PubMed Update June – August 2017

PubMed Update June-August 2017

 

75 papers this round. Lots of fentanyl which I tried to put up front. Also some interesting approaches to overdose research which deserve some real attention.

 

The first batch of papers are from a special issue of the International Journal of Drug Policy devoted to the fentanyl epidemic:

 

1) Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance.

Slavova S, Costich JF, Bunn TL, Luu H, Singleton M, Hargrove SL, Triplett JS, Quesinberry D, Ralston W, Ingram V.

Int J Drug Policy. 2017 Aug;46:120-129. doi: 10.1016/j.drugpo.2017.05.051. Epub 2017 Jul 18.

Comments: Interesting approach of comparing the ratio of heroin versus fentanyl overdose ED visits to deaths. Moral seems to be that surveillance in this arena is extremely challenging.

 

2) Heroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’.

Ciccarone D, Ondocsin J, Mars SG.

Int J Drug Policy. 2017 Aug;46:146-155. doi: 10.1016/j.drugpo.2017.06.004. Epub 2017 Jul 18.

Comments: Really excellent work by this team, with incredibly valuable and translatable qualitative research.

 

3) Today’s fentanyl crisis: Prohibition’s Iron Law, revisited.

Beletsky L, Davis CS.

Int J Drug Policy. 2017 Aug;46:156-159. doi: 10.1016/j.drugpo.2017.05.050. Epub 2017 Jul 18.

Comments: Beautiful abstract.

 

4) Why are some people who have received overdose education and naloxone reticent to call Emergency Medical Services in the event of overdose?

Koester S, Mueller SR, Raville L, Langegger S, Binswanger IA.

Int J Drug Policy. 2017 Jul 19. pii: S0955-3959(17)30179-2. doi: 10.1016/j.drugpo.2017.06.008. [Epub ahead of print]

Comments: Authors find that fear of legal status issues inhibits calling emergency medical services. While this is clearly the case and the paper adds to this by pointing out the failure of modern Good Samaritan laws to protect those already enmeshed in the criminal justice system (and suggestions – including those noted in another article this round – that people who overdose be involuntarily held), there is another reason for not calling for assistance. Prior research has demonstrated that the people are less likely to call for assistance after witnessing multiple overdoses. This is logical – just as a parent is less likely to seek emergency medical assistance for their child’s 10^th asthma exacerbation.

 

5) US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations.

Unick GJ, Ciccarone D.

Int J Drug Policy. 2017 Aug;46:112-119. doi: 10.1016/j.drugpo.2017.06.003. Epub 2017 Jul 5.

Comments: This is complicated.

 

6) Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic.

Fairbairn N, Coffin PO, Walley AY.

Int J Drug Policy. 2017 Aug;46:172-179. doi: 10.1016/j.drugpo.2017.06.005. Epub 2017 Jul 4.

Comments: A review of naloxone in three eras of opioid overdose mortality.

 

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Then some more fentanyl/synthetics papers:

 

7) Trends in Deaths Involving Heroin and Synthetic Opioids Excluding Methadone, and Law Enforcement Drug Product Reports, by Census Region – United States, 2006-2015.

O’Donnell JK, Gladden RM, Seth P.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):897-903. doi: 10.15585/mmwr.mm6634a2.

Comments: Straight from the abstract – Opioid overdose deaths quadrupled from 8,050 in 1999 to 33,091 in 2015; heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. In the Northeast, Midwest, and South, deaths involving synthetic opioids and fentanyl drug reports increased considerably after 2013

 

8) Overdose Deaths Related to Fentanyl and Its Analogs – Ohio, January-February 2017.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore IE, Harshbarger KE, Antonides HM, Carlson RR.

MMWR Morb Mortal Wkly Rep. 2017 Sep 1;66(34):904-908. doi: 10.15585/mmwr.mm6634a3.

Comments: Evidence of shift from opioid analgesics and heroin to fentanyl products.

 

9) Controversies and carfentanil: We have much to learn about the present state of opioid poisoning.

