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!

1) Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review.

Thakur T, Frey M, Chewning B.

J Am Pharm Assoc (2003). 2019 Jul 29. pii: S1544-3191(19)30320-6. doi: 10.1016/j.japh.2019.06.016. [Epub ahead of print] Review.

Comments: Legal, but underutilized. There’s an interesting difference between obtaining naloxone at syringe access programs versus pharmacies. Cost. The welcoming nature of syringe access programs (when they are run right). Stigma.

2) Opioid Overdose Hospitalization Trajectories in States With and Without Opioid-Dosing Guidelines.

Sears JM, Fulton-Kehoe D, Schulman BA, Hogg-Johnson S, Franklin GM.

Public Health Rep. 2019 Jul 31:33354919864362. doi: 10.1177/0033354919864362. [Epub ahead of print]

Comments: Tough analysis. And one that probably couldn’t be done today due to the geographic variability in fentanyl availability. They compared Colorada/Utah/Washington (as states with opioid prescribing guidelines) to Arizona/California/Michigan/New Jersey/South Carolina (as states without) from 2001-2014 to see what happened with opioid overdose hospitalizations. Of note, their state selection criteria did not include any assessment of similarity in opioid or drug use trends. Looking at the trendlines, it looks like the primary difference is that it took an extra 2 years for the curves to flatten in comparator states. Unknown if this corresponded to a decrease in overdose mortality.

3) Consideration of opioid agonist treatment in a pregnant adolescent: A case report and literature review.

Spada M, Kmiec J, Glance JB, Gopalan P.

Subst Abus. 2019 Jul 30:1-5. doi: 10.1080/08897077.2019.1635970. [Epub ahead of print]

Comments: Yes.

4) Who receives naloxone from emergency medical services? Characteristics of calls and recent trends.

Geiger C, Smart R, Stein BD.

Subst Abus. 2019 Jul 30:1-8. doi: 10.1080/08897077.2019.1640832. [Epub ahead of print]

Comments: Big increases in urban counties and among youth as fentanyl emerged. More multi-dose administrations. More refusal of transport. The West stands out in less of these trends, likely related to the delayed entrance of a significant street fentanyl market.

5) Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine.

Strang J, McDonald R, Campbell G, Degenhardt L, Nielsen S, Ritter A, Dale O.

Drugs. 2019 Jul 27. doi: 10.1007/s40265-019-01154-5. [Epub ahead of print] Review.

Comments: Review.

6) The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis.

Colledge S, Peacock A, Leung J, Larney S, Grebely J, Hickman M, Cunningham E, Trickey A, Stone J, Vickerman P, Degenhardt L.

Int J Drug Policy. 2019 Jul 24. pii: S0955-3959(19)30208-7. doi: 10.1016/j.drugpo.2019.07.030. [Epub ahead of print] Review.

Comments: Interesting approach – they determined that 20.5% and 41.5% of PWID have had a past year and lifetime overdose, respectively. The old back-of-the-napkin estimate was about 15% and 50%, respectively. I wonder how this applies though in fentanyl areas.

7) Heroin Overdose-Related Child and Adolescent Hospitalizations: Insight on Comorbid Psychiatric and Substance Use Disorders.

Queeneth U, Bhimanadham NN, Mainali P, Onyeaka HK, Pankaj A, Patel RS.

Behav Sci (Basel). 2019 Jul 13;9(7). pii: E77. doi: 10.3390/bs9070077.

Comments: The authors report that prescription opioids led to heroin use, although the data are from 2010-2014, and more recent data suggests that’s no longer the most common pathway.

8) Legal and policy changes urgently needed to increase access to opioid agonist therapy in the United States.

Davis CS, Carr DH.

Int J Drug Policy. 2019 Jul 20;73:42-48. doi: 10.1016/j.drugpo.2019.07.006. [Epub ahead of print]

Comments: Yes – there’s an urgent need to get rid of many of the regulatory barriers – such as the only “waiver” ever required to treat a disease. This actually harkens back to the 1914 Harrison Narcotics Act and the subsequent determination by the US Supreme Court that “addiction is not a disease” … what a mess.

9) Prevalence and correlates of carrying naloxone among a community-based sample of opioid-using people who inject drugs.

Reed M, Wagner KD, Tran NK, Brady KA, Shinefeld J, Roth A.

Int J Drug Policy. 2019 Jul 20;73:32-35. doi: 10.1016/j.drugpo.2019.07.010. [Epub ahead of print]

Comments: Syringe access programs.

10) Urban, individuals of color are impacted by fentanyl-contaminated heroin.

Rhodes B, Costenbader B, Wilson L, Hershow R, Carroll J, Zule W, Golin C, Brinkley-Rubinstein L.

Int J Drug Policy. 2019 Jul 19;73:1-6. doi: 10.1016/j.drugpo.2019.07.008. [Epub ahead of print]

Comments: Yep, this is the change that is less interesting to press…

11) “They’re making it so hard for people to get help:” Motivations for non-prescribed buprenorphine use in a time of treatment expansion.

McLean K, Kavanaugh PR.

Int J Drug Policy. 2019 Jul 19;71:118-124. doi: 10.1016/j.drugpo.2019.06.019. [Epub ahead of print]

Comments: Federal policies limit access, and funds poured into expanding access may not be reaching those it needs to reach.

12) Themes in published obituaries of people who have died of opioid overdose.

Rajesh K, Crijns TJ, Ring D.

J Addict Dis. 2019 Jul 22:1-6. doi: 10.1080/10550887.2019.1639485. [Epub ahead of print]

Comments: I can’t access the full article but would love to. The themes are love, joy, and sadness. No surprise here. People love people who use drugs.

13) Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts.

Oliver JE, Carlson C.

Pain Manag Nurs. 2019 Jul 18. pii: S1524-9042(19)30072-4. doi: 10.1016/j.pmn.2019.05.004. [Epub ahead of print] Review.

Comments: I can’t access the full article. They list misperceptions.

14) One single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning.

Harris K, Page CB, Samantray S, Parker L, Brier AJ, Isoardi KZ.

