PubMed Update March 2019

43 new papers for March of 2019.

1) Fighting fire with fire: development of intranasal nalmefene to treat synthetic opioid overdose.

Krieter P, Gyaw S, Crystal R, Skolnick P.

J Pharmacol Exp Ther. 2019 Apr 2. pii: jpet.118.256115. doi: 10.1124/jpet.118.256115. [Epub ahead of print]

Comments: Nalmefene has high affinity and >7h duration of effect. But not at all clear that we need a more potent opioid antagonist, as the high mortality with fentanyl is likely due to rapid progression to cardiac arrest.

2) The Affordable Care Act In The Heart Of The Opioid Crisis: Evidence From West Virginia.

Saloner B, Landis R, Stein BD, Barry CL.

Health Aff (Millwood). 2019 Apr;38(4):633-642. doi: 10.1377/hlthaff.2018.05049.

Comments: The ACA is really one of the best tools we have for the health system to approach this crisis appropriately.

3) News Media Reporting On Medication Treatment For Opioid Use Disorder Amid The Opioid Epidemic.

Kennedy-Hendricks A, Levin J, Stone E, McGinty EE, Gollust SE, Barry CL.

Health Aff (Millwood). 2019 Apr;38(4):643-651. doi: 10.1377/hlthaff.2018.05075.

Comments: Addiction experts aren’t so great at pitching their story.

4) Trends in and correlates of tranquilizer misuse among adults who misuse opioids in the United States, 2002-2014.

Boggis JS, Feder K.

Drug Alcohol Depend. 2019 Feb 16;198:158-161. doi: 10.1016/j.drugalcdep.2019.01.014. [Epub ahead of print]

Comments: 28% of those reporting opioid misuse also report tranquilizer misuse.

5) How prepared are pharmacists to provide over-the-counter naloxone? The role of previous education and new training opportunities.

Lai Joyce Chun K, Olsen A, Taing MW, Clavarino A, Hollingworth S, Dwyer R, Middleton M, Nielsen S.

Res Social Adm Pharm. 2019 Mar 22. pii: S1551-7411(18)30328-0. doi: 10.1016/j.sapharm.2019.03.003. [Epub ahead of print]

Comments: 81% of pharmacists in Australia were willing to be trained in opioid overdose prevention.

6) Evidence-Based Guidelines for EMS Administration of Naloxone.

Williams K, Lang ES, Panchal A, Gasper JJ, Taillac P, Gouda J, Hedges M.

Prehosp Emerg Care. 2019 Mar 29:1-41. doi: 10.1080/10903127.2019.1597955. [Epub ahead of print]

Comments: It makes sense that intranasal is preferred over intramuscular, but why would intravenous be preferred over other routes of administration when it’s challenging and risky to place an IV in emergency settings? This really doesn’t make sense.

7) Opioid agonist treatment and the process of injection drug use initiation.

Mittal ML, Jain S, Sun S, DeBeck K, Milloy MJ, Hayashi K, Hadland SE, Werb D.

Drug Alcohol Depend. 2019 Apr 1;197:354-360. doi: 10.1016/j.drugalcdep.2018.12.018. Epub 2019 Jan 22.

Comments: People who inject drugs but are in opioid agonist treatment were half as likely (0.52) to report recently helping someone else start injecting, compared to those not in treatment. This is a very compelling reason to expand treatment access. 

8) Microfluidic analysis of fentanyl-laced heroin samples by surface-enhanced Raman spectroscopy in a hydrophobic medium.

Salemmilani R, Moskovits M, Meinhart CD.

Analyst. 2019 Mar 28. doi: 10.1039/c9an00168a. [Epub ahead of print]

Comments: This looks like a qualitative way to identify fentanyl in heroin samples. While that is interesting, what is more needed is quantitative assessment / relative concentration.

9) Unintentional drug overdose deaths involving cocaine among middle-aged and older adults in New York City.

Han BH, Tuazon E, Kunins HV, Mantha S, Paone D.

Drug Alcohol Depend. 2019 Mar 14;198:121-125. doi: 10.1016/j.drugalcdep.2019.01.042. [Epub ahead of print]

Comments: “Characteristics of decedents of cocaine-involved overdose overlap with populations with high [cardiovascular disease] burden…”

10)Trends in fentanyl and fentanyl analogue-related overdose deaths – Montgomery County, Ohio, 2015-2017.

Daniulaityte R, Juhascik MP, Strayer KE, Sizemore IE, Zatreh M, Nahhas RW, Harshbarger KE, Antonides HM, Martins SS, Carlson RG.