Cole JB, Nelson LS.

Am J Emerg Med. 2017 Aug 24. pii: S0735-6757(17)30694-0. doi: 10.1016/j.ajem.2017.08.045. [Epub ahead of print] No abstract available.

Comments: Actually a somewhat reassuring paper, noting that the range between therapeutic and toxic dose for fentanyl and carfentanil is much larger than for morphine – suggesting that distributors should be able to figure out how to properly dose these agents. Furthermore, authors note data that carfentanil responds to standard naloxone doses – although “massive” overdose occurring from poorly dosed products could require more naloxone for competitive inhibition; authors also note that environmental exposure risks are unlikely. They conclude that a longer period of observation may be required after reversal. This is a controversial topic as existing data suggests discharge is safe and patients often want to leave, thus requiring providers to overrule patients’ autonomy – a procedure that brings law enforcement into medicine and causes enormous rifts between patients and providers with potential unintended consequences such as refusal to reach out for medical assistance at all.

 

10) Incidence of Naloxone Redosing in the Age of the New Opioid Epidemic.

Klebacher R, Harris MI, Ariyaprakai N, Tagore A, Robbins V, Dudley LS, Bauter R, Koneru S, Hill RD, Wasserman E, Shanes A, Merlin MA.

Prehosp Emerg Care. 2017 Jul 7:1-6. doi: 10.1080/10903127.2017.1335818. [Epub ahead of print]

Comments: A retrospective study of the old 2mg/2mL nasal naloxone dose by EMS showing 9% requiring re-dosing. Important although of declining relevance today.

 

11) Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose.

Griswold MK, Chai PR, Krotulski AJ, Friscia M, Chapman B, Boyer EW, Logan BK, Babu KM.

Clin Toxicol (Phila). 2017 Jul 6:1-6. doi: 10.1080/15563650.2017.1339889. [Epub ahead of print]

Comments: People who overdose don’t know that they were exposed to fentanyl.

 

12) A Primer on Heroin and Fentanyl.

Worley J.

J Psychosoc Nurs Ment Health Serv. 2017 Jun 1;55(6):16-20. doi: 10.3928/02793695-20170519-02.

Comments: Another.

 

13) Increases in self-reported fentanyl use among a population entering drug treatment: The need for systematic surveillance of illicitly manufactured opioids.

Cicero TJ, Ellis MS, Kasper ZA.

Drug Alcohol Depend. 2017 Aug 1;177:101-103. doi: 10.1016/j.drugalcdep.2017.04.004. Epub 2017 May 30.

Comments: More on fentanyl. Increase in use essentially entirely due to unknown fentanyl products.

 

14) Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study.

Carroll JJ, Marshall BDL, Rich JD, Green TC.

Int J Drug Policy. 2017 Aug;46:136-145. doi: 10.1016/j.drugpo.2017.05.023. Epub 2017 Jun 1.

Comments: The qualitative work has been critical for this epidemic.

 

15) A Cluster of Fentanyl-Laced Heroin Deaths in 2015 in Melbourne, Australia.

Rodda LN, Pilgrim JL, Di Rago M, Crump K, Gerostamoulos D, Drummer OH.

J Anal Toxicol. 2017 May 1;41(4):318-324. doi: 10.1093/jat/bkx013.

Comments: 9 cases of fentanyl-heroin death in Australia.

 

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And now the rest …

 

16) Trends in heroin and pharmaceutical opioid overdose deaths in Australia.

Roxburgh A, Hall WD, Dobbins T, Gisev N, Burns L, Pearson S, Degenhardt L.

Drug Alcohol Depend. 2017 Aug 14;179:291-298. doi: 10.1016/j.drugalcdep.2017.07.018. [Epub ahead of print]

Comments: Hmmm … seems like what happened in the US over the past twenty years started a bit later and less severely in Australia.

 

17) Rationale for cannabis-based interventions in the opioid overdose crisis.

Lucas P.

Harm Reduct J. 2017 Aug 18;14(1):58. doi: 10.1186/s12954-017-0183-9.

