Okay, we are WAY behind. And unfortunately a bit out of order. Skipping ahead to January 2020 for this round of 37 papers. Will try to wrap up 2019 next. Thanks again to Nicola Gerbino, Rebecca Martinez, Cathleen Beliveau, and Irene Liu at www.csuhsf.org for keeping this alive!
Nolan ML, Allen B, Paone D.
Addiction. 2020 Jan 28. doi: 10.1111/add.14958. [Epub ahead of print] No abstract available.
Comment: Hoots et al. calls for the expansion of the opioid epidemic public health response to include stimulants given the recent rise in stimulant related overdoses. This commentary, however, asks us to evaluate and clarify what that public health approach is – and if it is a “public health” approach at all. As many of us can recall with frustration, several responses to the opioid overdose have failed to incorporate or have delayed the implementation of evidence-based practices (e.g., maintaining the x-waiver requirement to prescribe buprenorphine). Before calling for the integration of stimulants into the response to the opioid epidemic, we should reevaluate, define, and improve our current approach to be more impactful in promoting the health of individuals and communities.
Dydyk AM, Jain NK, Gupta M.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
Comment: Overview of the etiology, epidemiology, and history of opioid use disorder diagnosis as well as pharmacological and nonpharmacological treatments.
Donovan E, Bratberg J, Baird J, Burstein D, Case P, Walley AY, Green TC.
Res Social Adm Pharm. 2020 Jan 18. pii: S1551-7411(19)30590-X. doi: 10.1016/j.sapharm.2020.01.006. [Epub ahead of print]
Comment: Through qualitative interviews with pharmacy leaders, this article provides insights about pharmacists’ role in opioid epidemic. It highlights the importance of extending the spectrum of care for opioid management to pharmacies, specifically regrading naloxone. Expanding the routes of distribution of naloxone can be an important step in helping halt the increase in opioid overdose deaths.
Ashburn NP, Ryder CW, Angi RM, Snavely AC, Nelson RD, Bozeman WP, McGinnis HD, Winslow JT, Stopyra JP.
Ann Emerg Med. 2020 Jan 23. pii: S0196-0644(19)31422-2. doi: 10.1016/j.annemergmed.2019.11.022. [Epub ahead of print]
Comment: Non-fatal overdose is strongly associated with subsequent overdose and with subsequent fatal overdose. This study contributes to that knowledge by matching out-of-hospital naloxone receipt with death over the following 365 days. Those who got out-of-hospital naloxone with clinical improvement were 13 times more likely to have died within a year compared to the general population. As the full text was not available due to Elsevier, we were limited in our ability to assess the details of the study. For example, they do not define in the abstract how they define “improvement” after naloxone administration. The comparison of death among those who improved and did not improve after naloxone administration is likely meaningless, as naloxone administration without clinical response is not a valuable proxy for an overdose (i.e. many, if not most, of those events were probably not overdoses).
5) Known fentanyl use among clients of harm reduction sites in British Columbia, Canada.
Karamouzian M, Papamihali K, Graham B, Crabtree A, Mill C, Kuo M, Young S, Buxton JA.
Int J Drug Policy. 2020 Jan 18;77:102665. doi: 10.1016/j.drugpo.2020.102665. [Epub ahead of print]
Comment: This study gives indication about who may be more likely to be use fentanyl, (intentionally or unintentionally), and the method of consumption in British Columbia. Recent exposure to fentanyl by participants was significantly associated with urban settings as well as cannabis, methamphetamine, and heroin/morphine use.
Fagiola M, Hahn T, Avella J.
Acad Forensic Pathol. 2019 Sep;9(3-4):191-199. doi: 10.1177/1925362119892005. Epub 2020 Jan 31.
Comment: Case study of acetyl fentanyl, fentanyl, heroin, and alprazolam death. Of note, there are meaningful differences between acetyl fentanyl and fentanyl (potency and duration of action) that likely contribute to the hugely variable potency of street opioids and resultant overdose crisis.
7) Effect of State Policy Changes in Florida on Opioid-Related Overdoses.
Guy GP Jr, Zhang K.
