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…

1) Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016.

Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M.

Natl Vital Stat Rep. 2018 Dec;67(9):1-14.

Comment: Nice summary of the data demonstrating the shift from prescribed opioids to heroin to fentanyl, with rising methamphetamine and persistent cocaine presence.

2) Enhanced Intranasal Absorption of Naltrexone by Dodecyl Maltopyranoside: Implications for the Treatment of Opioid Overdose.

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

J Clin Pharmacol. 2019 Jan 30. doi: 10.1002/jcph.1384. [Epub ahead of print]

Comment: Fascinating that the half-life of naltrexone is only 2.2 hours when administered intranasally … would be great to see that for managing alcohol use.

3) Emergency department physicians’ and pharmacists’ perspectives on take-home naloxone.

Holland TJ, Penm J, Dinh M, Aran S, Chaar B.

Drug Alcohol Rev. 2019 Jan 29. doi: 10.1111/dar.12894. [Epub ahead of print]

Comment: Qualitative assessment of opinions.

4) Take-home naloxone: a life saver in opioid overdose.

The Lancet.

Lancet. 2019 Jan 26;393(10169):296. doi: 10.1016/S0140-6736(19)30153-9. No abstract available. 

Comment: Editorial supporting take-home naloxone.

5) Feasibility and Acceptability of a Checklist and Learning Collaborative to Promote Quality and Safety in the Perinatal Care of Women with Opioid Use Disorders.

Goodman D, Zagaria AB, Flanagan V, Deselle FS, Hitchings AR, Maloney R, Small TA, Vergo AV, Bruce ML.

J Midwifery Womens Health. 2019 Jan;64(1):104-111. doi: 10.1111/jmwh.12943.

Comment: Some good changes – more naloxone provided, more counseling regarding breastfeeding, and more nicotine-replacement therapy initiated.

6) Correlates of seeking emergency medical help in the event of an overdose in British Columbia, Canada: Findings from the Take Home Naloxone program.

Karamouzian M, Kuo M, Crabtree A, Buxton JA.

Int J Drug Policy. 2019 Jan 25. pii: S0955-3959(19)30014-3. doi: 10.1016/j.drugpo.2019.01.006. [Epub ahead of print]

Comment: Great analysis of naloxone programmatic data. 55.7% of lay naloxone administrations were followed by a call for emergency medical services, again demonstrating that we do not have data showing a reduction in calling 911 when naloxone is administered. 

7) Seizures in tramadol overdoses reported in the ToxIC registry: predisposing factors and the role of naloxone.

Murray BP, Carpenter JE, Dunkley CA, Moran TP, Alfaifi M, Alsukaiti WS, Kazzi Z.

Clin Toxicol (Phila). 2019 Jan 24:1-5. doi: 10.1080/15563650.2018.1547826. [Epub ahead of print]

Comment: Tramadol is a weird drug. This analysis found that when it caused an opioid-like overdose, seizures were less likely, and that naloxone use was not associate with tramadol seizures.

8) “You Never Know What You’re Getting”: Opioid Users’ Perceptions of Fentanyl in Southwest Pennsylvania.

McLean K, Monnat SM, Rigg K, Sterner GE 3rd, Verdery A.

Subst Use Misuse. 2019 Jan 24:1-12. doi: 10.1080/10826084.2018.1552303. [Epub ahead of print]

Comment: Fentanyl use patterns are evolving – it seems to be here to stay this time.

9) Development of a Cascade of Care for responding to the opioid epidemic.

Williams AR, Nunes EV, Bisaga A, Levin FR, Olfson M.

Am J Drug Alcohol Abuse. 2019 Jan 24:1-10. doi: 10.1080/00952990.2018.1546862. [Epub ahead of print]

Comment: Nice to see this development.

10) Blockade of the human ether a-go-go related gene (hERG) potassium channel by fentanyl.

Tschirhart JN, Li W, Guo J, Zhang S.

Mol Pharmacol. 2019 Jan 21. pii: mol.118.114751. doi: 10.1124/mol.118.114751. [Epub ahead of print]

Comment: First, you gotta love the naming culture for these genes. Now the human ether a-go-go gene potassium channel effects could prolong the QT interval, which could result in ventricular arrhythmias and, ultimately, cardiac arrest. Is this playing a role in fentanyl-related deaths? Not sure. 

11) Changing risk and presentation of overdose associated with consumption of street drugs at a supervised injection site in Vancouver, Canada.

Notta D, Black B, Chu T, Joe R, Lysyshyn M.