Comments: Is cannabis useful to reduce reliance on opioids?

 

18) Multi-variant Genetic Panel for Genetic Risk of Opioid Addiction.

Donaldson K, Demers L, Taylor K, Lopez J, Chang S.

Ann Clin Lab Sci. 2017 Aug;47(4):452-456.

Comments: Fascinating abstract.

 

19) Drugs of Abuse.

Akerele E, Olupona T.

Psychiatr Clin North Am. 2017 Sep;40(3):501-517. doi: 10.1016/j.psc.2017.05.006. Review.

Comments: Interesting paper including cocaine overdose characteristics – a major topic of interest with little research. Glaring absence of discussion of methamphetamine …

 

20) The willingness of people who inject drugs in Boston to use a supervised injection facility.

León C, Cardoso L, Mackin S, Bock B, Gaeta JM.

Subst Abus. 2017 Aug 11:0. doi: 10.1080/08897077.2017.1365804. [Epub ahead of print]

Comments: Lots of interest and support for a facilty among people who use drugs.

 

21) Utilization of buprenorphine and methadone among opioid users who inject drugs.

Tsui JI, Burt R, Thiede H, Glick SN.

Subst Abus. 2017 Aug 10:0. doi: 10.1080/08897077.2017.1363844. [Epub ahead of print]

Comments: Health insurance is necessary to be able to provide proper care for people who use drugs. Let’s see how long we get it…

 

22) The opioid epidemic: Challenges of sustained remission.

Chopra N, Marasa LH.

Int J Psychiatry Med. 2017 Mar;52(2):196-201. doi: 10.1177/0091217417720900.

Comments: Based on abstract, this looks pretty interesting.

 

23) School nurse experiences with prescription opioids in urban and rural schools: A cross-sectional survey.

Pattison-Sharp E, Estrada RD, Elio A, Prendergast M, Carpenter DM.

J Addict Dis. 2017 Aug 8:1-7. doi: 10.1080/10550887.2017.1361725. [Epub ahead of print]

Comments: Do school nurses need naloxone?

 

24) Commentary on Hsu et al. (2017): A systems approach to improving health services for overdose in the hospital and across the continuum of care-an unmet need.

Binswanger IA.

Addiction. 2017 Sep;112(9):1565-1566. doi: 10.1111/add.13866. No abstract available.

Comments: Nice letter outling some key steps to improve in-hospital care of persons with opioid use disorders.

 

25) Heroin use onset among nonmedical prescription opioid users in the club scene.

Surratt HL, Kurtz SP, Buttram M, Levi-Minzi MA, Pagano ME, Cicero TJ.

Drug Alcohol Depend. 2017 Jul 26;179:131-138. doi: 10.1016/j.drugalcdep.2017.06.034. [Epub ahead of print]

Comment: Among club setting users of prescription opioids for nonmedical purposes, over 1 year 7.7% transitioned to heroin. Of note, the study was conducted from 2011 to 2014 – time period is critical in this research given the radical shifts in the opioid market. Florida had a substantial drop in access to prescription opioids in 2010 due to numerous clinics being shut down.

 

26) Naloxone use among overdose prevention trainees in New York City: A longitudinal cohort study.

Siegler A, Huxley-Reicher Z, Maldjian L, Jordan R, Oliver C, Jakubowski A, Kunins HV.

Drug Alcohol Depend. 2017 Jul 24;179:124-130. doi: 10.1016/j.drugalcdep.2017.06.029. [Epub ahead of print]

Comments: Finally, some rigorous data on naloxone use by distribution program recipients! So far we have relied only on passive surveillance (i.e. people coming back to programs for more naloxone), whereas this was prospective follow-up. Of note, only 34.7% of subjects had injected drugs in the year prior to getting naloxone and only 43.3% used heroin, so this was not the highest risk population or the population most likely to use naloxone. Nonetheless, the estimates of use exceed those from the previously mentioned passive surveillance. Over the follow-up of up to one year, 36% witnessed at least one overdose and naloxone was administered in 77% of those overdoses (by the recipient in 60% of those events); 25% of participants administered naloxone at least once.