Am J Prev Med. 2020 Jan 30. pii: S0749-3797(19)30530-6. doi: 10.1016/j.amepre.2019.11.008. [Epub ahead of print]
Comment: This study uses emergency department and inpatient databases to compare the impact of Florida’s Controlled Substance Monitoring Program (CSMP) policies to North Carolina’s (where no CSMP was implemented) between 2008-2015. Policies in Florida seemed to have an effect in reducing prescription opioid-related overdoses resulting in inpatient and ER settings, with no association with heroin related events. The biggest weakness in this analysis seems to be the limited reach of the data sources and absence of mortality analyses. Can’t access full paper due to Elsevier.
8) Routes of non-traditional entry into buprenorphine treatment programs.
Champagne-Langabeer T, Swank MW, Langabeer JR 2nd.
Subst Abuse Treat Prev Policy. 2020 Jan 20;15(1):6. doi: 10.1186/s13011-020-0252-z. Review.
Comment: This literature review identified routes of entry to buprenorphine including criminal justice, emergency medical care, and community outreach. This is a critical element of our overdose response.
Wright QE, Higginbotham S, Bunk E, Covvey JR.
J Am Pharm Assoc (2003). 2020 Jan 14. pii: S1544-3191(19)30535-7. doi: 10.1016/j.japh.2019.11.027. [Epub ahead of print]
Comment: About half of the participants in this study believed pharmacist-led naloxone education helped reduce the stigma of illicit opioid use.
10) Regional and temporal effects of naloxone access laws on opioid overdose mortality.
Cataife G, Dong J, Davis CS.
Subst Abus. 2020 Jan 17:1-10. doi: 10.1080/08897077.2019.1709605. [Epub ahead of print]
Comment: Interesting findings. Naloxone Access Laws were associated with lower fatal opioid-related overdoses in western states but had little impact in other regions. Can’t access the full article, but this definitely warrants further evaluation as the findings are impactful. The data go through 2014, while fentanyl started to emerge around 2014 in eastern states, which perhaps accounts for the lack of a benefit?
Bart GB, Saxon A, Fiellin DA, McNeely J, Muench JP, Shanahan CW, Huntley K, Gore-Langton RE.
Addict Sci Clin Pract. 2020 Jan 16;15(1):4. doi: 10.1186/s13722-020-0180-2.
Comment: A clinical decision support group from NIDA created a clinical decision support tool for OUD screening, assessment, and treatment in primary care settings.
Caré W, Langrand J, Vodovar D, Deveaux M, Alvarez JC, Mégarbane B, Dorandeu F.
Fundam Clin Pharmacol. 2020 Jan 16. doi: 10.1111/fcp.12534. [Epub ahead of print]
Comment: Reports opioid use and overdose in Paris, France over 10-year period (2008-2017).
Carter G, Caudill P.
Public Health Nurs. 2020 Jan 13. doi: 10.1111/phn.12707. [Epub ahead of print]
Comment: This study reports data from pre- and post-intervention survey about nursing students’ knowledge, stigma, and efficacy of naloxone. Hopefully, with more studies like this one, naloxone and other related substance use topics may be implemented as a normal part of health care professionals’ curriculums.
Rosenblum D, Unick J, Ciccarone D.
Drug Alcohol Depend. 2020 Mar 1;208:107779. doi: 10.1016/j.drugalcdep.2019.107779. Epub 2020 Jan 7.
Comment: Rosenblum et al. reports a decrease in heroin but increase in fentanyl in Ohio between 2009-2018 using Ohio’s Bureau of Criminal Investigation’s crime lab data. The authors suggest that crime lab data have the potential to be used as early indicators for people who inject drugs, first responders, and law enforcement to prepare and respond to the changes in illicit opioids. How these groups should respond, and how to respond quickly, to this information, if presented as an early warning sign, is another question.
Quast TC.
Drug Alcohol Depend. 2020 Feb 1;207:107807. doi: 10.1016/j.drugalcdep.2019.107807. Epub 2020 Jan 7.
Comment: I’m intrigued by this report of undercounting of deaths from specific drugs to the CDC. If the data are reported as cause of death by medical examiners, that should be reflected in the CDC data. Can’t access the full article (due to Elsevier) to figure out what this is all about, but it’s definitely concerning. There are already enough issues with mortality data (lack of specifying which drugs, potential bias in selecting which drugs are causal, etc.).
16) Association of Medicaid Expansion With Opioid Overdose Mortality in the United States.
