17 articles for May 2019. Lots on naloxone. June coming soon!
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!
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1) Opioid overdose history and awareness of naloxone in patients seeking outpatient detoxification.
Bhardwaj SB, Cochran G, Kmiec J.
J Opioid Manag. 2019 May/Jun;15(3):253-259. doi: 10.5055/jom.2019.0508.
Comments: More than half had overdosed and 52% of the total accepted naloxone. Detox is among the most important places to have naloxone available for people to take with them, given extensive data that detox dramatically increases the risk of overdose and overdose death.
2) Free trade and opioid overdose death in the United States.
Dean A, Kimmel S.
SSM Popul Health. 2019 May 23;8:100409. doi: 10.1016/j.ssmph.2019.100409. eCollection 2019 Aug.
Comments: Important analysis using CDC and Department of Labor data to demonstrate a positive association between trade-related job loss and opioid overdose death in counties across the U.S. When fentanyl is present in heroin supply, the increase in overdose deaths from the same number of job losses is even more extreme.
3) Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose.
Slavova S, Delcher C, Buchanich JM, Bunn TL, Goldberger BA, Costich JF.
Curr Epidemiol Rep. 2019;6(2):263-274. doi: 10.1007/s40471-019-00201-9. Epub 2019 May 2. Review.
Comments: This review describes how the lack of standardization in investigating, certifying, and coding drug overdose-related deaths limits the accuracy of drug overdose mortality surveillance data. Lack of routine comprehensive toxicology testing, challenges in detecting and quantifying novel synthetic opioids, and variations in the specificity and completeness of drug information listed on death certificates generates bias in the data. Based on local experience in three cities and collaboration in multi-state analyses of mortality data, there are real issues comparing one location to another – or even one location over time if the medical examiner staffing changes as well. Some particularly relevant issues include coding manner of death: some code most overdoses as “undetermined” whereas others code most as “unintentional”. More important is the variation in what specific drugs are reported, as well as if a death is attributed to drugs at all when there is an additional cause of death identified.
4) Discovering major opioid-related research themes over time: A text mining technique.
Kim YM.
AMIA Jt Summits Transl Sci Proc. 2019 May 6;2019:751-760. eCollection 2019.
Comments: Term frequencies in PubMed publications between 2000 and 2017 show that the early 2000s were marked with research on methadone maintenance treatment and opioid research related to managing pain for HIV and cancer. Over time, research emerged on prescription opioid misuse, associated health problems, and opioid-related deaths and ED visits. The changes within opioid research publication themes mirror the emerging health concerns over time.
Herring AA, Schultz CW, Yang E, Greenwald MK.
Am J Emerg Med. 2019 May 29. pii: S0735-6757(19)30364-X. doi: 10.1016/j.ajem.2019.05.053. [Epub ahead of print] No abstract available.
Comments Unable to access full text due to Elsevier conflicts with academia. No abstract available, so assume this is a letter discussing initiation of buprenorphine immediately after overdose. This is a really exciting emerging intervention, particularly given the impressive reduction in overdose risk among people after buprenorphine dosing. Some providers actually use rapid IV buprenorphine, which is fascinating.
6) West Virginia’s model of buprenorphine expansion: Preliminary results.
Winstanley EL, Lander LR, Berry JH, Mahoney JJ 3rd, Zheng W, Herschler J, Marshalek P, Sayres S, Mason J, Haut MW.
J Subst Abuse Treat. 2019 May 8. pii: S0740-5472(19)30059-5. doi: 10.1016/j.jsat.2019.05.005. [Epub ahead of print]
Comments: Process measures for West Virginia hub and spoke model to scale up medications for substance use disorders.
7) Preparing student pharmacists to identify opioid misuse, prevent overdose and prescribe naloxone.
Skoy E, Eukel H, Frenzel J, Werremeyer A.
Curr Pharm Teach Learn. 2019 May;11(5):522-527. doi: 10.1016/j.cptl.2019.02.013. Epub 2019 May 3.
Comments: Pre-post survey suggesting that student pharmacists’ participation in an opioid misuse and overdose training program significantly increased their knowledge, self-efficacy, and perceived value of the pharmacist’s role in preventing opioid overdose. Full text not accessible.
8) A chemically contiguous hapten approach for a heroin-fentanyl vaccine.
Natori Y, Hwang CS, Lin L, Smith LC, Zhou B, Janda KD.
Beilstein J Org Chem. 2019 May 3;15:1020-1031. doi: 10.3762/bjoc.15.100. eCollection 2019.
Comments: Drug “vaccines” are emerging again as a major pathway to develop medications for substance use disorders. There are always ethical issues with this pathway, in particular because society has a long history of forcing treatments upon people. Nonetheless, for substance use disorders that lack other good options (e.g. stimulants), the desperate need for treatments likely justifies the risk of misuse by society. This is somewhat harder to justify for opioid use disorder, which has good medications in place already. The larger issue with opioids – and fentanyl in particular – is the fact that there is actually a wide array of analogues already on the market that may not be covered by this targeted vaccine.
Dhowan B, Lim J, MacLean MD, Berman AG, Kim MK, Yang Q, Linnes J, Lee CH, Goergen CJ, Lee H.