 

27) Brain temperature effects of intravenous heroin: State dependency, environmental modulation, and the effects of dose.

Bola RA, Kiyatkin EA.

Neuropharmacology. 2017 Jul 27. pii: S0028-3908(17)30356-8. doi: 10.1016/j.neuropharm.2017.07.025. [Epub ahead of print]

Comments: Interesting. Not clear how to translate.

 

28) Awareness, Possession, and Use of Take-Home Naloxone Among Illicit Drug Users, Vancouver, British Columbia, 2014-2015.

Nolan S, Buxton J, Dobrer S, Dong H, Hayashi K, Milloy MJ, Kerr T, Montaner J, Wood E.

Public Health Rep. 2017 Jan 1:33354917717230. doi: 10.1177/0033354917717230. [Epub ahead of print]

Comments: 22% had a naloxone kit, 20% of whom had used it.

 

29) Harm reduction in the USA: the research perspective and an archive to David Purchase.

Des Jarlais DC.

Harm Reduct J. 2017 Jul 26;14(1):51. doi: 10.1186/s12954-017-0178-6.

Comments: We’ve come a long way, but have much further to travel.

 

30) Injection drug use and overdose among young adults who use prescription opioids non-medically.

Liebling EJ, Green TC, Hadland SE, Marshall BDL.

Addict Behav. 2017 Jul 18;76:20-26. doi: 10.1016/j.addbeh.2017.07.017. [Epub ahead of print]

Comments: Analysis of young non-medical prescription opioid users who ever injected compared to never having injected.

 

31) [Asthma and heroin use].

Underner M, Perriot J, Peiffer G, Jaafari N.

Presse Med. 2017 Jul 19. pii: S0755-4982(17)30301-9. doi: 10.1016/j.lpm.2017.06.002. [Epub ahead of print] French.

Comments: Heroin may contribute to asthma.

 

32) Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population.

Morgan JR, Schackman BR, Leff JA, Linas BP, Walley AY.

J Subst Abuse Treat. 2017 Jul 3. pii: S0740-5472(16)30413-5. doi: 10.1016/j.jsat.2017.07.001. [Epub ahead of print]

Comments: Intriguing analysis of use of these therapies for opioid use disorder (OUD), finding that sublingal buprenorphine/naloxone is associated with the lowest discontinuation rates.

 

33) Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Jan 6.

Comments: We don’t have sufficient data to say for sure that buprenorphine is superior that full agonist opioids for chronic pain.

 

34) Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone.

Okoro ON, Bastianelli KM, Wen YF, Bilden EF, Konowalchuk BK, Schneiderhan ME.

Subst Abus. 2017 Jul 20:0. doi: 10.1080/08897077.2017.1356787. [Epub ahead of print]

Comments: Only 10.6% of prescribers had prescribed naloxone in this region (North Dakota, northern Minnesota, and northwestern Wisconsin).

 

35) Naloxone.

Jordan M, Morrisonponce D.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-.
2017 Jul 1.

Comments: A review.

 

36) Increases from 2002 to 2015 in prescription opioid overdose deaths in combination with other substances.

Kandel DB, Hu MC, Griesler P, Wall M.

Drug Alcohol Depend. 2017 Sep 1;178:501-511. doi: 10.1016/j.drugalcdep.2017.05.047. Epub 2017 Jul 4.

Comments: Polydrug use.

 

37) Safer and more appropriate opioid prescribing: a large healthcare system’s comprehensive approach.

Losby JL, Hyatt JD, Kanter MH, Baldwin G, Matsuoka D.

J Eval Clin Pract. 2017 Jul 14. doi: 10.1111/jep.12756. [Epub ahead of print]

Comments: Effectively reduced opioid prescribing. Did this result in improved health outcomes? For patients? For their social networks?

 

38) Impact of New York prescription drug monitoring program, I-STOP, on statewide overdose morbidity.