Emerg Med Australas. 2019 Jul 21. doi: 10.1111/1742-6723.13344. [Epub ahead of print]

Comments: Perhaps a large (1.6mg IM in this study) IM dose reduces the likelihood of more complex management in an emergency department. It’s important to see this in the context of the old days, when paramedics would routinely given large naloxone doses, often seen as a “punishment” of a person for experiencing an overdose. The transition to 0.4mg IM was considered humane – the shift back to high dose needs to be considered seriously before being implemented because EMS has access to the means to support respiration, making immediate and full reversal of overdose less important, or – in some circumstances – undesired.

15) Impact of a pharmacist-driven intervention on the outpatient dispensing of naloxone.

Griffin S, Wishart B, Bricker K, Luebchow A.

J Am Pharm Assoc (2003). 2019 Jul – Aug;59(4S):S161-S166. doi: 10.1016/j.japh.2019.06.011.

Comments: Pharmacists were able to convince more patients to accept naloxone prescriptions.

16) Deploying science to change hearts and minds: Responding to the opioid crisis.

Walsh SL, Long KQX.

Prev Med. 2019 Jul 15:105780. doi: 10.1016/j.ypmed.2019.105780. [Epub ahead of print]

Comments: The abstract calls for increased access to evidence-based care for people with opioid use disorder and identifies some barriers to treatment. Full text not available through Elsevier. 

17) Heroin and healthcare: patient characteristics and healthcare prior to overdose.

Bohm MK, Bridwell L, Zibbell JE, Zhang K.

Am J Manag Care. 2019 Jul;25(7):341-347.

Comments: Interesting use of data from the IBM MarketScan Databases (insurance claims-based data set with millions of de-identified patient records) comparing annual heroin overdose rates between Medicaid and commercially-insured patients in the U.S. from 2010-2014. Heroin overdose was much more frequent among Medicaid compared to commercially-insured patients, with the exception of 15-24 year old persons. Over the four years, heroin overdose rates increased more rapidly for commercially-insured patients (270%) compared to Medicaid patients (94%), despite the fact that fewer commercially-insured patients had received prior opioid prescriptions in the month prior to overdose. 

18) Implementation evaluation of academic detailing on naloxone prescribing trends at the United States Veterans Health Administration.

Bounthavong M, Devine EB, Christopher MLD, Harvey MA, Veenstra DL, Basu A.

Health Serv Res. 2019 Jul 17. doi: 10.1111/1475-6773.13194. [Epub ahead of print]

Comments: Efforts to implement academic detailing on opioid overdose and naloxone distribution have not been uniform across all VA stations. This study found that VA stations where 100% of providers were exposed to an academic detailing intervention had a naloxone prescribing rate that was 5.52 times that of stations where no providers were exposed. 

19) Justice involvement patterns, overdose experiences, and naloxone knowledge among men and women in criminal justice diversion addiction treatment.

Gicquelais RE, Mezuk B, Foxman B, Thomas L, Bohnert ASB.

Harm Reduct J. 2019 Jul 16;16(1):46. doi: 10.1186/s12954-019-0317-3.

Comments: Examines overdose education and naloxone distribution (OEND) engagement of individuals diverted from the criminal justice system to addiction treatment. Just over half correctly identified naloxone as an opioid overdose treatment, while 68% had experienced an overdose and 79% had witnessed another person overdose. 

20) Supervised consumption sites: a nuanced assessment of the causal evidence.

Caulkins JP, Pardo B, Kilmer B.

Addiction. 2019 Jul 16. doi: 10.1111/add.14747. [Epub ahead of print]

Comments: Review article describing evidence around supervised consumption sites (SCS). Posits that the nature of such studies often precludes causal evidence, but that the literature generally shows associations between SCS and positive client outcomes. 

21) Pharmacist dispensed naloxone: Knowledge, availability, participation and cost in selected California counties.

Darracq MA, Lee J, Wilson T, Lasoff D, Armenian P.

Int J Drug Policy. 2019 Jul 10;71:113-117. doi: 10.1016/j.drugpo.2019.06.001. [Epub ahead of print]

Comments: Since AB1535 was signed into law in California, authorizing pharmacists to dispense naloxone without physician or mid level provider prescription, this study finds highly variable participation, availability of naloxone, charge for naloxone, and future interest at 622 pharmacies across various California counties. Unclear if there are trends or further analysis done on participating pharmacies due to lack of access to the full article.

22) Description of a pharmacist-led clinical video telehealth group clinic for opioid overdose prevention and naloxone education.

Jensen AN, Beam CM, Douglass AR, Brabson JE, Colvard M, Bean J.

Ment Health Clin. 2019 Jul 1;9(4):294-297. doi: 10.9740/mhc.2019.07.294. eCollection 2019 Jul.

Comments: Describes a video telehealth clinic led by a pharmacist to provide education about overdose and naloxone, intended to reach patients in more rural and difficult to reach areas. Seems to have reached additional people, but it is unclear how effective the education and training were at reducing overdose risk and overdose events. 

23) Public perceptions of naloxone use in the outpatient setting.

Smith JO, Malinowski SS, Ballou JM.

Ment Health Clin. 2019 Jul 1;9(4):275-279. doi: 10.9740/mhc.2019.07.275. eCollection 2019 Jul.

Comments: Among a sample of 405 participants who were reimbursed $0.10 for completing a survey through a crowdsourcing marketplace, the majority were aware that an overdose agent exists. However, although 88% of people believed naloxone is beneficial for accidental overdose, 51% still believe that naloxone enables people who misuse opioids. Public education campaigns about naloxone are still relevant to correct misconceptions and address stigma.

24) Keeping Up with Clinical Advances: Opioid Use Disorder.

Patel B, Kosten TR.

CNS Spectr. 2019 Jul 10:1-7. doi: 10.1017/S109285291900110X. [Epub ahead of print]

Comments: Overview of the various medications that treat opioid use disorder, including methadone, buprenorphine, and naltrexone. Clonidine and lofexidine, which are primarily used to manage symptoms of acute withdrawal, are also discussed. 

25) Overdose Deaths and Acute Hepatitis Infections among American Indians in North Carolina.

Cox ME, Dzialowy N, Armstrong L, Proescholdbell S.

N C Med J. 2019 Jul-Aug;80(4):197-203. doi: 10.18043/ncm.80.4.197.

Comments: Based on death certificate data, American Indians (AIs) have 1.3 times greater unintentional medication and drug overdose death rates compared to combined population rates in North Carolina, matching the rates of the white population. 

