Vincenti M, Acosta P, Tofighi B.

Am J Drug Alcohol Abuse. 2019 Jan 2:1-7. doi: 10.1080/00952990.2018.1550652. [Epub ahead of print]

Comment: Interesting results.

5) The value of harm reduction for injection drug use: A clinical and public health ethics analysis.

Vearrier L.

Dis Mon. 2018 Dec 29. pii: S0011-5029(18)30161-5. doi: 10.1016/j.disamonth.2018.12.002. [Epub ahead of print]

Comment: “From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.”

6) Quality Assessment of Expired Naloxone Products from First-Responders’ Supplies.

Pruyn S, Frey J, Baker B, Brodeur M, Graichen C, Long H, Zheng H, Dailey MW.

Prehosp Emerg Care. 2018 Dec 30:1-7. doi: 10.1080/10903127.2018.1563257. [Epub ahead of print]

Comment: Naloxone lasts for 30 years. This is quite reassuring!

7) Urban-rural variation in the socioeconomic determinants of opioid overdose.

Pear VA, Ponicki WR, Gaidus A, Keyes KM, Martins SS, Fink DS, Rivera-Aguirre A, Gruenewald PJ, Cerdá M.

Drug Alcohol Depend. 2018 Dec 21;195:66-73. doi: 10.1016/j.drugalcdep.2018.11.024. [Epub ahead of print]

Comment: Economic disadvantage. Important work.

8) Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study.

Clemency BM, Eggleston W, Shaw EW, Cheung M, Pokoj NS, Manka MA, Giordano DJ, Serafin L, Yu H, Lindstrom HA, Hostler D.

Acad Emerg Med. 2019 Jan;26(1):7-15. doi: 10.1111/acem.13567. Epub 2018 Dec 28.

Comment: If patients had normal oxygen saturation, respiratory rate, temperature, heart rate, and Glasgow Coma Scale score at one hour, only 1 out of 538 was felt to benefit from additional naloxone.

9) Incidence of mortality due to rebound toxicity after ‘treat and release’ practices in prehospital opioid overdose care: a systematic review.

Greene JA, Deveau BJ, Dol JS, Butler MB.

Emerg Med J. 2018 Dec 22. pii: emermed-2018-207534. doi: 10.1136/emermed-2018-207534. [Epub ahead of print]

Comment: Release is quite safe, although data for long-acting opioid toxicity is minimal.

10) Assessment of medication for opioid use disorder as delivered within the Vermont hub and spoke system.

Rawson R, Cousins SJ, McCann M, Pearce R, Van Donsel A.

J Subst Abuse Treat. 2019 Feb;97:84-90. doi: 10.1016/j.jsat.2018.11.003. Epub 2018 Nov 19.

Comment: It works.

11) Documenting need for naloxone distribution in the Los Angeles County jail system.

Davidson PJ, Wagner KD, Tokar PL, Scholar S.

Addict Behav. 2018 Dec 12;92:20-23. doi: 10.1016/j.addbeh.2018.12.017. [Epub ahead of print]

Comment: About 2 in 5 inmates wanted training.

12) Investigating the Social Ecological Contexts of Opioid Use Disorder and Poisoning Hospitalizations in Pennsylvania.

Mair C, Sumetsky N, Burke JG, Gaidus A.

J Stud Alcohol Drugs. 2018 Nov;79(6):899-908.

Comment: Places with more manual labor had more opioid overdoses and denser populations had more heroin overdose.

13) Prescription-, Illicit-, and Self-Harm Opioid Overdose Cases Treated in Hospital.

Conner KR, Wiegand TJ, Kaukeinen K, Gorodetsky R, Schult R, Heavey SC.

J Stud Alcohol Drugs. 2018 Nov;79(6):893-898.

Comment: Interesting approach to the analysis.

14) Drug, Opioid-Involved, and Heroin-Involved Overdose Deaths Among American Indians and Alaska Natives – Washington, 1999-2015.