Brown R, Riley MR, Ulrich L, Kraly EP, Jenkins P, Krupa NL, Gadomski A.

Drug Alcohol Depend. 2017 Sep 1;178:348-354. doi: 10.1016/j.drugalcdep.2017.05.023. Epub 2017 Jun 23.

Comments: Prescription opioid overdose deaths leveled off but any gain was outstripped by increased heroin deaths.ß

 

39) Developing Syndromic Surveillance to Monitor and Respond to Adverse Health Events Related to Psychoactive Substance Use: Methods and Applications.

Nolan ML, Kunins HV, Lall R, Paone D.

Public Health Rep. 2017 Jul/Aug;132(1_suppl):65S-72S. doi: 10.1177/0033354917718074.

Comments: Important steps forward in overdose surveillance.

 

40) Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015.

Daly ER, Dufault K, Swenson DJ, Lakevicius P, Metcalf E, Chan BP.

Public Health Rep. 2017 Jul/Aug;132(1_suppl):73S-79S. doi: 10.1177/0033354917707934.

Comments: Another surveillance example.

 

41) Commentary on Marsden et al. (2017): While epidemiological studies can help to identify areas of overdose risk, we need more focused hypothesis-driven trials to inform clinical intervention strategies.

Kidd B, Matthews C.

Addiction. 2017 Aug;112(8):1419-1420. doi: 10.1111/add.13857. No abstract available.

Comments: As the title says.

 

42) Descriptive Epidemiology for Community-wide Naloxone Administration by Police Officers and Firefighters Responding to Opioid Overdose.

Heavey SC, Delmerico AM, Burstein G, Moore C, Wieczorek WF, Collins RL, Chang YP, Homish GG.

J Community Health. 2017 Aug 29. doi: 10.1007/s10900-017-0422-8. [Epub ahead of print]

Comments: This is certainly the most advanced paper that’s been produced about law enforcement naloxone. It’s a bit concerning that only 81.6% survived the overdose, although it is always difficult to interpret mortality in non-medical reversal scenarios.

 

43) Fentanyl-Induced Brain Hypoxia Triggers Brain Hyperglycemia and Biphasic Changes in Brain Temperature.

Solis E, Cameron-Burr KT, Shaham Y, Kiyatkin EA.

Neuropsychopharmacology. 2017 Aug 29. doi: 10.1038/npp.2017.181. [Epub ahead of print]

Comments: Interesting, unclear implications.

 

44) Pulmonary hemorrhage in acute heroin overdose: a report of two cases.

Riccardello GJ Jr, Maldjian PD.

Emerg Radiol. 2017 Jul 4. doi: 10.1007/s10140-017-1531-5. [Epub ahead of print]

Comments: A new complicated of heroin overdose…

 

45) On-Scene Rescue Breathing Resulting in Gastric Perforation and Massive Pneumoperitoneum.

Butterfield M, Peredy T.

Prehosp Disaster Med. 2017 Jul 3:1-2. doi: 10.1017/S1049023X17006653. [Epub ahead of print]

Comments: I have increasingly leaned toward chest compressions for lay overdose response.

 

46) Surveying the opinions of Pennsylvania Chiefs of Police toward officers carrying and administering naloxone.

Smyser PA, Lubin JS.

Am J Drug Alcohol Abuse. 2017 Jun 30:1-8. doi: 10.1080/00952990.2017.1339053. [Epub ahead of print]

Comments: 60% thought the benefits outweighed the risks.

 

47) Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids-Conception and maturation.

McDonald R, Campbell ND, Strang J.

Drug Alcohol Depend. 2017 Sep 1;178:176-187. doi: 10.1016/j.drugalcdep.2017.05.001. Epub 2017 May 25. Review.

Comments: Review of 1996-2016 lay naloxone research.

 

48) A case report of methadone-associated hypoglycemia in an 11-month-old male.

Toce MS, Stefater MA, Breault DT, Burns MM.

