Monday, November 9, 2015

PubMed Update October 2015

28 in a month.

Eizadi-Mood N, Yaraghi A, Sharifian Z, Feizi A, Hedaiaty M, Sabzghabaee AM.
Mater Sociomed. 2015 Aug;27(4):276-9. doi: 10.5455/msm.2015.27.276-279.
Comments: Some interesting data on methadone toxicity in Iran. Length of stay was 33 hours (median). 90.3% survived. There were several complications. GCS on admission predicted survival. Useful data for economic modeling …

Zucker H, Annucci AJ, Stancliff S, Catania H.
Harm Reduct J. 2015 Nov 5;12(1):51. doi: 10.1186/s12954-015-0084-8.
PMID: 26541987 Free Article
Comments: Early report describing the establishment of a prison naloxone program in NY. Some of the most important work happening in this area…

Winstanley EL, Clark A, Wilder CM.
J Addict Med. 2015 Dec;9(6):503-4. doi: 10.1097/ADM.0000000000000160. No abstract available.
Comments: Can’t access. Meh.

Orkin AM, Bingham K, Buick JE, Klaiman M, Leece P, Kouyoumdjian F.
J Addict Med. 2015 Dec;9(6):502-3. doi: 10.1097/ADM.0000000000000161. No abstract available.
Comments: Also can’t access.

Clark A, Winstanley EL, Martsolf DS, Rosen M.
Addict Behav. 2015 Oct 8;53:141-145. doi: 10.1016/j.addbeh.2015.10.006. [Epub ahead of print] No abstract available.
Comments: Authors report on development of an electronic book on overdose prevention for use in addiction treatment settings.

Ashrafioun L, Gamble S, Herrmann M, Baciewicz G.
Subst Abus. 2015 Oct 29:0. [Epub ahead of print]
Comments: Those trained in intranasal naloxone were more confident than those trained in injectable. That is odd, as studies suggest that injectable is easier than intranasal.

Lev R, Petro S, Lee A, Lee O, Lucas J, Castillo EM, Egnatios J, Vilke GM.
Forensic Sci Int. 2015 Oct 22;257:347-352. doi: 10.1016/j.forsciint.2015.09.021. [Epub ahead of print]
Comments: The lack of data from methadone maintenance programs makes it quite challenging to interpret some of the methadone-related mortality data.

McAuley A, Aucott L, Matheson C.
Int J Drug Policy. 2015 Oct 1. pii: S0955-3959(15)00306-0. doi: 10.1016/j.drugpo.2015.09.011. [Epub ahead of print]
Comments: 9% of kits were likely to be used for overdose rescue. That looks like a rather low number, but it’s over a 3-month period. I suspect the annual rate is closer to 20% +/- 5%.

Davis CS, Carr D.
Drug Alcohol Depend. 2015 Oct 22. pii: S0376-8716(15)01695-6. doi: 10.1016/j.drugalcdep.2015.10.013. [Epub ahead of print]
Comments: Great paper, title says it all.

Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J.
PLoS One. 2015 Oct 23;10(10):e0140995. doi: 10.1371/journal.pone.0140995. eCollection 2015.
Comments: I like this study. The physiology of “overdose” is totally fascinating and nowhere near as simple as it seems.

Baillif-Couniou V, Kintz P, Sastre C, Pok PP, Chèze M, Pépin G, Leonetti G, Pelissier-Alicot AL.
J Forensic Leg Med. 2015 Sep 4;36:172-176. doi: 10.1016/j.jflm.2015.08.014. [Epub ahead of print]
Comments: Morphine overdose in an adolescent in France. It’s news there because they don’t see people dying of prescription opioids like in the U.S.

Wiebelhaus JM, Walentiny DM, Beardsley PM.
J Pharmacol Exp Ther. 2015 Oct 21. pii: jpet.115.228940. [Epub ahead of print]
Comments: Oxycodone works like other opioids.

Tucker D, Hayashi K, Milloy MJ, Nolan S, Dong H, Kerr T, Wood E.
Addict Behav. 2015 Oct 9;52:103-107. doi: 10.1016/j.addbeh.2015.10.002. [Epub ahead of print]
Comments: Benzo use is associated with lots of risk factors for negative health outcomes, including blood-borne virus transmission, among drug users.