Drug Alcohol Depend. 2019 Jan 15;196:46-50. doi: 10.1016/j.drugalcdep.2018.12.016. [Epub ahead of print]

Comment: Great use of these data. As fentanyl entered the heroin supply in Vancouver, the rate of “heroin” overdoses rose 4.8 fold. This is interesting, as fentanyl knowingly used at the Sydney injection facility was 4 times more likely than heroin to result in overdose – honestly I would have expected an even more substantial increase in “heroin” overdose events in the context of heroin contaminated with fentanyl. Notably, there was a several fold increase in overdose events for all drugs being injected in Vancouver over the period studied. They also saw an increase in rigidity (a potential complication of fentanyl) from 10.4% of “heroin” overdoses in 2010/11 to 18.9% in 2017.

12) High Prevalence of Self-Reported Exposure to Adulterated Drugs Among People Who Experienced an Opioid Overdose in Canada: A Cohort Study.

Prangnell A, Fairgrieve C, Nosova E, DeBeck K, Milloy MJ, Hayashi K.

Subst Use Misuse. 2019 Jan 20:1-6. doi: 10.1080/10826084.2018.1555257. [Epub ahead of print]

Comment: Two-thirds of people who overdosed believed their drugs had been adulterated. While the current drug supply is very dynamic, I suspect this finding would hold for overdoses in areas not heavily affected by fentanyl; that is, this is a common perception among people who have overdosed, explained by the actor-observer bias.

13) Associations between implementation of Project Lazarus and opioid analgesic dispensing and buprenorphine utilization in North Carolina, 2009-2014.

Alexandridis AA, Dasgupta N, McCort AD, Ringwalt CL, Rosamond WD, Chelminski PR, Marshall SW.

Inj Epidemiol. 2019 Jan 21;6(1):2. doi: 10.1186/s40621-018-0179-2.

Comment: Limited effects.

14) What should clinicians do as fentanyl replaces heroin?

Bisaga A.

Addiction. 2019 Jan 20. doi: 10.1111/add.14522. [Epub ahead of print] No abstract available. 

Comment: Be creative, be innovative, don’t be shy.

15) Twenty years of the methadone treatment protocol in Ireland: reflections on the role of general practice.

Delargy I, Crowley D, Van Hout MC.

Harm Reduct J. 2019 Jan 17;16(1):5. doi: 10.1186/s12954-018-0272-4. Review.

Comment: 20 years and 10,000 patients later.

16) Overdose Deaths Involving Fentanyl and Fentanyl Analogs – New York City, 2000-2017.

Colon-Berezin C, Nolan ML, Blachman-Forshay J, Paone D.

MMWR Morb Mortal Wkly Rep. 2019 Jan 18;68(2):37-40. doi: 10.15585/mmwr.mm6802a3.

Comment: It’s always tricky to use toxicology results in overdose mortality surveillance because there are many substances found on toxicology which may not have contributed to the death (e.g. something the patient takes medically that was at a low or appropriately therapeutic level and doesn’t interact with likely causal drugs, or something that is a by-product of decomposition). In this circumstance, however, it made sense.

17) Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion.

Saloner B, Levin J, Chang HY, Jones C, Alexander GC.

JAMA Netw Open. 2018 Aug 3;1(4):e181588. doi: 10.1001/jamanetworkopen.2018.1588.

Comment: Buprenorphine treatment increased and opioid pain reliever prescriptions did not. That makes solid sense.

18) Pharmacokinetics of a novel, approved, 1.4 mg intranasal naloxone formulation for reversal of opioid overdose- a randomised controlled trial.

Skulberg AK, Åsberg A, Khiabani HZ, Røstad H, Tylleskar I, Dale O.

Addiction. 2019 Jan 14. doi: 10.1111/add.14552. [Epub ahead of print]

Comment: Intranasal 1.4mg was ~50% bioavailable, which is half as good as intramuscular, and the pharmacokinetics were similar to 0.8mg intramuscular, although the time to peak effect was about 5 minutes slower.

19) Overdose mortality rates in Croatia and factors associated with self-reported drug overdose among persons who inject drugs in three Croatian cities.

Handanagic S, Bozicevic I, Sekerija M, Rutherford GW, Begovac J.

Int J Drug Policy. 2019 Jan 11;64:95-102. doi: 10.1016/j.drugpo.2018.11.017. [Epub ahead of print]

Comment: Polydrug injection.

20) Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention.

Nolan ML, Shamasunder S, Colon-Berezin C, Kunins HV, Paone D.