Drug Alcohol Depend. 2019 Mar 18;198:116-120. doi: 10.1016/j.drugalcdep.2019.01.045. [Epub ahead of print]

Comments: Solid data on the emergency of fentanyl and analogues in Ohio.

11)The association between county-level safety net treatment access and opioid hospitalizations and mortality in New York.

Haley SJ, Maroko AR, Wyka K, Baker MR.

J Subst Abuse Treat. 2019 May;100:52-58. doi: 10.1016/j.jsat.2019.02.004. Epub 2019 Feb 22.

Comments: Geographic proximity to opioid treatment programs/buprenorphine providers is associated with less of an increase in opioid overdose mortality.

12)Medications for Opioid Use Disorder Save Lives.

Leshner AI, Mancher M; Committee on Medication-Assisted Treatment for Opioid Use Disorder, Board on Health Sciences Policy, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine.

Washington (DC): National Academies Press (US); 2019 Mar 20.

Comments: Review of medications.

13)US Emergency Department Visits for Acute Harms From Prescription Opioid Use, 2016-2017.

Lovegrove MC, Dowell D, Geller AI, Goring SK, Rose KO, Weidle NJ, Budnitz DS.

Am J Public Health. 2019 May;109(5):784-791. doi: 10.2105/AJPH.2019.305007. Epub 2019 Mar 21.

Comments: Fascinating data on opioids in 267,020 ED visits. 38.9% were therapeutic use, 30.4% of which were due to gastrointestinal effects (e.g. constipation). 47.6% were due to nonmedical use, 30.0% of which were due to unresponsiveness or cardiorespiratory failure and 35.7% of which were due to altered mental status. 13.5% were due to self-harm. These are very useful data.

14)Opioid Use Disorders in Adolescents-Updates in Assessment and Management.

Yule AM, Lyons RM, Wilens TE.

Curr Pediatr Rep. 2018 Jun;6(2):99-106. doi: 10.1007/s40124-018-0161-z. Epub 2018 Apr 25.

Comments: Buprenorphine use is supported.

15)Comparative Human Factors Evaluation of Two Nasal Naloxone Administration Devices: NARCAN_®Nasal Spray and Naloxone Prefilled Syringe with Nasal Atomizer.

Tippey KG, Yovanoff M, McGrath LS, Sneeringer P.

Pain Ther. 2019 Mar 15. doi: 10.1007/s40122-019-0118-0. [Epub ahead of print]

Comments: No surprise here – the manufactured device is easier to use, particularly for untrained bystanders.

16)Development and evaluation of a standardized research definition for opioid overdose outcomes.

Binswanger IA, Narwaney KJ, Gardner EM, Gabella BA, Calcaterra SL, Glanz JM.

Subst Abus. 2019 Mar 15:1-9. doi: 10.1080/08897077.2018.1546263. [Epub ahead of print]

Comments: An important first step, but there’s a lot left to figure out.

17)At-a-glance – Supervised Injection Services: a community-based response to the opioid crisis in the City of Ottawa, Canada.

DelVillano S, de Groh M, Morrison H, Do MT.

Health Promot Chronic Dis Prev Can. 2019 Mar;39(3):112-115. doi: 10.24095/hpcdp.39.3.03. English, French. 

Comments: As title describes.

18)Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects.

Johansson J, Hirvonen J, Lovró Z, Ekblad L, Kaasinen V, Rajasilta O, Helin S, Tuisku J, Sirén S, Pennanen M, Agrawal A, Crystal R, Vainio PJ, Alho H, Scheinin M.

Neuropsychopharmacology. 2019 Mar 13. doi: 10.1038/s41386-019-0368-x. [Epub ahead of print]

Comments: It’s long been thought that there would be other potential benefits to intranasal naloxone. Authors suggest gambling and alcohol use disorder. Others have suggested eating disorders.

19)Managing Opioid Use in Orthopaedic Patients Through Harm Reduction Strategies.

Worley J.

Orthop Nurs. 2019 Mar/Apr;38(2):129-135. doi: 10.1097/NOR.0000000000000524.

Comments: Targeting orthopedic providers.

20)Comparison of the Pharmacokinetic Properties of Naloxone Following the Use of FDA-Approved Intranasal and Intramuscular Devices Versus a Common Improvised Nasal Naloxone Device.

Krieter PA, Chiang CN, Gyaw S, McCann DJ.