Dailey M.
Addiction. 2015 Nov;110(11):1775-6. doi: 10.1111/add.13093. No abstract available.
Comments: Nice commentary, pointing out the opportunities for intervention among those who contact the medical system with an overdose.

Sivilotti ML.
Br J Clin Pharmacol. 2015 Aug 7. doi: 10.1111/bcp.12731. [Epub ahead of print] Review.
Comments: Fascinating differences between benzo and opioid-induced respiratory depression. Benzos cause apnea usually because the upper airway is blocked or collapses – so respiratory support is the need – and the antidote can lead to seizures. Opioids are different and naloxone much safer.

Cheatle MD, Webster LR.
Pain Med. 2015 Oct;16 Suppl 1:S22-6. doi: 10.1111/pme.12910. Review.
Comments: Opioids might be dangerous with sleep disorders.

Morris MD, Bates A, Andrew E, Hahn J, Page K, Maher L.
Drug Alcohol Depend. 2015 Nov 1;156:275-81. doi: 10.1016/j.drugalcdep.2015.09.025. Epub 2015 Sep 30.
Comments: Injection partnerships can have divergent benefits and risks.

Berlin J.
Tex Med. 2015 Oct 1;111(10):41-7.
Comments: Naloxone in Texas!

Lake S, Hayashi K, Buxton J, Milloy MJ, Dong H, Wood E, Montaner J, Kerr T.
Drug Alcohol Depend. 2015 Nov 1;156:297-303. doi: 10.1016/j.drugalcdep.2015.09.026. Epub 2015 Sep 30.
Comments: Interesting analysis – injecting prescription opioids didn’t by itself increase overdose risk. Injecting of both prescription opioids and heroin did, however. So there is probably some protection offered by the known doses and constituents in prescription opioids.

Martins SS, Sampson L, Cerdá M, Galea S.
Am J Public Health. 2015 Nov;105(11):e29-49. doi: 10.2105/AJPH.2015.302843.
Comments: Nice summary of global data looking at some basic overdose results. Mean/median rate of witnessed overdose in a drug user’s lifetime = 73/70%. Lifetime prevalence of experienced overdose was mean of 45.4% and median of 47%. Population-based overdose mortality rates varied from 0.4-46.6 / 100,000 person years (note, this is population based).

Humphreys K.
Health Aff (Millwood). 2015 Oct 1;34(10):1624-7. doi: 10.1377/hlthaff.2015.0934.
Comments: Review of naloxone based on summer 2015 FDA meeting.

Zalewska-Kaszubska J.
Vaccine. 2015 Oct 2. pii: S0264-410X(15)01369-9. doi: 10.1016/j.vaccine.2015.09.079. [Epub ahead of print] Review.
Comments: Really interesting idea – use antibodies against drugs, like cocaine, to manage overdose on those drugs. Excellent.

Partownavid P, Sharma S, Li J, Umar S, Rahman S, Eghbali M.
Anesth Analg. 2015 Aug;121(2):340-7. doi: 10.1213/ANE.0000000000000788.
Comments: Opioid receptors are required for rescuing people from the cardiac toxicity of bupivacaine overdose.

Rech MA, Donahey E, Cappiello Dziedzic JM, Oh L, Greenhalgh E.
Pharmacotherapy. 2015 Feb;35(2):189-97. doi: 10.1002/phar.1522. Epub 2014 Dec 4. Review.
Comments: Desomorphine. Blech.

Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM.
Drug Alcohol Depend. 2014 Dec 1;145:34-47. doi: 10.1016/j.drugalcdep.2014.10.001. Epub 2014 Oct 14. Review.
Comments: Not much.

Chakrapani V, Kamei R, Kipgen H, Kh JK.
Int J Prison Health. 2013;9(2):82-91. doi: 10.1108/17449201311326952.
Comments: Access is … no there.