26) Factors associated with willingness to wear an electronic overdose detection device.

Ahamad K, Dong H, Johnson C, Hyashi K, DeBeck K, Milloy MJ, Wood E.

Addict Sci Clin Pract. 2019 Jul 3;14(1):23. doi: 10.1186/s13722-019-0153-5.

Comments: About half of a cohort of people who use drugs in Vancouver, Canada, said they would be willing to wear an overdose detection device, which would alert others in the case that they overdosed. Factors associated with willingness are described. 

27) Mortality and causes of death among patients with opioid use disorder receiving opioid agonist treatment: a national register study.

Bech AB, Clausen T, Waal H, Šaltytė Benth J, Skeie I.

BMC Health Serv Res. 2019 Jul 2;19(1):440. doi: 10.1186/s12913-019-4282-z.

Comments: Analysis of crude mortality rate (CMR) and causes of death in Norway’s OAT patient population from January 2014 to December 2015. 1.4% mortality rate among OAT patients in this 2-year period. Deaths were attributed to somatic disease (45%), followed by drug-induced death (42%), and violent death (12%). CMR was higher in men and in patients taking methadone compared with buprenorphine. Results may be somewhat limited by small sample size of deaths in OAT patients (n=200). 

28) Knowledge of Fentanyl and Perceived Risk of Overdose Among Persons Who Use Drugs in Vancouver, Canada.

Moallef S, Nosova E, Milloy MJ, DeBeck K, Fairbairn N, Wood E, Kerr T, Hayashi K.

Public Health Rep. 2019 Jul/Aug;134(4):423-431. doi: 10.1177/0033354919857084. Epub 2019 Jun 18.

Comments: 93.9% of participants who report drug use in this Vancouver study reported some level of fentanyl risk knowledge. 72.5% of participants (and 60% of opioid users in the sample) perceived their risk of fentanyl overdose as nonexistent or low. Participants who perceived a lower risk were also less likely to report a recent nonfatal overdose, recent injection drug use, and awareness of recent exposure to fentanyl citing never or rarely using opioids as the most common reason. Additional findings show that people who were incarcerated were less likely than those who were not incarcerated to perceive their risk of fentanyl overdose as lower. Results are limited to self-reported data.

29) Monoclonal Antibodies for Combating Synthetic Opioid Intoxication.

Smith LC, Bremer PT, Hwang CS, Zhou B, Ellis B, Hixon MS, Janda KD.

J Am Chem Soc. 2019 Jul 3;141(26):10489-10503. doi: 10.1021/jacs.9b04872. Epub 2019 Jun 25.

Comments: Study about a monoclonal antibody therapy to treat exposure to fentanyl and its analogs. The authors propose this antibody therapy as a potential alternative to naloxone; its half life is much longer and would eliminate the risk of falling back into overdose (which is actually remarkably low…). Ethical issues certainly do come up and there are real logical challenges, with which opioids are targeted, administration, prolonged withdrawal, etc.

30) Clarification re naloxone administered to study subject versus other overdose victim in the N-ALIVE pilot randomized trial.

Parmar MKB, Strang J, Choo L, Meade AM, Bird SM.

Addiction. 2019 Jul;114(7):1325. doi: 10.1111/add.14284. No abstract available.

Comments: This is clarification of the study results reported in the N-ALIVE trial of NOR (Naloxone-on-Release), which provided naloxone to former heroin users after release from prison. The committee stopped the trial early because only 5/20 of the former inmates who received naloxone on release used it on themselves and 15/20 used it on other people. This was supposed to be the definitive study of naloxone as overdose prevention, but it got beaten by the reality of naloxone as a community medication.

31) Changing Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among Veterans.

Lin LA, Peltzman T, McCarthy JF, Oliva EM, Trafton JA, Bohnert ASB.

Am J Prev Med. 2019 Jul;57(1):106-110. doi: 10.1016/j.amepre.2019.01.016. Epub 2019 May 22.

Comments: Analysis of opioid categories and receipt of prescription opioids among veterans who died from opioid overdose in the Veteran’s Health Administration.  Rates of overdose from synthetic opioids and heroin increased substantially from 2010 to 2016, while prescription opioid receipt within 3 months before death decreased from 54% in 2010 to 26% in 2016. Full text not available. 

32) Suspected Heroin Overdoses in US Emergency Departments, 2017-2018.

Vivolo-Kantor AM, Hoots B, David F, Gladden RM.

Am J Public Health. 2019 Jul;109(7):1022-1024. doi: 10.2105/AJPH.2019.305053. Epub 2019 May 16.

Comments: Analysis of suspected heroin overdoses during 2017-2018 in 23 states and jurisdictions funded by the CDC and Prevention Enhanced State Opioid Overdose Surveillance program. Results show 21.5% overall decline in heroin overdose ED visits, but significant increase in Illinois, Indiana and Utah. Limitations of the study include lack of examining other opioids such as fentanyl and limited sensitivity of ED coding. 

33) Overdose following initiation of naltrexone and buprenorphine medication treatment for opioid use disorder in a United States commercially insured cohort.

Morgan JR, Schackman BR, Weinstein ZM, Walley AY, Linas BP.

Drug Alcohol Depend. 2019 Jul 1;200:34-39. doi: 10.1016/j.drugalcdep.2019.02.031. Epub 2019 May 3.

Comments: The Massachusetts database allows for extraordinary analyses. This one demonstrated, in a cohort of 43,846 people, that individuals receiving buprenorphine therapy following an opioid use disorder diagnosis were at a lower risk of opioid overdose (hazard ratio 0.40 [0.35-0.46]), whereas a significant risk reduction or association was not observed for naltrexone (oral [hazard ratio 0.93 {0.71-1.22}] or extended-release injectable [hazard ratio 0.74 {0.42-1.31}]). The naltrexone category is underpowered here, but does not appear likely to achieve the benefits of buprenorphine.

34) Why aren’t Australian pharmacists supplying naloxone? Findings from a qualitative study.

Olsen A, Lawton B, Dwyer R, Taing MW, Chun KLJ, Hollingworth S, Nielsen S.

Int J Drug Policy. 2019 Jul;69:46-52. doi: 10.1016/j.drugpo.2019.03.020. Epub 2019 May 9.