Kravitz-Wirtz N, Davis CS, Ponicki WR, Rivera-Aguirre A, Marshall BDL, Martins SS, Cerdá M.
JAMA Netw Open. 2020 Jan 3;3(1):e1919066. doi: 10.1001/jamanetworkopen.2019.19066.
Comment: Medicaid expansion was associated with a 6% reduction in total opioid overdose deaths and categories including heroin and synthetic opioids other than methadone. Unfortunately, there was an 11% increase in methadone related opioid overdoses in states that expanded Medicaid. Authors believe these improvements are related to better access to medications for opioid use disorder.
Strang J, Volkow ND, Degenhardt L, Hickman M, Johnson K, Koob GF, Marshall BDL, Tyndall M, Walsh SL.
Nat Rev Dis Primers. 2020 Jan 9;6(1):3. doi: 10.1038/s41572-019-0137-5. Review.
Comment: Strang et al. discusses the brain chemistry of OUD, individual and public burdens of OUD, and various medications for treatment.
Endo N, Ghaeli N, Duvallet C, Foppe K, Erickson TB, Matus M, Chai PR.
J Med Toxicol. 2020 Jan 9. doi: 10.1007/s13181-019-00756-5. [Epub ahead of print]
Comment: Wastewater analyses are increasingly fascinating.
19) Individual and county-level variation in outcomes following non-fatal opioid-involved overdose.
Lowder EM, Amlung J, Ray BR.
J Epidemiol Community Health. 2020 Jan 9. pii: jech-2019-212915. doi: 10.1136/jech-2019-212915. [Epub ahead of print]
Comment: Lowder et al. shows an increase in mortality and fatal overdoses in counties with increased naltrexone treatment providers. Further, Black patients had higher mortality rates in counties with higher-than-average naltrexone providers compared to those with lower-than-average naltrexone providers – a trend that was less notable among white patients. These results highlight important issues with extended-release naltrexone as well as equity concerns in opioid use disorder treatment.
20) Preventing opioid overdose with peer-administered naloxone: findings from a rural state.
Hanson BL, Porter RR, Zöld AL, Terhorst-Miller H.
Harm Reduct J. 2020 Jan 9;17(1):4. doi: 10.1186/s12954-019-0352-0.
Comment: This study uses qualitative interviews to give a voice to people who have used or currently use opioids and who have administered naloxone to a peer during an overdose. Participants expressed satisfaction with having received naloxone training, suggesting that naloxone should be made widely available. Notably, the authors also concluded that overdose experiences do not have a lasting impact on drug use behavior, which is in some contrast to earlier study data. Given the powerful nature of overdose events, there has been interest in leverage such events to develop safer drug use habits or consideration of therapeutic options.
Schneider KE, O’Rourke A, White RH, Park JN, Musci RJ, Kilkenny ME, Sherman SG, Allen ST.
Int J Drug Policy. 2020 Feb;76:102642. doi: 10.1016/j.drugpo.2019.102642. Epub 2020 Jan 7.
Comment: This study examined the associated between polysubstance use, overdose, and take-home naloxone in rural West Virginia. Over 40% of the 420 individuals surveyed had experienced an overdose in the last 6 months and less than half of all participants received take-home naloxone. This is an extremely high rate of overdose, raising serious concerns! The limited coverage of naloxone is equally concerning.
Eldridge LA, Agley J, Meyerson BE.
J Am Pharm Assoc (2003). 2020 Jan 6. pii: S1544-3191(19)30532-1. doi: 10.1016/j.japh.2019.11.024. [Epub ahead of print]
Comment: Indiana had a considerable increase in the number of pharmacies stocking and dispensing naloxone between 2016 and 2018 as a result of the statewide standing order.
Park TW, Larochelle MR, Saitz R, Wang N, Bernson D, Walley AY.
Addiction. 2020 Jan 8. doi: 10.1111/add.14886. [Epub ahead of print]
Comment: Using a large sample of over 63,000 Massachusetts residents receiving buprenorphine between 2012 and 2015, the authors sought to understand if benzodiazepine co-prescribing with buprenorphine was associated with increased overdose risk and/or improved retention in treatment since both outcomes have been found in the literature. This study raised further questions about behaviors around buprenorphine and benzodiazepine co-prescribing. Filled benzodiazepine prescriptions during buprenorphine prescriptions were associated with an increased risk of fatal and nonfatal opioid overdose, as well as all-cause mortality – but a decreased risk of buprenorphine discontinuation. These results suggest that further studies need to examine these relationships as well as factors associated with each outcome.