J Urban Health. 2019 Jan 11. doi: 10.1007/s11524-018-00343-z. [Epub ahead of print]

Comment: These data suggest that fentanyl is responsible for a good amount of the increase in cocaine deaths in NYC. Was that intentionally consumed or contaminating cocaine? Given that the demographics of cocaine related deaths have historically been fairly distinct from opioid deaths in NYC, I wonder if comparing demographics would help to elucidate which is the case.

21) Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health.

Lovrecic B, Lovrecic M, Gabrovec B, Carli M, Pacini M, Maremmani AGI, Maremmani I.

Int J Environ Res Public Health. 2019 Jan 9;16(2). pii: E177. doi: 10.3390/ijerph16020177. Review.

Comment: Yup, we’re in a mess.

22) Primary Care for Persons Who Inject Drugs.

Visconti AJ, Sell J, Greenblatt AD.

Am Fam Physician. 2019 Jan 15;99(2):109-116.

Comment: Love this topic, which drove me into medicine in the first place. Excellent to see physicians, scientists, and academic publications take on this need.

23) Reversal of Pediatric Opioid Toxicity with Take-Home Naloxone: a Case Report.

Lebin JA, Chen BC, Valento MJ.

J Med Toxicol. 2019 Jan 10. doi: 10.1007/s13181-018-0695-z. [Epub ahead of print]

Comment: This may be the first journal report of pediatric reversal with take-home naloxone, but it’s not the first story … it’s been happening in the community for decades.

24) Drug Overdose Deaths Among Women Aged 30-64 Years – United States, 1999-2017.

VanHouten JP, Rudd RA, Ballesteros MF, Mack KA.

MMWR Morb Mortal Wkly Rep. 2019 Jan 11;68(1):1-5. doi: 10.15585/mmwr.mm6801a1.

Comment: Increased overdose mortality across the board among women.

25) Increasing Naloxone Access and Use to Prevent Opioid Overdose Death and Disability.

White ND.

Am J Lifestyle Med. 2018 Oct 20;13(1):33-35. doi: 10.1177/1559827618803874. eCollection 2019 Jan-Feb. Review.

Comment: Legislation and pronouncements have only done so much.

26) Opioid overdose detection using smartphones.

Nandakumar R, Gollakota S, Sunshine JE.

Sci Transl Med. 2019 Jan 9;11(474). pii: eaau8914. doi: 10.1126/scitranslmed.aau8914.

Comment: This is a fascinating topic. We can saturate the world with naloxone, but it still won’t prevent overdose events from becoming fatal among people who are isolated from others (e.g. marginally housed, living in hotel rooms). In San Francisco, about one-third of deaths occurred in single-room occupancy hotel units – a number that is unlikely to be significantly affected by responder interventions. To have non-invasive tools that can detect concerning vital signs could be hugely beneficial if implemented well.

27) Intravenous Misuse of Methadone, Buprenorphine and Buprenorphine-Naloxone in Patients Under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study.

Lugoboni F, Zamboni L, Cibin M, Tamburin S; Gruppo InterSERT di Collaborazione Scientifica (GICS).

Eur Addict Res. 2019;25(1):10-19. doi: 10.1159/000496112. Epub 2019 Jan 9.

Comment: People who inject drugs frequently try to inject other drugs.

28) Predictive Factors of Treatment Outcomes for Hospital Care in Children with Acute Methadone Poisoning.

Atighi Y, Eizadi-Mood N, Mansourian M, Zamani A, Saffaei A, Sabzghabaee AM.

J Res Pharm Pract. 2018 Oct-Dec;7(4):200-204. doi: 10.4103/jrpp.JRPP_16_141.

Comment: Accidental opioid poisoning amoung children at home is always tragic. While our first effort has to be avoiding such events, an earlier manuscript today showed that having naloxone at home can help mitigate when they do occur.

29) Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study.

Goldman JE, Waye KM, Periera KA, Krieger MS, Yedinak JL, Marshall BDL.

Harm Reduct J. 2019 Jan 8;16(1):3. doi: 10.1186/s12954-018-0276-0.

Comment: People use them and often implement some overdose prevention or management strategies when results are positive.

30) Legally Lethal Kratom: A Herbal Supplement with Overdose Potential.

Palasamudram Shekar S, Rojas EE, D’Angelo CC, Gillenwater SR, Martinez Galvis NP.

J Psychoactive Drugs. 2019 Jan 8:1-3. doi: 10.1080/02791072.2018.1562591. [Epub ahead of print]

Comment: Kratom’s another “weird” drug with some opioid properties. Took 10 days to recover – wow!

31) The importance of buprenorphine research in the opioid crisis.

Pendergrass SA, Crist RC, Jones LK, Hoch JR, Berrettini WH.