Comments: In Australia, over-the-counter naloxone dispensing by pharmacists is happening, though still very under-utilized. Strategies to improve pharmacist uptake are at individual (training) and system (regulation, supply) levels. 

35) Evaluation of a lateral flow immunoassay for the detection of the synthetic opioid fentanyl.

Angelini DJ, Biggs TD, Maughan MN, Feasel MG, Sisco E, Sekowski JW.

Forensic Sci Int. 2019 Jul;300:75-81. doi: 10.1016/j.forsciint.2019.04.019. Epub 2019 Apr 26.

Full text not available. There remains a huge fear of fentanyl among many first responders, irresponsibly promoted in this abstract. Fentanyl and its analogues don’t absorb well through skin. In general, to get sufficient exposure, one would have to essentially bathe in fentanyl. The cases of purported exposure commonly involve panic attacks or, in some subsequently documented circumstances, surreptitious ingestion of the drugs that were found at the scene. This fear leads to stigma against people who use drugs, dangerous legislation, and abandonment of patients in need.

36) Editorial: Prescription for Addiction.

Riggs P.

J Am Acad Child Adolesc Psychiatry. 2019 Jul;58(7):659-660. doi: 10.1016/j.jaac.2019.03.030. Epub 2019 Apr 17.

The editorial calls attention to the gap in knowledge of predictive risk factors for drug use in youth, which limits the ability to develop effective interventions. Full text not available.  

37) Pharmacokinetic Interaction between Naloxone and Naltrexone Following Intranasal Administration to Healthy Subjects.

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

Drug Metab Dispos. 2019 Jul;47(7):690-698. doi: 10.1124/dmd.118.085977. Epub 2019 Apr 16.

Comments: I’m really not clear on why we need longer acting opioid overdose reversal agents. There are rare circumstnaces where this is desirable, but that is really uncommon. Most of the time people don’t want to be in a prolonged withdrawal. Use of buprenorphine after naloxone has been done and can be effective. This is a weird research pathway. 

38) Opioid users reflect on their experiences responding to suspected opioid overdoses using take-home naloxone.

Donaghy J.

Evid Based Nurs. 2019 Jul;22(3):77. doi: 10.1136/ebnurs-2019-103072. Epub 2019 Mar 21. No abstract available.

Reflections of opioid users who have used take home naloxone on others when overdosing. Full text or abstract not available.  

39) No end to the crisis without an end to the waiver.

Frank JW, Wakeman SE, Gordon AJ.

Subst Abus. 2018;39(3):263-265. doi: 10.1080/08897077.2018.1543382. No abstract available.

Requiring a waiver to prescribe the most important medication to treat opioid use disorder is really messed up, especially since so many of these patients were provided the opioids that got them hooked by providers who didn’t need a waiver to prescribe those medications. Backwards and archaic.

40) Novel Formulations of Buprenorphine for Treatment of Opioid Use Disorder.

Rosenthal RN.

Focus (Am Psychiatr Publ). 2019 Apr;17(2):104-109. doi: 10.1176/appi.focus.20180043. Epub 2019 Apr 10.

Comments: The study aims to find novel delivery systems to improve outcomes of intermediate and long acting exposure to buprenorphine. Novel formulations are helpful to ensure buprenorphine access in circumstances that limit adherence, as well as where daily dose formulations may be perceived as problematic (such as correctional settings).

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!

_____

1) A national survey of approaches to manage the ICU patient with opioid use disorder.

Reichheld AM, Hills-Evans K, Sheehan JK, Tocci NX, Tandon M, Hsu D, Marshall J, O’Donoghue S, Stevens JP.

J Crit Care. 2019 Jun 29;54:42-47. doi: 10.1016/j.jcrc.2019.06.032. [Epub ahead of print]

Comments: Managing patients with opioid use disorder can be complicated, more so when taking methadone for treatment, and even more so when taking buprenorphine due to the partial agonist effect of that drug. I love the word “iatrogenic”, which basically means “caused by the medical system”, and pertains frequently to what happens to patients on buprenorphine treatment when they are admitted to the hospital. Buprenorphine is often stopped when it shouldn’t be, patients are in agony for prolonged periods, and end up discharged on huge doses of full agonists, like hydromorphone (Dilaudid), and relapsing to illicit opioid use. It can be extremely disruptive.

2) Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization.

Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B.

Addict Behav. 2019 Jun 26;98:106037. doi: 10.1016/j.addbeh.2019.106037. [Epub ahead of print]

Comments: Community-based participatory research is fascinating.

3) Responding to the opioid and overdose crisis with innovative services: The recovery community center office-based opioid treatment (RCC-OBOT) model.

Ashford RD, Brown AM, McDaniel J, Neasbitt J, Sobora C, Riley R, Weinstein L, Laxton A, Kunzelman J, Kampman K, Curtis B.

Addict Behav. 2019 Jun 21;98:106031. doi: 10.1016/j.addbeh.2019.106031. [Epub ahead of print]

Comments: My university dropped Elsevier, so I can’t access this one and the abstract doesn’t give details on the model proposed, except that it involves using medications which is key to treating opioid use disorder.

4) Prescription opioid misuse among U.S. Hispanics.

Cano M.

Addict Behav. 2019 Jun 13;98:106021. doi: 10.1016/j.addbeh.2019.06.010. [Epub ahead of print]

Comments: The narrative surrounding the opioid epidemic has mostly focused on low-income white communities. However, just because the overall prevalence of opioid misuse among U.S. Hispanics is low doesn’t mean we can ignore this population. It turns out that the higher the generation of U.S. Hispanic adults, the higher the prevalence of prescription opioid misuse (e.g 6.8% prevalence 3rd generation and 6.2% for higher than 3rd generation Hispanics).  English language orientation and length of time living in the U.S. were also associated with higher odds of past-year and lifetime prescription opioid misuse.

5) State Approaches to Addressing the Overdose Epidemic: Public Health Focus Needed.

Davis C, Green T, LaSalle L, Beletsky L.

J Law Med Ethics. 2019 Jun;47(2_suppl):43-46. doi: 10.1177/1073110519857315.