Clin Toxicol (Phila). 2017 Jun 26:1-3. doi: 10.1080/15563650.2017.1338347. [Epub ahead of print]

Comments: Methadone can induce insulin secretion, resulting in hypoglycemia (like a sulfonylurea?).

 

49) A retrospective review of unintentional opioid overdose risk and mitigating factors among acutely injured trauma patients.

Baird J, Faul M, Green TC, Howland J, Adams CA, George A, Mello MJ.

Drug Alcohol Depend. 2017 Sep 1;178:130-135. doi: 10.1016/j.drugalcdep.2017.04.030. Epub 2017 Jun 13.

Comments: Lots of potential risk factors even in acute injury treated with opioids, emphasizing the role of lay naloxone.

 

50) Risk Factors for Severe Respiratory Depression from Prescription Opioid Overdose.

Fox LM, Hoffman RS, Vlahov D, Manini AF.

Addiction. 2017 Jun 23. doi: 10.1111/add.13925. [Epub ahead of print]

Comments: This is an interesting paper that is quite complex to understand. First, they define an overdose as coming to the ED within 24 hours of exposure and taking sufficient illicit drug to cause symptoms or taking more than prescribed opioid dose – thus the focus is really on quantity of drug consumed rather than symptoms. Further, they define “severe respiratory depression” as receiving naloxone or endotracheal intubation – a definition I have not seen before in the literature (and in fact the vital signs at initial ED presentation were not different between those with “severe respiratory depression” and the others). This really raises issues around how we define “overdose” that are beguiling research of late. This definition also raises some questions as to their findings. For example, they found that opioid “misuse” was associated with “severe respiratory depression” – other studies have found that naloxone administration is associated with illicit opioid use (see for example, the next paper discussed), so it’s no surprise that when it is clear that someone is injecting or otherwise using opioids in a way not intended by prescription, paramedics and other medical providers are more likely to administer naloxone because there is less clinical doubt as to etiology. Thus this finding may represent that clinicians are more willing to give naloxone to someone they perceive as “misusing” opioids – rather than the suggestion that those who misuse opioids are more likely to have severe symptoms. Notably, mortality was 2%.

 

51) Heroin and pharmaceutical opioid overdose events: Emergency medical response characteristics.

Banta-Green CJ, Coffin PO, Schoeppe JA, Merrill JO, Whiteside LK, Ebersol AK.

Drug Alcohol Depend. 2017 Sep 1;178:1-6. doi: 10.1016/j.drugalcdep.2017.04.021. Epub 2017 Jun 10.

Comments: Heroin cases were more likely to get naloxone and less likely to be intubated. A possible reason is that heroin cases were more “obvious” and thus more likely to be treated with naloxone rather than endotracheal intubation.

 

52) Young people who use drugs engaged in harm reduction programs in New York City: Overdose and other risks.

Calvo M, MacFarlane J, Zaccaro H, Curtis M, Cabán M, Favaro J, Passannante MR, Frost T.

Drug Alcohol Depend. 2017 Sep 1;178:106-114. doi: 10.1016/j.drugalcdep.2017.04.032. Epub 2017 Jun 15.

Comments: Youth had more overdoses, worse housing, more incarceration, more residential drug treatment, less insurance, and were more educated and more likely to be White.

 

53) An increase in per-patient naloxone requirements in an opioid epidemic.

Birmingham LE, Nielson JA.

Am J Emerg Med. 2017 May 22. pii: S0735-6757(17)30414-X. doi: 10.1016/j.ajem.2017.05.033. [Epub ahead of print] No abstract available.

Comments: Possible increase in naloxone needs.

 

54) Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone.

Kelty E, Hulse G.

Int J Drug Policy. 2017 Aug;46:54-60. doi: 10.1016/j.drugpo.2017.05.039. Epub 2017 Jun 10.

Comments: Hm. I’m used to papers like this using SMRs and related statistics which are not used here. And as we know it is on thin ice that we compare methadone to buprenorphine to naltrexone patients due to characteristics that lead to each of the treatment options.