Mol Psychiatry. 2019 Jan 7. doi: 10.1038/s41380-018-0329-5. [Epub ahead of print]

Comment: Yep. Although I’d say implementation is more important.

32) Implementation of a collaborative model for opioid overdose prevention on campus.

Hill LG, Holleran Steiker LK, Mazin L, Kinzly ML.

J Am Coll Health. 2019 Jan 7:1-4. doi: 10.1080/07448481.2018.1549049. [Epub ahead of print]

Comment: Further expansion of naloxone.

33) Divergence In Recent Trends In Deaths From Intentional And Unintentional Poisoning.

Hempstead K, Phillips J.

Health Aff (Millwood). 2019 Jan;38(1):29-35. doi: 10.1377/hlthaff.2018.05186.

Comment: Notwithstanding a huge increase in unintentional opioid deaths and a shift in the causal opioids, poisoning suicide deaths have not changed during this period, again suggesting that suicide and unintentional overdose are distinct processes.

34) Medication Treatment For Opioid Use Disorders In Substance Use Treatment Facilities.

Mojtabai R, Mauro C, Wall MM, Barry CL, Olfson M.

Health Aff (Millwood). 2019 Jan;38(1):14-23. doi: 10.1377/hlthaff.2018.05162.

Comment: Uh … yeah. Please.

35) Changes in Pharmacists’ Perceptions After a Training in Opioid Misuse and Accidental Overdose Prevention.

Eukel HN, Skoy E, Werremeyer A, Burck S, Strand M.

J Contin Educ Health Prof. 2019 Jan 3. doi: 10.1097/CEH.0000000000000233. [Epub ahead of print]

Comment: More training pharmacists.

36) Commentary on Stam et al. (2019): Drugs, death and statistics.

Darke S.

Addiction. 2019 Jan 6. doi: 10.1111/add.14520. [Epub ahead of print] No abstract available. 

Comment: As usual, the author has insightful comments on overdose research and surveillance. Heroin deaths are often miscoded as morphine (or codeine?) deaths and stimulant deaths are often missed because the immediate medical cause of a cerebral hemorrhage or cardiac arrest is sufficient for the cause of death field.

37) On-site identification of psychoactive drugs by portable Raman spectroscopy during drug-checking service in electronic music events.

Gerace E, Seganti F, Luciano C, Lombardo T, Di Corcia D, Teifel H, Vincenti M, Salomone A.

Drug Alcohol Rev. 2019 Jan;38(1):50-56. doi: 10.1111/dar.12887. Epub 2019 Jan 6.

Comment: Portable drug detection is very exciting.

38) An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada.

Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K.

Subst Abuse Treat Prev Policy. 2018 Nov 27;13(1):41. doi: 10.1186/s13011-018-0180-3.

Comment: No age differences.

39) Utilizing Buprenorphine in the Emergency Department after Overdose.

Johns SE, Bowman M, Moeller FG.

Trends Pharmacol Sci. 2018 Dec;39(12):998-1000. doi: 10.1016/j.tips.2018.10.002. Review.

Comment: Good idea, when patients want it.

40) Pharmacological Research as a Key Component in Mitigating the Opioid Overdose Crisis.

Baumann MH, Kopajtic TA, Madras BK.

Trends Pharmacol Sci. 2018 Dec;39(12):995-998. doi: 10.1016/j.tips.2018.09.006. Review.

Comment: Review with focus on what new medications could provide.

41) At-a-glance – What can paramedic data tell us about the opioid crisis in Canada?

Do MT, Furlong G, Rietschlin M, Leyenaar M, Nolan M, Poirier P, Field B, Thompson W.

Health Promot Chronic Dis Prev Can. 2018 Sep;38(9):339-342. doi: 10.24095/hpcdp.38.9.06. English, French. 

Comment: It’s tricky to track opioid overdose with paramedic calls for several reasons (e.g. diagnosis codes are preliminary in this triage service, using naloxone administration as a marker misses a lot of events that aren’t “typical” heroin overdoses, the impact of naloxone programming is unclear, etc). Nonetheless, if you can access the data in a useful way, exploring this data source is irresistible.

42) Review of Case Narratives from Fatal Overdoses Associated with Injectable Naltrexone for Opioid Dependence.

Saucier R, Wolfe D, Dasgupta N.

Drug Saf. 2018 Oct;41(10):981-988. doi: 10.1007/s40264-018-0653-3. Erratum in: Drug Saf. 2018 May 24. 

Comment: It is concerning that in overdose deaths the manufacturer placed the blame on opioid use disorder and did not consider elevated risk for overdose after treatment discontinuation. I would agree that a registry is in order.