Comments: Overview of the common approaches used by states to address opioid-related harm, some of which are public health-based (i.e. overdose prevention and syringe exchange programs) while others are more punitive (i.e. drug-induced homicide statutes, compulsory treatment for OUD). Article stresses that public health approaches reduce opioid-related harm while punitive approaches exacerbate it by further stigmatizing drug use and discouraging people who use drugs from seeking care after an overdose.

6) Computational Systems Pharmacology-Target Mapping for Fentanyl-laced Cocaine Overdose.

Cheng J, Wang S, Lin W, Wu N, Wang Y, Chen M, Xie XS, Feng Z.

ACS Chem Neurosci. 2019 Jun 29. doi: 10.1021/acschemneuro.9b00109. [Epub ahead of print]

Comments: This paper tries to look at overdoses from fentanyl and cocaine (most believe that it is rarely “fentanyl-laced cocaine”, but instead generally co-use or mistaken use) by looking at genes, receptors, etc., that the drugs bind through simulations. It’s an interesting concept and one that is a bit over my head, admittedly. Unfortunately, the results and discussion are one section so it’s difficult to tease out the conclusions of the authors, besides that a cannabinoid 2 agonist should be used to treat cocaine and fentanyl overdose. 

7) The Role of Pharmacists in Safe Opioid Dispensing.

Gregory T, Gregory L.

J Pharm Pract. 2019 Jun 30:897190019852803. doi: 10.1177/0897190019852803. [Epub ahead of print]

Comments: Review article that describes the role of pharmacists in the era of opioid pharmacovigilance. Mentions patient education about medications and naloxone, but focuses mostly on reduction of opioid diversion and use of non-prescription opioids through identification of “red-flag” behaviors. Missed opportunity for a discussion about the patient/pharmacist relationship as a way for patients to seek further education about their medications.

8) Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder.

Haffajee RL, Lin LA, Bohnert ASB, Goldstick JE.

JAMA Netw Open. 2019 Jun 5;2(6):e196373. doi: 10.1001/jamanetworkopen.2019.6373.

Comments: In this cross-sectional study, “opioid high-risk counties” are defined by low availability of providers who can prescribe medications for OUD and high overdose mortality rate. Out of 3142 counties in the U.S., 419 were identified as opioid high-risk. Characteristics of these counties include higher rates of unemployment, micropolitan rather than metropolitan (e.g. <10,000 people), lower primary care provider density and located in East North Central, South Atlantic, or Mountain divisions.

9) Commentary on Elliot et al. (2019): How stigma shapes overdose revival and possible avenues to disrupt it.

Farrugia A.

Addiction. 2019 Jun 27. doi: 10.1111/add.14660. [Epub ahead of print] No abstract available.

Comments: Emergency medical responders can have stigmatizing attitudes and uncaring professional practices towards people they revive from overdose. Understandably, this increases the chance of conflictual encounters; however, providers are more likely to perceive these encounters as a sign of ingratitude rather than a byproduct of poor practices, thus generating a circular stigmatizing dynamic. This article posits that strategies such as addiction stigma reduction education initiatives and better naloxone administration practices are not sufficient to resolve the problem of stigma in healthcare. Accordingly, “more ambitious disruptions” to stigma must be undertaken, although what these disruptions might look like is not articulated.

10) Pain Management Strategies To Reduce Opioid Use Following Total Knee Arthroplasty.

Derogatis MJ, Sodhi N, Anis HK, Ehiorobo JO, Bhave A, Mont MA.

Surg Technol Int. 2019 Jun 25;35. pii: sti35/1156. [Epub ahead of print]

Comments: A review on the literature describing non-narcotic treatments to manage pain following total knee arthroplasty (TKA) finds conflicting evidence on prescribing acetaminophen or gabapentinoids and subsequent reduced opioid use. Multiple studies identified reductions in TKA pain with knee braces as a recommended non-invasive and non-pharmacological treatment. Full article unavailable.

11) Effect of Formulation Variables on the Nasal Permeability and Stability of Naloxone Intranasal Formulations.

Hsu HJ, Yang Y, Pavuluri V, Abraham C, Naraharisetti SB, Ashraf M, Al-Ghabeish M.

AAPS PharmSciTech. 2019 Jun 24;20(6):232. doi: 10.1208/s12249-019-1452-6.

Comments: The science of intranasal naloxone gets interesting when you try to ensure it will be absorbed – and you try to ensure it lasts a long time. Low pH helps it last longer but reduces absorption. Benzalkonium chloride improves absorption a lot, benzyl alcohol somewhat.

12) A Randomized Cross-Over Trial Comparing the Effect of Intramuscular Versus Intranasal Naloxone Reversal of Intravenous Fentanyl on Odor Detection in Working Dogs.

Essler JL, Smith PG, Berger D, Gregorio E, Pennington MR, McGuire A, Furton KG, Otto CM.

Animals (Basel). 2019 Jun 22;9(6). pii: E385. doi: 10.3390/ani9060385.

Comments: Dog’s olfactory abilities are not impacted or impaired by the administration of intranasal or intramuscular naloxone to reverse intravenous fentanyl sedation. However, the article starts out with the premise that exposure to fentanyl in first responders causes overdose. This is not true – unless they are pasting on fentanyl patches that have been designed to improve dermal absorption and then waiting 12 hours. 

13) A standardized team-based approach for identifying naloxone-eligible patients in a grocery store pharmacy.

Sexton SM, Armstrong A, Gatton O, Rhodes LA, Marciniak MW.

J Am Pharm Assoc (2003). 2019 Jun 20. pii: S1544-3191(19)30144-X. doi: 10.1016/j.japh.2019.03.015. [Epub ahead of print]df

Comments: A community pharmacy utilized a standardized team-based approach for identifying naloxone-eligible patients, which resulted in a >300% increase in naloxone orders over the course of a year in comparison to the control store (which followed standard of practice). Full text not available.

14) One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose.

Weiner SG, Baker O, Bernson D, Schuur JD.

Ann Emerg Med. 2019 Jun 19. pii: S0196-0644(19)30343-9. doi: 10.1016/j.annemergmed.2019.04.020. [Epub ahead of print]

Comments: Can’t access full article so may be missing something here. Paper addresses mortality following opioid overdose cared for in emergency departments in Massachusetts. About 6.5% died within one year, which is markedly high, but they don’t describe what people died from so their conclusion that substance use interventions are needed may or may not be correct based on the data. The statistics presented in the abstract, moreover, are a bit strange, as they devote lines to basically just giving the proportion of the proportions in previous sentences. Would be nice to see a more sophisticated analysis from such a fantastic dataset.

15) Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States.

Sohn M, Talbert JC, Huang Z, Lofwall MR, Freeman PR.

JAMA Netw Open. 2019 Jun 5;2(6):e196215. doi: 10.1001/jamanetworkopen.2019.6215.

Comments: Suggests that naloxone coprescription laws are associated with increased dispensing of prescribed naloxone in pharmacies.

16) Transforming lives and empowering communities: evidence, harm reduction and a holistic approach to people who use drugs.

Southwell M, Shelly S, MacDonald V, Verster A, Maher L.

Curr Opin HIV AIDS. 2019 Jun 18. doi: 10.1097/COH.0000000000000566. [Epub ahead of print]

Comments: Harm reduction programs are still extremely underfunded and insufficiently supported, stigmatizing people who use drugs and creating barriers to care. New(ish) innovations discussed include peer distribution of naloxone, low dead space syringes, drug consumption rooms and drug-checking services.

17) Using natural language processing of clinical text to enhance identification of opioid-related overdoses in electronic health records data.

Hazlehurst B, Green CA, Perrin NA, Brandes J, Carrell DS, Baer A, DeVeaugh-Geiss A, Coplan PM.

Pharmacoepidemiol Drug Saf. 2019 Jun 19. doi: 10.1002/pds.4810. [Epub ahead of print]

Comments: Electronic health records generally don’t include fields for substance use, such as whether or not someone injects drugs. These data may exist in provider notes, although patients know that those data in health records can stigmatize them, lead providers not to care for them (e.g. orthopedic surgeons), and cause financial and legal headaches (such as losing access to life insurance) – thus patients may understandably conceal drug use from their providers as much as possible and providers, particularly in this age of open medical records, may alter their language to allow patients that confidentiality while trying not to compromise patient care.

In the mix of this, “big data” and other efforts to use existing data sources has led a lot of substance use research toward electronic health records. This study attempted to create a natural language processing algorithm to identify opioid overdoses. It did fairly well but hit some snags, particularly in the validation cohort. Intentional overdose was readily identified. About two-thirds of unintentional overdoses were identified, with about 11% of the cases identified being false positives. Identifying specific substances got much more problematic. Overall, a much needed step toward understanding how to do this – but we still need to interact with actual people.

18) In-flight opioid overdose and the availability of onboard naloxone: An international survey of commercial airlines.

Wang JJ, Poirier V, Carvalho AM, Biary R, Su MK.

Travel Med Infect Dis. 2019 Jun 16. pii: S1477-8939(19)30100-0. doi: 10.1016/j.tmaid.2019.06.003. [Epub ahead of print] No abstract available.

Comments: Abstract and full text unavailable.

19) Opioid overdose prevention education for medical students: Adopting harm reduction into mandatory clerkship curricula.

Oldfield BJ, Tetrault JM, Wilkins KM, Edelman EJ, Capurso NA.

Subst Abus. 2019 Jun 18:1-6. doi: 10.1080/08897077.2019.1621241. [Epub ahead of print]

Comments: Describes a mandatory educational intervention for medical students to provide overdose prevention information in a harm reduction framework, with a post-survey showing improved knowledge and attitudes.

20) Comprehensive Perioperative Management Considerations in Patients Taking Methadone.

Cornett EM, Kline RJ, Robichaux SL, Green JB, Anyama BC, Gennuso SA, Okereke EC, Kaye AD.

Curr Pain Headache Rep. 2019 Jun 17;23(7):49. doi: 10.1007/s11916-019-0783-z. Review.

Comments: Perioperative pain management strategies for patients on medications for opioid use disorder, including methadone, should be multimodal. Opioid-sparing techniques can be used when appropriate. Unable to access full article for more details through Elsevier.

21) Suspected involvement of fentanyl in prior overdoses and engagement in harm reduction practices among young adults who use drugs.

Goldman JE, Krieger MS, Buxton JA, Lysyshyn M, Sherman SG, Green TC, Bernstein E, Hadland SE, Marshall BDL.

Subst Abus. 2019 Jun 17:1-8. doi: 10.1080/08897077.2019.1616245. [Epub ahead of print]

Comments: In a small study of 93 participants who use drugs, those who had experienced a suspected fentanyl-related overdose (n=18) were more likely to carry and administer naloxone. This same group was more likely to have administered naloxone to someone else experiencing an overdose than those who had never overdosed or who had overdosed on substances not believed to be fentanyl.

22) Long-term tracking of opioid consumption in two United States cities using wastewater-based epidemiology approach.

Gushgari AJ, Venkatesan AK, Chen J, Steele JC, Halden RU.

Water Res. 2019 Jun 3;161:171-180. doi: 10.1016/j.watres.2019.06.003. [Epub ahead of print]

Comments: Analyzing municipal raw wastewater from two Midwestern cities for morphine, codeine, oxycodone, heroin, fentanyl, and some opioid metabolites to try to predict the number of opioid overdose deaths. Can’t access the full article so difficult to verify, but they claim to have been able to use the algorithm to fairly accurately predict the number of deaths in 2016.

23) Naloxone interventions in opioid overdoses: a systematic review protocol.

Shaw LV, Moe J, Purssell R, Buxton JA, Godwin J, Doyle-Waters MM, Brasher PMA, Hau JP, Curran J, Hohl CM.

Syst Rev. 2019 Jun 11;8(1):138. doi: 10.1186/s13643-019-1048-y.

Comments: Protocol paper for a systematic review of administration of naloxone for opioid overdose (looking at dosing, effectiveness, and adverse effects of naloxone). Not an urgent study, as naloxone is known to be safe in a wide range of doses. However, administering naloxone to an individual experiencing an overdose often causes immediate opioid withdrawal and significant discomfort in that individual. Additional research on naloxone dose administered for different opioids, especially suspected ultra-potent opioids like fentanyl, could be a useful tool in understanding how to humanely reverse opioid overdoses.

24) Pulmonary Complications of Opioid Overdose Treated With Naloxone.