24) An Inpatient Psychiatric Program Targeting Opioid Overdoses.
Mahgoub N, O’Connell K, Gevint K, Dedonatis A, Velasco J, Tham A, Cangemi S, Tai FJ, Stellman M, Radosta M, Anthony D.
J Psychiatr Pract. 2020 Jan;26(1):71-75. doi: 10.1097/PRA.0000000000000446.
Comment: A description of the implementation of a program training patients and families how to respond to an opioid overdose and administer naloxone in New York.
Flavin L, Malowney M, Patel NA, Alpert MD, Cheng E, Noy G, Samuelson S, Sreshta N, Boyd JW.
J Psychiatr Pract. 2020 Jan;26(1):17-22. doi: 10.1097/PRA.0000000000000437.
Comment: Flavin et al. looked at the accuracy of SAMSHA’s database of buprenorphine treatment. The authors contacted all providers listed in the SAMSHA database within a 25-mile radius of a region with a high rate of overdoses in 10 states with the highest drug related death rates to confirm if the database information was correct. In total they called 505 providers, but only 60% of the phone numbers were correct and only 40% of the providers listed provided buprenorphine. Around 60% accepted Medicaid as insurance and the average wait time was 16.8 days for those with waitlists. In total, over 70% did not have appointments available. This study demonstrates one of the many challenges associated with getting buprenorphine prescriptions. While the database is intended to be a resource, this study shows that it is only marginally useful in areas of high need.
26) Preventing Morphine Seeking Behavior through the Re-engineering of Vincamine’s Biological Activity.
Norwood VM, Brice-Tutt A, Eans SO, Stacy H, Shi G, Ratnayake R, Rocca JR, Abboud KA, Li C, Luesch H, McLaughlin JP, Huigens Iii RW.
J Med Chem. 2020 Jan 8. doi: 10.1021/acs.jmedchem.9b01924. [Epub ahead of print]
Comment: A new compound, caused by ring distortion, showed promising results in animal studies.
Hoots B, Vivolo-Kantor A, Seth P.
Addiction. 2020 Jan 7. doi: 10.1111/add.14878. [Epub ahead of print]
Comment: Drug deaths identified by ICD-10 multiple cause of death codes for cocaine, psychostimulants, all opioids, heroin, and synthetic opioids showed the increase in cocaine involved deaths in the US since 2006 has been driven by opioids (particularly synthetic opioids). Nonfatal and fatal psychostimulant related overdoses, however, are increasing with and without opioids. Recognizing this difference can help better guide prevention and harm reduction efforts. Further exploration into regional differences in substance use and overdose trends is needed, as is, a better understanding of the role of stimulants in fatalities.
28) Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA.
Abraham AJ, Andrews CM, Harris SJ, Friedmann PD.
Neurotherapeutics. 2020 Jan;17(1):55-69. doi: 10.1007/s13311-019-00814-4. Review.
Comment: This literature review highlights the limited use of opioid and alcohol use disorder medication in the United States despite an increase in availability of opioid use disorder medications over the past decade. Unfortunately, availability of alcohol use disorder medications has decreased over the past decade. Like many, Abraham et al. calls for increased substance use disorder training among health professionals, stigma reduction, policy reform for buprenorphine and methadone prescribing, among other strategies to address the ongoing opioid epidemic.
Alinsky RH, Zima BT, Rodean J, Matson PA, Larochelle MR, Adger H Jr, Bagley SM, Hadland SE.
JAMA Pediatr. 2020 Jan 6:e195183. doi: 10.1001/jamapediatrics.2019.5183. [Epub ahead of print]
Comment: This study identified how and if youths received evidence-based treatments following an opioid overdose using Medicaid claims data from 2009-2015. A large majority of the youths experienced an overdose related to opioids other than heroin. Youth who previously overdosed on heroin were significantly more likely to overdose again compared to those who overdosed on other opioids. 30% of youth received behavioral health services while only 1.9% received pharmacotherapy. Youth who used heroin were significantly less likely to receive any treatment compared to those who used other opioids. The discrepancy between overdose and treatment among youth using heroin compared to other opioids signifies a significant stigma associated with heroin use. As opioid overdose rates among youth continue to rise, as has happened with fentanyl, greater accessibility of treatment, including pharmacotherapy, is essential.