J Control Release. 2019 May 31;306:130-137. doi: 10.1016/j.jconrel.2019.05.041. [Epub ahead of print]
Comments: It’s been a real challenge to address overdoses that occur when people are alone. Closed-loop devices that alert emergency help or even administer naloxone have been considered for year.s It’s nice to see something start to move through the stages, although there is a LOT more to do before this were to make it to the real world – it’s an implant that likely requires an outpatient surgery and I’d be concerned about the need for (frequent) refill. Unable to access the full paper so may be missing some details.
Stopka TJ, Jacque E, Kelso P, Guhn-Knight H, Nolte K, Hoskinson R Jr, Jones A, Harding J, Drew A, VanDonsel A, Friedmann PD.
Prev Med. 2019 May 31:105740. doi: 10.1016/j.ypmed.2019.05.028. [Epub ahead of print]
Comments: Geographic analysis of opioid overdose rates, HCV rates and harm reduction access in rural areas of New Hampshire, Vermont and Massachusetts.
11) Effect of pill mill laws on opioid overdose deaths in Ohio & Tennessee: A mixed-methods case study.
Brighthaupt SC, Stone EM, Rutkow L, McGinty EE.
Prev Med. 2019 May 29;126:105736. doi: 10.1016/j.ypmed.2019.05.024. [Epub ahead of print]
Comments: Examined the impact of pill mill laws–regulations that prevent the issuing of opioid prescriptions without medical indication–on overall opioid overdose death rate and drug-specific opioid overdose death rates (prescription opioids, heroin, and synthetic opioids) in Ohio and Tennessee. Pill mill laws, even when robustly implemented, neither reduced nor increased overdose death. Full text not available.
Mitchell MT.
Oncologist. 2019 May 31. pii: theoncologist.2019-0340. doi: 10.1634/theoncologist.2019-0340. [Epub ahead of print]
Comments: Examines the use of novel “abuse-deterrent” formulas for managing cancer pain. This article acknowledges the economic barriers to patients using these more expensive formulas and warns that the novel formulas are no less prone to misuse by taking larger doses or switching to heroin. Additionally, use of naloxone as a means of harm-reduction in patients with end-stage cancer is controversial due to symptoms associated with imminent death being similar to opioid overdose; naloxone has the potential to exacerbate emotional and physical pain in this population.
13) Naloxone urban legends and the opioid crisis: what is the role of public health?
Crabtree A, Masuda JR.
BMC Public Health. 2019 May 30;19(1):670. doi: 10.1186/s12889-019-7033-5.
Comments: This article describes and discredits sensationalized media reports about naloxone kits being used not as intended. These stories are discussed in a sociological framework of urban legends, wherein these reports incite a fear-based response against stigmatized activities and communities (there’s a long history of this related to drug use – see, for example, this excellent piece discussing a Pulitzer Prize-winning series by Washington Post journalist Janet Cooke, which led to massive manhunts for a drug dealing child, and was later determined to be entirely fraudulent). This article posits that these naloxone urban legends can be a useful tool to the public health field in understanding and addressing the underlying anxieties of the opioid crisis.
Daniulaityte R, Carlson RR, Juhascik MP, Strayer KE, Sizemore IE.
Int J Drug Policy. 2019 May 27;71:3-9. doi: 10.1016/j.drugpo.2019.05.020. [Epub ahead of print]
Comments: In a sample of 60 people who self-reported heroin and non-prescription fentanyl use, nearly 90% tested positive for non-prescription fentanyl. Participants were not able to accurately identify when they were using heroin compared to when they were using non-prescription fentanyl. Study sampling and methodology were somewhat unclear from the abstract only (full text unavailable), since it does not speak to whether participants intentionally used both substances. This study took place in Dayton, Ohio, which had one of the highest overdose death rates in the country in 2017.
15) A gender-based analysis of nonmedical prescription opioid use among people who use illicit drugs.
Cheng T, Nosova E, Small W, Hogg RS, Hayashi K, DeBeck K.
Addict Behav. 2019 Oct;97:42-48. doi: 10.1016/j.addbeh.2019.05.022. Epub 2019 May 21.
Comments: Analyzed factors associated with nonmedical prescription opioid use among 1,459 people in Vancouver who use illicit drugs. There were no differences between men and women with regards to accessing prescription opioids for non-medical purposes. Those who used heroin, had overdosed, and had difficulty accessing health and social services were more likely to use prescription opioids for non-medical purposes. Unable to access full text.
Plunkett AR, Peden RM.
Pain Manag. 2019 May;9(3):297-306. doi: 10.2217/pmt-2018-0046. Epub 2019 May 29.
Comments: A review of the literature surrounding opioid use amidst changing sociological and political environments. Full text unavailable.
Nielsen S, Crossin R, Middleton M, Martin C, Wilson J, Lam T, Scott D, Smith K, Lubman D.
BMJ Open. 2019 May 27;9(5):e029170. doi: 10.1136/bmjopen-2019-029170.
Comments: This article outlines the protocol for an upcoming study of non-prescription pharmaceutical opioid use in Australia using data from ambulance clinical records. Funded by a pharmaceutical company that makes tapentadol, the study outlines a particular focus on non-prescription use of tapentadol and oxycodone.