Farkas A, Lynch MJ, Westover R, Giles J, Siripong N, Nalatwad A, Pizon AF, Martin-Gill C.

Ann Emerg Med. 2019 Jun 7. pii: S0196-0644(19)30309-9. doi: 10.1016/j.annemergmed.2019.04.006. [Epub ahead of print]

Comments: Unable to access full article. This retrospective, observational, cross-sectional study found that patients who had received more than 4.4mg of naloxone (in other words more than 1 dose) were 62% more likely to have a pulmonary complication like aspiration pneumonia. This is not remotely unexpected, as multiple doses are administered when someone is not responding and thus has further pulmonary compromise from their overdose.

25) [Improve the benefit/risk balance of methadone by respecting its pharmacological specificities].

Frauger E, Fouilhé Sam-Laï N, Mallaret M, Micallef J; le French Addictovigilance Network (FAN).

Therapie. 2019 Jun;74(3):383-388. doi: 10.1016/j.therap.2018.09.070. Epub 2018 Sep 27. French.

Comments: French article, full-text unavailable, describes methadone-related adverse events (overdose, diversion, death) from 2003-2017 in France.

26) Opioid use and misuse: health impact, prevalence, correlates and interventions.

Bolshakova M, Bluthenthal R, Sussman S.

Psychol Health. 2019 Jun 8:1-35. doi: 10.1080/08870446.2019.1622013. [Epub ahead of print]

Comments: A broad review and history of opioid use and misuse in recent years examining individual and environmental factors that lead to problematic use, preventative strategies, and current alternatives to pain management. This article calls for a balance of limiting access to opioids for potential misusers and ensuring that patients who need pain management do not experience additional barriers to accessing prescription opioids. However, the question remains about how this distinction could be implemented in an unbiased way. 

27) Development of vaccines to treat opioid use disorders and reduce incidence of overdose.

Pravetoni M, Comer SD.

Neuropharmacology. 2019 Jun 4:107662. doi: 10.1016/j.neuropharm.2019.06.001. [Epub ahead of print] Review.

Comments: Review article; discusses possibilities of using vaccines to treat substance use disorders, and opioid use disorders in particular. As discussed in our last release, there are both logistic (there is such a variety of opioids and the market is shifting constantly) and potential ethical issues with vaccines, particularly related to forced use in criminal justice settings and particularly relevant to opioid use disorder, for which we already have effective treatments. Unable to access full article through Elsevier.

28) The relative lethal toxicity of pharmaceutical and illicit substances; A 16-year study of the Greater Newcastle Hunter Area, Australia.

Brett J, Wylie CE, Raubenheimer J, Isbister GK, Buckley NA.

Br J Clin Pharmacol. 2019 Jun 7. doi: 10.1111/bcp.14019. [Epub ahead of print]

Comments: Interesting article. Can’t access the full text to really evaluate what they did. Seems they combined mortality data with dispensing data and data from the Hunter Area Toxicology Service (in Australia; seems to be an emergency department of sorts) to generate two data points: 1) the fatal toxicity index (FTI) = the number of fatal poisonings from a drug per year of daily dispensed drug; and (2) case fatality (CF) = the rate of fatal poisonings to total poisonings. There were 444 overdose deaths and 21,296 overdoses recorded from 2002 to 2016. Of prescribed drugs, opioids had the highest FTI (40.3 deaths per 100 years of dispensed drug) and CF (12.4% of overdoses resulted in death). Among the opioids, the highest FTI came from fentanyl, methadone and morphine (does Australia have illictly-manufactured fentanyl? That would mess up this analysis). Heroin had a CF of 26.4%. This is interesting, because heroin overdose is well established to result in death in about 4% of cases; these data suggest that, among heroin overdoses that make it to an emergency department (or toxicology unit?), 26.4% result in death. These results are quite useful for modeling on overdose prevention.

29) Availability and Cost of Naloxone Nasal Spray at Pharmacies in Philadelphia, Pennsylvania, 2017.

Guadamuz JS, Alexander GC, Chaudhri T, Trotzky-Sirr R, Qato DM.

JAMA Netw Open. 2019 Jun 5;2(6):e195388. doi: 10.1001/jamanetworkopen.2019.5388.

Comments: Evaluation of naloxone nasal spray availability at Philadelphia pharmacies following a standing order allowing pharmacies to dispense naloxone without a prescription. Findings show that only 34% of pharmacies had naloxone in stock and it was less likely to be available in areas with higher rates of opioid overdose deaths. Average out of pocket cost was $145. Results indicate that naloxone access is still restricted, especially for communities that may need it most.

30) Concerns that an opioid antidote could “make things worse”: Profiles of risk compensation beliefs using the Naloxone-Related Risk Compensation Beliefs (NaRRC-B) scale.

Winograd RP, Werner KB, Green L, Phillips S, Armbruster J, Paul R.

Subst Abus. 2019 Jun 6:1-7. doi: 10.1080/08897077.2019.1616348. [Epub ahead of print]

Comments: This study examined a way to classify concerns about naloxone distribution on a risk compensation belief scale and found that amongst service providers including police, EMS, social services and others, attending an overdose education and naloxone distribution training decreased beliefs about naloxone-related risk compensation behaviors. Education among service providers is important to reduce stigma surrounding naloxone distribution.

31) Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston.

Park JN, Sherman SG, Rouhani S, Morales KB, McKenzie M, Allen ST, Marshall BDL, Green TC.

J Urban Health. 2019 Jun;96(3):353-366. doi: 10.1007/s11524-019-00365-1.

Comments: Study investigating trends in willingness to use safe consumption spaces among people who use drugs in the (north)east. 77% of 326 opioid users from three major cities were willing to use a safe consumption space. Female gender, racial minority status, and injecting in public spaces were associated with higher willingness to use a safe consumption space.

32) Prevention of Opioid Overdose.

Babu KM, Brent J, Juurlink DN.

N Engl J Med. 2019 Jun 6;380(23):2246-2255. doi: 10.1056/NEJMra1807054. Review. No abstract available.

Comments: Review of provider strategies for prevention of opioid overdose among patients who are initiating opioid therapy, those on long-term opioid therapy and those living with an opioid use disorder. Strategies include tapering, medication-assisted treatment, use of buprenorphine for pain management, naloxone provision, etc.

33) Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic.