Joshi S, Weiser T, Warren-Mears V.

MMWR Morb Mortal Wkly Rep. 2018 Dec 21;67(50):1384-1387. doi: 10.15585/mmwr.mm6750a2.

Comment: Fascinating – lack of correct racial/ethnic identification by medical examiners led to a 40% underestimate of overdose mortality among American Indians and Alaska Natives.

15) Emergency Department and Hospital Care for Opioid Use Disorder: Implementation of Statewide Standards in Rhode Island, 2017-2018.

Samuels EA, McDonald JV, McCormick M, Koziol J, Friedman C, Alexander-Scott N.

Am J Public Health. 2019 Feb;109(2):263-266. doi: 10.2105/AJPH.2018.304847. Epub 2018 Dec 20.

Comment: Really amazing things have happened in Rhode Island.

16) State variation in opioid treatment policies and opioid-related hospital readmissions.

Blanchard J, Weiss AJ, Barrett ML, McDermott KW, Heslin KC.

BMC Health Serv Res. 2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8.

Comment: We are still early in understanding the utility of healthcare utilization data for opioid issues.

17) Shifting characteristics of nonmedical prescription tranquilizer users in the United States, 2005-2014.

Palamar JJ, Han BH, Martins SS.

Drug Alcohol Depend. 2018 Dec 8;195:1-5. doi: 10.1016/j.drugalcdep.2018.11.015. [Epub ahead of print]

Comment: There are real issues with trend analysis in the NSDUH, which largely missed increased use of opioids over the past 20 years.

18) Stakeholder perspectives on implementing fentanyl drug checking: Results from a multi-site study.

Glick JL, Christensen T, Nyeong Park J, McKenzie M, Green TC, Sherman SG.

Drug Alcohol Depend. 2019 Jan 1;194:527-532. doi: 10.1016/j.drugalcdep.2018.10.017. Epub 2018 Nov 13.

Comment: Most stakeholders think this is a good idea.

19) Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder.

Bagley SM, Cabral H, Saia K, Brown A, Lloyd-Travaglini C, Walley AY, Rose-Jacobs R.

Addict Sci Clin Pract. 2018 Dec 14;13(1):26. doi: 10.1186/s13722-018-0126-0.

Comment: Great to see overdose research reach into the population of pregnant women.

20) Evaluating the Impact of Prescribed Versus Nonprescribed Benzodiazepine Use in Methadone Maintenance Therapy: Results from a Population-based Retrospective Cohort Study.

Eibl JK, Wilton AS, Franklyn AM, Kurdyak P, Marsh DC.

J Addict Med. 2018 Dec 12. doi: 10.1097/ADM.0000000000000476. [Epub ahead of print]

Comment: Benzodiazapines for patients in methadone treatment … is a really complicated issue.

21) Pharmacotherapy for opioid addiction in community corrections.

Schwartz RP, Mitchell MM, O’Grady KE, Kelly SM, Gryczynski J, Mitchell SG, Gordon MS, Jaffe JH.

Int Rev Psychiatry. 2018 Dec 6:1-19. doi: 10.1080/09540261.2018.1524373. [Epub ahead of print]

Comment: Yes!

22) A Smarter War on Drugs.

Koh HK, Kerlikowske RG, Botticelli MP.

JAMA. 2018 Dec 11;320(22):2301-2302. doi: 10.1001/jama.2018.18397. No abstract available. 

Comment: The title seems an oxymoron, but there’s some good material inside.

23) Naloxone distribution, trauma, and supporting community-based overdose responders.

Shearer D, Fleming T, Fowler A, Boyd J, McNeil R.

Int J Drug Policy. 2018 Dec 5. pii: S0955-3959(18)30292-5. doi: 10.1016/j.drugpo.2018.11.008. [Epub ahead of print] No abstract available. 