Tacelosky DM, Alexander DN, Morse M, Hajnal A, Berg A, Levenson R, Grigson PS.
Behav Neurosci. 2015 Oct 26. [Epub ahead of print]
Comments: Holding drug exposure constant, reducing dopamine D2 receptors or that other thing (Wntless) results in more opioid craving.

Allread V, Paul S.
MD Advis. 2014 Fall;7(4):12-20. Review.
Comments: Can’t access. Review for New Jersey and rest of US regarding prescription opioids and heroin use.

Friday, October 9, 2015

PubMed Update September 2015

Twelve this month. Enjoy!

Ries R, Krupski A, West II, Maynard C, Bumgardner K, Donovan D, Dunn C, Roy-Byrne P.
J Addict Med. 2015 Oct;9(5):417-26. doi: 10.1097/ADM.0000000000000151.
Comment: Can’t access the full article, but the abstract suggests a fascinating look into opioid-using safety net primary care patients.

Kazour F, Soufia M, Rohayem J, Richa S.
Community Ment Health J. 2015 Sep 30. [Epub ahead of print]
Comment: Most studies of heroin users find that heroin is *not* the usual method of suicide attempts. Interestingly, this study finds something quite different, with nearly half of attempts being through heroin use in Lebanon.

Roxburgh A, Hall WD, Burns L, Pilgrim J, Saar E, Nielsen S, Degenhardt L.
Med J Aust. 2015 Oct 5;203(7):299.
Comment: Interesting paper exploring deaths related to one, low-potency, opioid. Those deaths seemed to be increasing, over a third were intentional (that’s much higher than other opioids), and a remarkably high proportion were polydrug – which makes sense since it would be tough to die from codeine alone.

Kampman K, Jarvis M.
J Addict Med. 2015 Oct;9(5):358-67. doi: 10.1097/ADM.0000000000000166.
Comment: Another that I can’t access but whose abstract looks compelling.

Kharasch ED, Regina KJ, Blood J, Friedel C.
Anesthesiology. 2015 Sep 19. [Epub ahead of print]
Comment: Ah, the complexities of methadone. Genetic differences in hepatic metabolism are more prominent in oral than intravenous methadone.

Saturday, September 5, 2015

PubMed Update August 2015

Sixteen in August. Back on schedule (thanks to jetlag).

Hawk KF, Vaca FE, D'Onofrio G.
Yale J Biol Med. 2015 Sep 3;88(3):235-245. eCollection 2015 Sep. Review.
Comment: Can’t access full article. Appears to be a review of harm reduction strategies for opioid overdose prevention.

Brady KT, McCauley JL, Back SE.
Am J Psychiatry. 2015 Sep 4:appiajp201515020262. [Epub ahead of print]
Comment: Appropriately draws attention to the problem now faced in the United States: we are cutting back on opioid prescribing to try to limit further opioid dependence, but effectively abandoning many of the people who are already dependent.

DeVido J, Connery H, Hill KP.
J Opioid Manag. 2015 Jul-Aug;11(4):363-6. doi: 10.5055/jom.2015.0285.
Comment: Two case reports of sleep-disordered breathing among buprenorphine patients suggesting that buprenorphine may contribute to sleep apnea.

Paone D, Tuazon E, Stajic M, Sampson B, Allen B, Mantha S, Kunins H.
Drug Alcohol Depend. 2015 Aug 15. pii: S0376-8716(15)01598-7. doi: 10.1016/j.drugalcdep.2015.08.007. [Epub ahead of print]
Comment: Actually, none of the decedents tested positive for buprenorphine - very few (2) were found to have positive toxicology for norbuprenorphine, a metabolite demonstrating recent – but not recent enough to be causal – consumption of buprenorphine. This is not surprising since it’s tough to overdose on buprenorphine. Nice work.

Hassanian-Moghaddam H, Soltaninejad K, Shadnia S, Kabir A, Movahed M, Mirafzal A.
Basic Clin Pharmacol Toxicol. 2015 Aug 24. doi: 10.1111/bcpt.12476. [Epub ahead of print]
Comment: Lower consciousness/respirations once in the emergency room were associated with increased likelihood of being intubated and/or dying from methadone overdose. This is interesting in the context of previous papers included on this blog that demonstrate lower likelihood of such outcomes when naloxone is administered in the field. Is it time to think of naloxone as an automated electronic defibrillator?