30) The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada.
Piske M, Zhou H, Min JE, Hongdilokkul N, Pearce LA, Homayra F, Socias ME, McGowan G, Nosyk B.
Addiction. 2020 Jan 3. doi: 10.1111/add.14947. [Epub ahead of print]
Comment: Using a large sample of 55,000+ people with opioid use disorder in British Columbia, Canada, this retrospective cohort study identified factors associated with increased engagement with opioid agonist treatment. This is a fantastic use of data and we desperately need to replicate and expand upon this in order to track and improve implementation of evidence-based interventions addressing substance use disorders and health sequelae.
Prieto JT, Scott K, McEwen D, Podewils LJ, Al-Tayyib A, Robinson J, Edwards D, Foldy S, Shlay JC, Davidson AJ.
J Med Internet Res. 2020 Jan 3;22(1):e15645. doi: 10.2196/15645.
Comment: As the opioid crisis continues, innovative surveillance methods, such as this one, have potential. Further research on the effectiveness as well as positive and negative implications of such work is needed.
Coupet E Jr, Werner RM, Polsky D, Karp D, Delgado MK.
J Gen Intern Med. 2020 Jan 2. doi: 10.1007/s11606-019-05605-3. [Epub ahead of print]
Comment: As a criticism of the ACA, some policymakers cite that the ACA expansion fueled opioid overdoses due to increased subsidization of opioid medicine. In a difference-in-difference analysis looking at emergency department encounters and out-of-hospital deaths for opioid overdoses per 100,000 US adults, Coupet et al. refute this claim. The study did find that there was an increase in non-prescription opioid related emergency department encounters, although this change could be due to a variety of other factors other than ACA expansion, as ecological analyses are problematic.
33) Importance and Approach to Manner of Death Opinions in Opioid-Related Deaths.
Abiragi M, Bauler LD, Brown T.
J Forensic Sci. 2020 Jan 2. doi: 10.1111/1556-4029.14266. [Epub ahead of print]
Comment: Most fatal opioid overdoses are accidental; however, some opioid overdose deaths are suicides, which can be difficult to determine. In the case presented by Abiragi et al., a phone call with the decedent’s family during a follow-up interview indicated the heroin overdose death was likely a suicide. There is actually a fascinating mechanism in suicide research called “psychological autopsy” that involves interviews with decedent’s friends and relatives and has also contributed critical information about heroin overdose deaths (way back in the ‘80s). While it’s unlikely to happen in all deaths, this type of ancillary information can be hugely helpful.
Frank JW, Binswanger IA. Commentary on Rhee & Rosenheck. Addiction. 2020 Apr;115(4):786-787. doi: 10.1111/add.14907. Epub 2020 Jan 12.
Comment: Outpatient OUD treatment should be more commonplace to help increase access to effective and possibly life-saving treatments. Other steps, such as removing the X-waiver requirement, should also be taken.
Thylstrup B, Seid AK, Tjagvad C, Hesse M.
Drug Alcohol Depend. 2020 Jan 1;206:107714. doi: 10.1016/j.drugalcdep.2019.107714. Epub 2019 Nov 5.
Comment: Intriguing study of >10,000 people who had been treated for opioid use disorder with 10 years of follow-up data, demonstrating 28% of people with a ‘registered’ overdose (assume that means medically-attended overdose) and 6% with a fatal overdose. Risks for overdose were prior overdose, injected drug use, and benzodiazepine use.
36) The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It.
Bohringer C, Astorga C, Liu H.
Transl Perioper Pain Med. 2020;7(1):152-157.
Comment: This article discusses and suggests the use of non-opioid analgesic alternatives for perioperative use to avoid the negative side effects of opioids.
37) Concurrent Alcohol and Opioid Use Among Harm Reduction Clients.
Winstanley EL, Stover AN, Feinberg J.
Addict Behav. 2020 Jan;100:106027. doi: 10.1016/j.addbeh.2019.06.016. Epub 2019 Jun 20.
Comment: Over half of syringe access clients had concurrent alcohol and opioid use – this was associated with additional drug use beyond opioids… polydrug use begets polydrug use.