 

55) Zoning out methadone and rising opioid-related deaths in Ontario: Reforms and municipal government actions.

Strike C, Miskovic M.

Can J Public Health. 2017 Jun 16;108(2):e205-e207. doi: 10.17269/cjph.108.5858.

Comments: Restrictions on methadone provision are problematic in the current epidemic.

 

56) The prevalence of nasal obstruction as a consideration in the treatment of opioid overdose.

Weiner SG, Joyce AR, Thomson HN.

J Opioid Manag. 2017 Mar/Apr;13(2):69-76. doi: 10.5055/jom.2017.0370.

Comments: Interesting, although a fairly modest associated – and unclear if this could be related to nasal naloxone effectiveness.

 

57) Two steps forward, one step back: current harm reduction policy and politics in the United States.

Nadelmann E, LaSalle L.

Harm Reduct J. 2017 Jun 12;14(1):37. doi: 10.1186/s12954-017-0157-y.

Comments: Some progress, but that is challenged by current politics.

 

58) International patent applications for non-injectable naloxone for opioid overdose reversal: Exploratory search and retrieve analysis of the PatentScope database.

McDonald R, Danielsson Glende Ø, Dale O, Strang J.

Drug Alcohol Rev. 2017 Jun 8. doi: 10.1111/dar.12571. [Epub ahead of print] Review.

Comments: Review of novel/impending naloxone products.

 

59) Clinical Outcomes of Start-Low, Go-Slow Methadone Initiation for Cancer-Related Pain: What’s the Hurry?

Hawley P, Chow L, Fyles G, Shokoohi A, O’Leary MJ, Mittelstadt M.

J Palliat Med. 2017 Jun 8. doi: 10.1089/jpm.2017.0090. [Epub ahead of print]

Comments: There’s been a lot of hype about the risks of methadone. Some are warranted, others not so much. When it is the right medication choice, titrating slowly works well.

 

60) A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City.

Bennett AS, Golub A, Elliott L.

PLoS One. 2017 Jun 8;12(6):e0179054. doi: 10.1371/journal.pone.0179054. eCollection 2017.

Comments: Categorizing overdose risk by use patterns among veterans.

 

61) Hospitalizations for Endocarditis and Associated Health Care Costs Among Persons with Diagnosed Drug Dependence – North Carolina, 2010-2015.

Fleischauer AT, Ruhl L, Rhea S, Barnes E.

MMWR Morb Mortal Wkly Rep. 2017 Jun 9;66(22):569-573. doi: 10.15585/mmwr.mm6622a1.

Comments: They identified a large increase in the rate of admissions for both endocarditis and a substance use disorder. While this is likely true, the argument would certainly have been bolstered if they had also provided us the overall rate of endocarditis. If the overall rate is not increasing, than this could be an artifact of coding. While this may seem slightly off topic for the overdose list, it came up on the search and contains many references to the U.S. overdose epidemic.

 

62) Naloxone and the Inner City Youth Experience (NICYE): a community-based participatory research study examining young people’s perceptions of the BC take home naloxone program.

Mitchell K, Durante SE, Pellatt K, Richardson CG, Mathias S, Buxton JA.

Harm Reduct J. 2017 Jun 7;14(1):34. doi: 10.1186/s12954-017-0160-3.

Comments: Naloxone programs are engaging and empowering.

 

63) Misuse of Novel Synthetic Opioids: A Deadly New Trend.

Prekupec MP, Mansky PA, Baumann MH.

J Addict Med. 2017 Jul/Aug;11(4):256-265. doi: 10.1097/ADM.0000000000000324.

Comments: Review of recent synthetic opioids / fentanyl analogues.

 

64) Intravenous Heroin Induces Rapid Brain Hypoxia and Hyperglycemia that Precede Brain Metabolic Response.

Solis E Jr, Cameron-Burr KT, Shaham Y, Kiyatkin EA.

eNeuro. 2017 Jun 7;4(3). pii: ENEURO.0151-17.2017. doi: 10.1523/ENEURO.0151-17.2017. eCollection 2017 May-Jun.