Larance B, Lintzeris N, Bruno R, Peacock A, Cama E, Ali R, Kihas I, Hordern A, White N, Degenhardt L.
J Subst Abuse Treat. 2015 Jun 24. pii: S0740-5472(15)00137-3. doi: 10.1016/j.jsat.2015.06.001. [Epub ahead of print]
Comment: This is a complex population. Although risk outcomes appear closer to those of someone who uses heroin than those of someone prescribed opioids, the clinical characteristics overlap substantially with the latter group.

Wednesday, August 12, 2015

PubMed Update June - July 2015

Great stuff this time! 34 in two months.

Wheeler E, Jones TS, Gilbert MK, Davidson PJ.
MMWR Morb Mortal Wkly Rep. 2015 Jun 19;64(23):631-5.
Comment: The long-awaited sequel to 2010’s blockbuster naloxone MMWR report! 152,283 laypersons trained and 26,463 overdose reversals reported to naloxone programs through 2014.

Mars SG, Fessel JN, Bourgois P, Montero F, Karandinos G, Ciccarone D.
Soc Sci Med. 2015 Jun 30;140:44-53. doi: 10.1016/j.socscimed.2015.06.032. [Epub ahead of print]
Comment: Interesting use of qualitative data exploring the role of heroin markets on overdose risk, suggesting that factors such as open-air versus behind-closed-door markets can affect risk.

Cropsey KL, Stevens EN, Valera P, Brendan Clark C, Bulls HW, Nair P, Lane PS.
Drug Alcohol Depend. 2015 Jul 10. pii: S0376-8716(15)00352-X. doi: 10.1016/j.drugalcdep.2015.06.038. [Epub ahead of print]
Comment: There’s a movement toward not prescribing opioids with benzodiazepines at all. This makes some sense from an overdose prevention perspective, however the impact of such a policy is unknown. Those who require both opioids and benzodiazepines generally have far more complex and substantial mental health challenges. Just removing one or the other of the agents may results in worsening mental health or even increased rates of self-harm. Or not. Nobody knows.

Soukup-Baljak Y, Greer AM, Amlani A, Sampson O, Buxton JA.
Int J Drug Policy. 2015 Jul 2. pii: S0955-3959(15)00200-5. doi: 10.1016/j.drugpo.2015.06.006. [Epub ahead of print]
Comment: This is interesting, particularly in an era of frequent high-potency batches of heroin or even pure fentanyl derivatives. Subjects recommend using words like “dangerous” or “lethal” instead of “potent” which can be misconstrued as desirable. They also emphasized timeliness. As one of the first studies to really look at this issue, this paper is well worth the read.

Visconti AJ, Santos GM, Lemos NP, Burke C, Coffin PO.
J Urban Health. 2015 Jun 16. [Epub ahead of print]
Comment: Epidemiology of opioid overdose mortality in San Francisco – the first since Pete Davidson’s seminal geocoding paper in 2003 that led SF to refocus overdose prevention efforts to the hardest hit neighborhoods. This paper documents that heroin overdose is now remarkably rare in San Francisco, although for me it raises more questions than it answers.

Monday, July 27, 2015

PubMed Update March - May 2015

Three months. 46 papers. I’m already a month behind.

Dahlem CH, Horstman MJ, Williams BC.
J Am Assoc Nurse Pract. 2015 Mar 26. doi: 10.1002/2327-6924.12249. [Epub ahead of print]
Comments: Naloxone programs have been providing kits to settings where homeless people receive services for many years. This is a description of a program at a homeless health clinic.

Christoffersen DJ, Brasch-Andersen C, Thomsen JL, Worm-Leonhard M, Damkier P, Brøsen K.
Forensic Sci Med Pathol. 2015 Jun;11(2):193-201. doi: 10.1007/s12024-015-9673-9. Epub 2015 Mar 24.
Comments: It’s been awhile since we had a forensics paper here. I think this is a novel method of identifying enantiomers.