Irvine MA, Kuo M, Buxton JA, Balshaw R, Otterstatter M, Macdougall L, Milloy MJ, Bharmal A, Henry B, Tyndall M, Coombs D, Gilbert M.

Addiction. 2019 Jun 5. doi: 10.1111/add.14664. [Epub ahead of print]

Comments: Mathematical model based on British Columbia data evaluating effect of opioid overdose interventions. Take-home naloxone averted the highest number of deaths (1580 over four years), which is in line with previous studies showing the effectiveness of providing take-home naloxone. They further estimated that 230 deaths were prevented by safe consumption services and 590 by medications for opioid use disorder treatment. This occurred during a tragic opioid overdose death crisis in the region, thus authors note that the number of overdose deaths did not decline in the context of expanded overdose prevention services.

34) The role of take-home naloxone in the epidemic of opioid overdose involving illicitly manufactured fentanyl and its analogs.

Kim HK, Connors NJ, Mazer-Amirshahi ME.

Expert Opin Drug Saf. 2019 Jun;18(6):465-475. doi: 10.1080/14740338.2019.1613372. Epub 2019 May 16. Review.

Comments: Fentanyl and its analogs are coming (or already came) to dominate the street opioid supply in North America. There is concern that higher or repeated doses of naloxone may be required to reverse fentanyl. When administered in clinical settings, fentanyl is just as responsive to naloxone as other opioids. In the community, however, people may consume a substantial overdose of fentanyl which, because naloxone is a competitive antagonist, may require additional naloxone. Further, and this may be a common cause of the perceived need, fentanyl overdoses occur rapidly and can progress to cardiac arrest much more quickly than heroin overdoses. Many of the cases of fentanyl overdose are “worse” – by which I mean further along, more severe, and more likely to also involve the heart stopping – than what we are used to seeing with heroin or other opioids.

35) Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland.

Latkin CA, Gicquelais RE, Clyde C, Dayton L, Davey-Rothwell M, German D, Falade-Nwulia S, Saleem H, Fingerhood M, Tobin K.

Int J Drug Policy. 2019 Jun;68:86-92. doi: 10.1016/j.drugpo.2019.03.012. Epub 2019 Apr 23.

Comments: Experiencing stigma was associated with likelihood of experiencing a non-fatal overdose, as was using drugs in a public setting. Data on these subjects and overdose risk has been mixed over the years. Unable to access full article through Elsevier.

36) U.S. National 90-Day Readmissions After Opioid Overdose Discharge.

Peterson C, Liu Y, Xu L, Nataraj N, Zhang K, Mikosz CA.

Am J Prev Med. 2019 Jun;56(6):875-881. doi: 10.1016/j.amepre.2018.12.003. Epub 2019 Apr 17.

Comments: Out of 58,850 admissions for opioid overdose in the US in 2016, 24% resulted in a readmission within 90 days; 3% (1,658) were readmitted for another overdose. Leaving against medical advice was associated with readmission (no surprise for those of us who provide inpatient care), suggesting the real benefit that addiction medicine consult services could provide.

37) Acceptability of implementing community-based drug checking services for people who use drugs in three United States cities: Baltimore, Boston and Providence.

Sherman SG, Morales KB, Park JN, McKenzie M, Marshall BDL, Green TC.

Int J Drug Policy. 2019 Jun;68:46-53. doi: 10.1016/j.drugpo.2019.03.003. Epub 2019 Apr 13.

Comments: 63% of this cohort of street-based people who use drugs had overdosed; 42% had witnessed a fatal overdose. 90% thought checking drugs with things like fentanyl strips would help then prevent overdose. Older and non-white participants were more likely to intend to use drug checking.

38) Opioid-prescribing Patterns for Pediatric Patients in the United States.

Groenewald CB.

Clin J Pain. 2019 Jun;35(6):515-520. doi: 10.1097/AJP.0000000000000707.

Comments: Narrative review noting the increasing prescribing of opioids to children since 2000 (I assume that trend has reversed in recent years, but don’t know the data). 40% of children receive opioids during hospitalization. By the age of 18, almost 20% of children in the United States report having received an opioid prescription at some point in their lifetime. 

39) Opioid overdose deaths and potentially inappropriate opioid prescribing practices (PIP): A spatial epidemiological study.

Stopka TJ, Amaravadi H, Kaplan AR, Hoh R, Bernson D, Chui KKH, Land T, Walley AY, LaRochelle MR, Rose AJ.

Int J Drug Policy. 2019 Jun;68:37-45. doi: 10.1016/j.drugpo.2019.03.024. Epub 2019 Apr 11.

Comments: Fascinating analysis in Massachusetts looking to see if clusters of potentially inappropriate opioid prescribing were associated with clusters of opioid overdoses from 2011 to 2016. They found that prescribing didn’t entirely explain overdoses. Not surprising, but useful for prioritizing prevention resources.

40) Retrospective Review of Need for Delayed Naloxone or Oxygen in Emergency Department Patients Receiving Naloxone for Heroin Reversal.

Heaton JD, Bhandari B, Faryar KA, Huecker MR.

J Emerg Med. 2019 Jun;56(6):642-651. doi: 10.1016/j.jemermed.2019.02.015. Epub 2019 Apr 5.

Comments: This study makes the case for standardizing the emergency department observation period for patients who receive naloxone after a heroin overdose. They felt a need to provide oxygen or naloxone to 4.6% of patients after two hours of observation, 1.9% after 3 hours, and 0.9% after 4 hours. 

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. 

5) Rapid induction onto sublingual buprenorphine after opioid overdose and successful linkage to treatment for opioid use disorder.

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.

9) Simple minimally-invasive automatic antidote delivery device (A2D2) towards closed-loop reversal of opioid overdose.

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.

10) The opioid epidemic in rural northern New England: An approach to epidemiologic, policy, and legal surveillance.

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. 

12) Dancing with Deterrents: Understanding the Role of Abuse-Deterrent Opioid Formulations and Naloxone in Managing Cancer Pain.

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. 

14) Street fentanyl use: Experiences, preferences, and concordance between self-reports and urine toxicology.

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. 

16) Opioid maintenance, weaning and detoxification techniques; where we have been, where we are now and what the future holds: an update.

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.

17) Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study.

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. 

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.