Comment: This theme makes me think of that 1999 Nicolas Cage movie – Bringing Out the Dead. Caring for people who overdose can be traumatic, for sure.

24) Operation Naloxone: Overdose prevention service learning for student pharmacists.

Hill LG, Sanchez JP, Laguado SA, Lawson KA.

Curr Pharm Teach Learn. 2018 Oct;10(10):1348-1353. doi: 10.1016/j.cptl.2018.07.010. Epub 2018 Jul 24.

Comment: Training pharmacy students!

25) Commentary on Madah-Amiri et al. (2019): Beyond saturation.

Bennett AS, Elliott L, Wolfson-Stofko B.

Addiction. 2019 Jan;114(1):101-102. doi: 10.1111/add.14499. Epub 2018 Dec 5. No abstract available. 

Comment: Utilize people who sell drugs as naloxone distributors.

26) Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol.

Gisev N, Pearson SA, Dobbins T, Currow DC, Blyth F, Larney S, Dunlop A, Mattick RP, Wilson A, Degenhardt L.

BMJ Open. 2018 Dec 4;8(12):e025840. doi: 10.1136/bmjopen-2018-025840.

Comment: Protocol paper on a huge study in New South Wales following all residents prescribed an opioid – oh the power of database linkage.

27) Remission from chronic opioid use-Studying environmental and socio-economic factors on recovery (RECOVER): Study design and participant characteristics.

Ling W, Nadipelli VR, Ronquest NA, Albright VA, Aldridge AP, Learned SM, Mehra V, Heidbreder C.

Contemp Clin Trials. 2019 Jan;76:93-103. doi: 10.1016/j.cct.2018.11.015. Epub 2018 Nov 30.

Comment: Cohort of patients followed after participation in an injectable buprenorphine program. Less than a quarter had ever overdosed, suggesting a relatively low-risk population. 

28) Opioid-Related Harms: Simplistic Solutions to the Crisis Ineffective and Cause Collateral Damage.

Gallagher R.

Health Serv Insights. 2018 Nov 25;11:1178632918813321. doi: 10.1177/1178632918813321. eCollection 2018.

Comment: Yes.

29) Prevention and Treatment of Opioid Misuse and Addiction: A Review.

Volkow ND, Jones EB, Einstein EB, Wargo EM.

JAMA Psychiatry. 2018 Dec 5. doi: 10.1001/jamapsychiatry.2018.3126. [Epub ahead of print]

Comment: A nice companion to the article listed above.

30) Illicit fentanyls in the opioid street market: desired or imposed?

Mars SG, Rosenblum D, Ciccarone D.

Addiction. 2018 Dec 4. doi: 10.1111/add.14474. [Epub ahead of print]

Comment: The authors argue imposed, by market forces. 

31) Postmortem Hyperthermia: Two Case Reports and a Review of the Literature.

Angélique F, Guillaume G, Nicolas G, Jean Sébastien R, Laurent M.

Am J Forensic Med Pathol. 2018 Dec;39(4):364-366. doi: 10.1097/PAF.0000000000000431. Review.

Comment: Fascinating cases of rapid onset rigor mortis and temperature elevation related to toxic exposure to MDMA and to methadone with possible neuroleptic malignant syndrome.

32) Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates.

Pietrusza LM, Puskar KR, Ren D, Mitchell AM.

J Addict Nurs. 2018 Jul/Sep;29(3):188-195. doi: 10.1097/JAN.0000000000000235.

Comment: One-third filled the prescription. Distribution models remain the essential linchpin for naloxone programming.

33) Naloxone Academic Detailing: Role of Community Outreach Teaching.

Abd-Elsayed A, Albert CA, Fischer M, Anderson B.

Curr Pain Headache Rep. 2018 Aug 27;22(11):72. doi: 10.1007/s11916-018-0730-4. Review.

Comment: Another paper showing that academic detailing is effective at increasing naloxone prescribing.