Spaulding AC, Sharma A, Messina LC, Zlotorzynska M, Miller L, Binswanger IA.
Am J Public Health. 2015 May;105(5):e51-7. doi: 10.2105/AJPH.2014.302546. Epub 2015 Mar 19.
Comments: Stunningly low rate of drug overdose mortality in this cohort of prisoners in Georgia. This is one of the first times I’ve seen a paper on opioid overdose find radically different results in a different setting. I can’t access for details.

Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA.
Subst Abus. 2015 Mar 16:1-14. [Epub ahead of print]
Comments: A review toward the end of using community distribution data to build clinical care naloxone prescription.

Hser YI, Evans E, Grella C, Ling W, Anglin D.
Harv Rev Psychiatry. 2015 Mar-Apr;23(2):76-89. doi: 10.1097/HRP.0000000000000052.
Comments: This is a systematic review of long-term studies of opioid users. Among many fascinating data reported, the length of time not using a drug of choice increases the likelihood of continuing to not use that drug. This seems obvious to many, but I don’t believe it’s been documented before. Good read for anyone looking to understand some of the longitudinal outcome data.

Sunday, March 8, 2015

PubMed Update November 2014 - February 2015

Catching up on 51 papers in 4 months. Did you miss me?

Rech MA, Donahey E, Cappiello Dziedzic JM, Oh L, Greenhalgh E.
Pharmacotherapy. 2014 Dec 4. doi: 10.1002/phar.1522. [Epub ahead of print]
Comment: Review of management of drug toxicities among novel, synthetic compounds.

Ray B, O'Donnell D, Kahre K.
Drug Alcohol Depend. 2015 Jan 1;146:107-10. doi: 10.1016/j.drugalcdep.2014.10.026. Epub 2014 Nov 8.
Comment: Police officers like being trained to carry naloxone.

Robinson A, Wermeling DP.
Am J Health Syst Pharm. 2014 Dec 15;71(24):2129-35. doi: 10.2146/ajhp130798.
Comment: Review of intranasal naloxone for overdose reversal.

Dasgupta N, Creppage K, Austin A, Ringwalt C, Sanford C, Proescholdbell SK.
Drug Alcohol Depend. 2014 Dec 1;145:238-41. doi: 10.1016/j.drugalcdep.2014.10.005. Epub 2014 Oct 18.
Comment: Heroin overdoses are increasing.

Jones JD, Roux P, Stancliff S, Matthews W, Comer SD.
Int J Drug Policy. 2014 Jan;25(1):166-70. doi: 10.1016/j.drugpo.2013.05.006. Epub 2013 Jun 15.
Comment: Brief overdose training works for naloxone distribution. This is important because many places are requiring prolonged trainings that end up limiting access to those who are unable or unwilling to invest that degree of time.

Behar E, Santos GM, Wheeler E, Rowe C, Coffin PO.
Drug Alcohol Depend. 2015 Mar 1;148:209-12. doi: 10.1016/j.drugalcdep.2014.12.009. Epub 2014 Dec 19.
Comment: Again, brief overdose training works for naloxone distribution.

Sunday, November 16, 2014

PubMed Update August-October 2014

Three months. 32 articles. Enough said.

Darke S, Marel C, Mills KL, Ross J, Slade T, Burns L, Teesson M.
Drug Alcohol Depend. 2014 Sep 16. [Epub ahead of print]
Comment: This study (the ATOS) and the team of investigators have produced some of the most powerful and useful data in substance use research. Once again they have delved into heroin overdose by following treatment patients 11 years out. At least 10.2% of the cohort had died by that time and an additional 9.4% were unaccounted for. Among the 70.1% interviewed, 67.5% had overdosed, 24.4% had experienced five or more overdoses (again suggesting that there are “overdosers” out there who are at very elevated risk of the event). In the past year before the follow-up visit, 4.9% had overdosed (11.8% of those who had used heroin in that period), 95.2% of whom had overdosed previously. Those who overdosed were more likely to report higher levels of non-heroin opiate use, as well as benzodiazepine, cocaine, and methamphetamine use.

