9 papers this month.
Thanks again to Rebecca Martinez, Cathleen Beliveau, Nataliya Karashchuk, and Laila Esfandiari at the Center on Substance Use and Health (www.csuhsf.org) for collaborating to produce these summaries!
Brar R, Sutherland C, Nolan S.
BMJ Case Rep. 2019 Aug 1;12(7). pii: e229456. doi: 10.1136/bcr-2019-229456.
Comments: Desperate for such options.
Gicquelais RE, Genberg BL, Astemborski J, Celentano DD, Kirk GD, Mehta SH.
AIDS Educ Prev. 2019 Aug;31(4):344-362. doi: 10.1521/aeap.2019.31.4.344.
Comments: Given the issue with tolerance and overdose risk, many of us used to wonder if intermittent opioid injection would be a particularly high-risk activity. This is the second study to show the opposite.
Nugent K, Matthews P, Gissendaner J, Papas M, Occident D, Patel A, Johnson M, Megargel RE, Nomura JT.
Prehosp Disaster Med. 2019 Aug;34(4):350-355. doi: 10.1017/S1049023X19004527. Epub 2019 Jul 19.
Comments: This study of EMS providers between 2014-2015 is somewhat outdated now but found that patients will receive naloxone faster if Basic Life Support (BLS) providers have the ability to provide naloxone as well as Advanced Life Support providers since BLS providers are often quicker to the scene. All Emergency Medical Services systems should allow BLS providers to carry and administer naloxone if they don’t already.
4) Opioid-related US hospital discharges by type, 1993-2016.
Peterson C, Xu L, Florence C, Mack KA.
J Subst Abuse Treat. 2019 Aug;103:9-13. doi: 10.1016/j.jsat.2019.05.003. Epub 2019 May 10.
Comments: Assessment of the annual percentage change in the rate of opioid-related hospital discharges by type (i.e. opioid overdose, opioid use disorder with or without detoxification/rehabilitation services, etc.) from 1993 to 2016. Documentation of OUD without opioid overdose or detoxification/rehabilitation services quadrupled over the full time period and the discharge rate for heroin-related overdoses increased sharply (~23% annually) from 2010-2016. Despite this, the rate of discharges that included rehabilitation services including pharmacotherapy and counseling declined by ~2% annually from 1993-2016. Suggests that inpatient settings could be doing much more to engage patients with OUD in treatment plans.
Krawczyk N, Buresh M, Gordon MS, Blue TR, Fingerhood MI, Agus D.
J Subst Abuse Treat. 2019 Aug;103:1-8. doi: 10.1016/j.jsat.2019.05.002. Epub 2019 May 9.
Comments: Examines the development, patient characteristics and outcomes for Project Connections at Re-Entry, a low-threshold, mobile buprenorphine treatment program that engages with patients through a van parked outside the Baltimore City Jail. Of those who began treatment, 67.9% returned for a second visit and 31.6% were still in treatment after 30 days; 20.5% were transferred to continue buprenorphine treatment at a different site.
6) Low overdose responding self-efficacy among adults who report lifetime opioid use.
Tormohlen KN, Tobin KE, Davey-Rothwell MA, Latkin C.
Drug Alcohol Depend. 2019 Aug 1;201:142-146. doi: 10.1016/j.drugalcdep.2019.03.028. Epub 2019 Jun 7.
Comments: Assessment of overdose responding self-efficacy in a study of people who reported lifetime opioid use; 67% of people reported low self-efficacy. High self-efficacy was associated with witnessing an overdose, receiving and using naloxone, and experience with naloxone training. Full text not available through Elsevier.
Chang HY, Krawczyk N, Schneider KE, Ferris L, Eisenberg M, Richards TM, Lyons BC, Jackson K, Weiner JP, Saloner B.
Drug Alcohol Depend. 2019 Aug 1;201:127-133. doi: 10.1016/j.drugalcdep.2019.04.016. Epub 2019 Jun 7.
Comments: During the study period, 3.24% of >25,000 patients prescribed buprenorphine (verified by Maryland’s controlled substance monitoring program) had a non-fatal overdose. Such an event was associated with being male, getting buprenorphine paid for through public or private insurance, and receiving more benzodiazepine prescriptions, and less likely among those on treatment for longer periods. It’s important to note that benzodiazepines are NOT a reason to not prescribe buprenorphine: the risk of overdose is far, far lower on buprenophine plus benzodiazepine compared to a full opioid agonist plus benzodiazepine.
Schuler MS, Dick AW, Stein BD.
Drug Alcohol Depend. 2019 Aug 1;201:78-84. doi: 10.1016/j.drugalcdep.2019.04.014. Epub 2019 Jun 7.
Comments: In a sample of >100,000 individuals from the National Survey of Drug Use and Health, lesbian, gay, and bisexual (LGB) subgroups had higher lifetime rates of pain reliever misuse compared to same gender heterosexuals. Bisexual women had the highest rates of high-risk injection use and OUD. Additionally, LGB women had lower perceived risk and greater access to heroin. This study does not include other groups such as people who identify as transgender, queer, intersex, and asexual who maybe also experience opioid use disparities compared to heterosexual adults. Full text not available.
Schneider KE, Park JN, Allen ST, Weir BW, Sherman SG.
Drug Alcohol Depend. 2019 A 201:71-77. doi: 10.1016/j.drugalcdep.2019.03.026. Epub 2019 Jun 6.
Comments: Among three groups of people who inject drugs (PWID), using mutiple drugs through multiple routes of administration was associated with past month overdose, compared to those reporting cocaine/heroin injection or heroin injection. The heroin/cocaine group had the highest prevalence of overdose training but the groups did not differ significantly in current naloxone possession.