Comments: So interesting that these come out at the same time.

 

65) Mortality Trends among Cocaine Users Treated between 1989 and 2013 in Northern Italy: Results of a Longitudinal Study.

Pavarin RM, Fioritti A.

J Psychoactive Drugs. 2017 Aug 28:1-9. doi: 10.1080/02791072.2017.1365976. [Epub ahead of print]

Comments: Fascinating and somewhat unexpected causes of death. Suicide and motor vehicle injury for cocaine users; opioid overdose and cardiovascular disease for heroin/cocaine users.

 

66) The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland.

O’Halloran C, Cullen K, Njoroge J, Jessop L, Smith J, Hope V, Ncube F.

Int J Drug Policy. 2017 Aug;46:34-40. doi: 10.1016/j.drugpo.2017.05.017. Epub 2017 Jun 3.

Comments: Fairly low rate of past-year overdose at 15%. Some useful and some possibly spurious associations.

 

67) [Intoxication with psychotropic drugs].

Bellmann R, Joannidis M.

Med Klin Intensivmed Notfmed. 2017 Aug 21. doi: 10.1007/s00063-017-0323-8. [Epub ahead of print] German.

Comments: Review of toxicology.

 

68) “I love having benzos after my coke shot”: The use of psychotropic medication among cocaine users in downtown Montreal.

Motta-Ochoa R, Bertrand K, Arruda N, Jutras-Aswad D, Roy É.

Int J Drug Policy. 2017 Aug 18;49:15-23. doi: 10.1016/j.drugpo.2017.07.012. [Epub ahead of print]

Comments: Qualitative study of use of prescribed psychotropic medications by people who use cocaine.

 

69) High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City.

Mateu-Gelabert P, Jessell L, Goodbody E, Kim D, Gile K, Teubl J, Syckes C, Ruggles K, Lazar J, Friedman S, Guarino H.

Int J Drug Policy. 2017 Aug;46:17-27. doi: 10.1016/j.drugpo.2017.05.016. Epub 2017 May 31.

Comments: Essential to recognize the role of substances in a person’s life rather than simply say “don’t use …”

 

70) 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 Aug;10(8):799-807. doi: 10.1080/17512433.2017.1336434. Epub 2017 Jun 21. Review.

Comments: The downside of the implact is that it’s a surgical procedure and you need to dig it out after 6 months and implant more in another spot, leaving a scar behind. Not optimal for a potentially lifelong therapy.

 

71) Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.

Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, Ferri M, Pastor-Barriuso R.

BMJ. 2017 Apr 26;357:j1550. doi: 10.1136/bmj.j1550. Review.

Comments: Big reductions in mortality, with some risk initiating and stopping methadone.

 

72) Intravenous Buprenorphine: A Substitute for Naloxone in Methadone-Overdosed Patients?

Zamani N, Hassanian-Moghaddam H.

Ann Emerg Med. 2017 Jun;69(6):737-739. doi: 10.1016/j.annemergmed.2016.12.024. Epub 2017 Feb 23.

Comments: A perennially interesting topic.

 

73) Staring down the opioid epidemic.

Unger JR.

J Fam Pract. 2017 Jan;66(1):8.

Comments: Opioid epidemic review.

 

74) Tell-Tale SNPs: The Role of CYP2B6 in Methadone Fatalities.

Ahmad T, Sabet S, Primerano DA, Richards-Waugh LL, Rankin GO.

J Anal Toxicol. 2017 May 1;41(4):325-333. doi: 10.1093/jat/bkw135.

Comments: Fascinating work trying to identify genetic predictors of methadone overdose. This could help us toward understanding the frequent vs rare overdoser.

 

75) Recent Increases in Cocaine-Related Overdose Deaths and the Role of Opioids.

McCall Jones C, Baldwin GT, Compton WM.

Am J Public Health. 2017 Mar;107(3):430-432. doi: 10.2105/AJPH.2016.303627.

Comments: Increased cocaine deaths were opioid-related.