Simonson W.
Geriatr Nurs. 2014 Sep-Oct;35(5):381-2.
Comment: A review of the role of take-home naloxone in the form of the new autoinjector.

Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A, Gabella B, Hume B, Huntamer T, Kariisa M, Largo TW, Miles J, Newmyer A, Nitcheva D, Perez BE, Proescholdbell SK, Sabel JC, Skiba J, Slavova S, Stone K, Tharp JM, Wendling T, Wright D, Zehner AM.
MMWR Morb Mortal Wkly Rep. 2014 Oct 3;63(39):849-54.
Comment: This report demonstrates declining prescription opioid deaths (-6.6%), but heroin deaths increased so much (+101.7%) that the data actually demonstrate an overall increase in opioid overdose mortality from 2010 to 2012 (+4.3%). There is disagreement as to what is driving the increase in heroin use and overdose. Is it an inevitable consequence of increased availability of opioids? Or is it the result of growing restrictions on access to those opioids? Clearly there are elements of both, leaving us with conflicting duties when it comes to managing those already reliant upon prescription opioids. Western medical ethics is clear on this point: our patient is the person we treat, who may have been harmed by the very same prescribing behavior we are now trying to change and who may be further harmed by those changes. If we truly believe that this epidemic is “iatrogenic” (i.e. caused by medical care, akin to a surgeon leaving scissors in an abdomen), then we have to be extremely cautious and thoughtful in fixing the problem and we can never abandon the patient.

Lenton S, Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C.
Drug Alcohol Rev. 2014 Oct 1. doi: 10.1111/dar.12198. [Epub ahead of print]
Comment: It's taken an incredibly long time for take-home naloxone to reach Australia, especially given how innovative that country has been with respect to managing drug policy and overdose.

Green TC, Bratberg J, Dauria EF, Rich JD.
R I Med J (2013). 2014 Oct 1;97(10):29-33.
Comment: The first of three articles in this post from Rhode Island, US, which has been facing a surge in opioid overdose deaths and has been responding with expanded naloxone treatment availability. This and the next two articles are free at:

Tuesday, August 19, 2014

PubMed Update July 2014

Hooray for a mere 7 paper reprieve this month.

Mertz KJ, Janssen JK, Williams KE.
J Forensic Sci. 2014 Jul 16. doi: 10.1111/1556-4029.12541. [Epub ahead of print]
Comments: This manuscript presents critical and very concerning results regarding interpretation of our prescription opioid overdose epidemic. Morphine and codeine are commonly present and without 6-MAM (a third heroin metabolite) present at sufficient levels those deaths are coded as morphine and codeine. On this review of 112 such deaths, 66% met criteria for heroin involvement based on a history of heroin use (which may not be sufficient given the frequent use of other opioids among heroin users), drug paraphernalia or stamp bags, track marks, and detection of 6-MAM (generally at very low levels). Good toxicologists always check for 6-MAM so that shouldn’t be a major issue, but it is conceivable that some of these morphine/codeine cases are in fact heroin – an important caveat as we respond to the epidemic.

Trafton JA, Oliva EM.
Addiction. 2014 Aug;109(8):1243-4. doi: 10.1111/add.12585. No abstract available.
Comments: Authors argue that Good Samaritan and naloxone legislation may be effective strategies to reduce overdose.

Yen YF, Yen MY, Lin T, Li LH, Jiang XR, Chou P, Deng CY.
BMC Public Health. 2014 Jul 4;14(1):682. doi: 10.1186/1471-2458-14-682.
Comments: Again, HIV infection is associated with a history of overdose among persons who inject drugs.

Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi-Mood N, Gheshlaghi F, Farajzadegan Z.
J Res Pharm Pract. 2013 Jul;2(3):130-4. doi: 10.4103/2279-042X.122387.
Comments: an analysis of methadone poisonings in Iran. Among 385 patients, 57.7% of cases were “intentional” and demonstrated high rates of psychiatric disorders (25.8%). Among the full cohort, 40% had opioid use disorders and 25.5% were in a methadone program.