J Clin Pharmacol. 2019 Mar 12. doi: 10.1002/jcph.1401. [Epub ahead of print]

Comments: We’ve known this for awhile and nobody has used the improvised device in years, so … 

21)Provider perceptions of system-level opioid prescribing and addiction treatment policies.

Haffajee RL, French CA.

Curr Opin Psychol. 2019 Feb 4;30:65-73. doi: 10.1016/j.copsyc.2019.01.018. [Epub ahead of print] Review.

Comments: Awareness is increasing.

22)Life after opioid-involved overdose: survivor narratives and their implications for ER/ED interventions.

Elliott L, Bennett AS, Wolfson-Stofko B.

Addiction. 2019 Mar 9. doi: 10.1111/add.14608. [Epub ahead of print]

Comments: A really important element of medicine is not to blame patients for their disease. This gets difficult in emergency settings – and not just for substance use disorders. Recurrent visits for unmanaged diabetes, noncompliance with congestive heart failure regimens, etc., can lead to judgmental care and lack of empathy. Nonetheless, the stigma for substance use disorders comes far more readily.

23)Prescription Drug and Alcohol Use Disorders: Safe Prescribing of Opioids.

Shin T.

FP Essent. 2019 Mar;478:11-18.

Comments: The important element to the CDC guidelines described here is that they were not designed for people already on opioids. The guidelines don’t say you should automatically taper people to the levels identified in the CDC guidelines, and increasing data shows that can be hazardous (including a recent FDA statement on the issue)

24)Evaluation and optimization of take-home naloxone in an academic medical center.

Cooler J, Ross CA, Robert S, Linder L, Ruhe AM, Philip A.

Ment Health Clin. 2019 Mar 1;9(2):105-109. doi: 10.9740/mhc.2019.03.105. eCollection 2019 Mar.

Comments: Use of educational videos.

25)From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study.

Brådvik L, Löwenhielm P, Frank A, Berglund M.

Int J Environ Res Public Health. 2019 Mar 5;16(5). pii: E801. doi: 10.3390/ijerph16050801.

Comments: Great idea, but this study lumped suicide with undetermined with accidental overdose. Not sure what to do with such results.

26)Potential uses of naltrexone in emergency department patients with opioid use disorder.

Bradley ES, Liss D, Carriero SP, Brush DE, Babu K.

Clin Toxicol (Phila). 2019 Mar 4:1-7. doi: 10.1080/15563650.2019.1583342. [Epub ahead of print]

Comments: In the context of an overdose after prolonged abstinence, this might be reasonable. Again, while important to have as an option, the applications of naltrexone for opioid use disorder are limited.

27)Successful treatment with slow-release oral morphine following afentanyl-related overdose: A case report.

Prinsloo G, Ahamad K, Socías ME MD, MSc.

Subst Abus. 2019 Mar 4:1-3. doi: 10.1080/08897077.2019.1576086. [Epub ahead of print]

Comments: There are many options for treating opioid use disorder, beyond the three options available in the U.S.

28)An evaluation of Take Home Naloxone program implementation in British Columbian correctional facilities.

Pearce LA, Mathany L, Rothon D, Kuo M, Buxton JA.

Int J Prison Health. 2019 Mar 11;15(1):46-57. doi: 10.1108/IJPH-12-2017-0058. Epub 2019 Feb 20.

Comments: Focus groups.

29)Scotland’s National Naloxone Programme.

Bird SM, McAuley A.

Lancet. 2019 Jan 26;393(10169):316-318. doi: 10.1016/S0140-6736(18)33065-4. No abstract available. 

Comments: Review of some of the estimates produced in Scotland.

30)Trends and correlates of perceived access to heroin among young adults in the United States, 2002-2016.

Salas-Wright CP, Oh S, Vaughn MG, Muroff J, Amodeo M, Delva J.

Drug Alcohol Depend. 2018 Dec 1;193:169-176. doi: 10.1016/j.drugalcdep.2018.09.009. Epub 2018 Oct 18.

Comments: “probably impossible” to obtain heroin.

31)Characterizing fentanyl-related overdoses and implications for overdose response: Findings from a rapid ethnographic study in Vancouver, Canada.

Mayer S, Boyd J, Collins A, Kennedy MC, Fairbairn N, McNeil R.

Drug Alcohol Depend. 2018 Dec 1;193:69-74. doi: 10.1016/j.drugalcdep.2018.09.006. Epub 2018 Oct 12.

Comments: Rapid onset, chest rigidity, etc.

32)Utilization of opioid agonist therapy among incarcerated persons with opioid use disorder in Vancouver, Canada.

Bozinoff N, DeBeck K, Milloy MJ, Nosova E, Fairbairn N, Wood E, Hayashi K.

Drug Alcohol Depend. 2018 Dec 1;193:42-47. doi: 10.1016/j.drugalcdep.2018.09.003. Epub 2018 Oct 6.

Comments: It reduces illicit use and overdose.

33)The Impact of Patient Characteristics and Postoperative Opioid Exposure on Prolonged Postoperative Opioid Use: An Integrative Review.

Lanzillotta JA, Clark A, Starbuck E, Kean EB, Kalarchian M.

Pain Manag Nurs. 2018 Oct;19(5):535-548. doi: 10.1016/j.pmn.2018.07.003. Epub 2018 Aug 29. Review.

Comments: Unclear how much the actual act of prescribing for prolonged periods has on post-operative opioid use, as there are many other predictors of prolonged post-operative use that may be outside of the surgeon’s control.

34)Addressing the Fentanyl Analogue Epidemic by Multiplex UHPLC-MS/MS Analysis of Whole Blood.

Bergh MS, Bogen IL, Wilson SR, Øiestad ÅML.

Ther Drug Monit. 2018 Dec;40(6):738-748. doi: 10.1097/FTD.0000000000000564.

Comments: Identifying fentanyl analogues in blood.

35)Young Man After Overdose.

Lebin JA, Wu EH, McCoy AM, Gross JA.

J Emerg Med. 2018 Oct;55(4):e109-e110. doi: 10.1016/j.jemermed.2018.07.002. Epub 2018 Aug 16. No abstract available. 

Comments: Undigested pasta mistaken for drug packing materials.

36)Reducing the opioid overdose death toll in North America.

Hall WD, Farrell M.

PLoS Med. 2018 Jul 31;15(7):e1002626. doi: 10.1371/journal.pmed.1002626. eCollection 2018 Jul.

Comments: Review of strategies including medications, naloxone, and supervised injection sites.

37)Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic.

Manchikanti L, Sanapati J, Benyamin RM, Atluri S, Kaye AD, Hirsch JA.

Pain Physician. 2018 Jul;21(4):309-326.

Comments: A review of the crisis and education, increased access to non-opioid pain management options, and use of medications for opioid use disorder.

38)Unit-Dose Packaging and Unintentional Buprenorphine-Naloxone Exposures.

Wang GS, Severtson SG, Bau GE, Dart RC, Green JL.

Pediatrics. 2018 Jun;141(6). pii: e20174232. doi: 10.1542/peds.2017-4232. Epub 2018 May 3.

Comments: Appears to have reduced pediatric exposures.

39)Scene Safety and Force Protection in the Era of Ultra-Potent Opioids.

Lynch MJ, Suyama J, Guyette FX.

Prehosp Emerg Care. 2018 Mar-Apr;22(2):157-162. doi: 10.1080/10903127.2017.1367446. Epub 2017 Sep 28.

Comments: As the article describes, this is media craziness. The “overdose” events from touching fentanyl are consistent with panic attacks, not opioid toxicity. If transdermal exposure to fentanyl was a concern, there would be no way to distribute it to people who use drugs. Some serious education is needed.

40)Death From Opioid Overdose After Deep Brain Stimulation: A Case Report.

Zhang C, Huang Y, Zheng F, Zeljic K, Pan J, Sun B.

Biol Psychiatry. 2018 Jan 1;83(1):e9-e10. doi: 10.1016/j.biopsych.2017.07.018. Epub 2017 Aug 1. No abstract available. 

Comments: This is a death during a clinical trial of deep brain stimulation for treatment of opioid use disorder. A patient relapsed and died from heroin overdose.

41)Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts.

Rose ME.

Pain Med. 2018 Apr 1;19(4):793-807. doi: 10.1093/pm/pnx048. Review.

Comments: This is a more complex issue than this article makes it out to be.

42)Pharmacist-led health-system approaches to reduce opioid overdose and death.

Saldaña SN, Weaver N, Stanford B.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S8-S9. doi: 10.1016/j.japh.2016.09.005. Epub 2016 Nov 16. No abstract available. 

Comments: Encouraging.

43)Bringing naloxone to ground zero: Huntington, West Virginia.

Babcock C, Rockich-Winston N, Booth C.

J Am Pharm Assoc (2003). 2017 Mar – Apr;57(2S):S9-S10. doi: 10.1016/j.japh.2016.09.006. Epub 2016 Nov 9. No abstract available. 

Comments: West Virginia. Oh West Virginia. If there were a place more in need…