Tuesday, December 6, 2016

PubMed Update October/November 2016

43 papers this round, and there are some goodies in here for sure (don't miss #38!). Given the number and varied issues addressed, I divided them up into topic areas and, given the number on naloxone, I divided up the naloxone topic areas as well.



Naloxone interventions


Primary care

Takeda MY, Katzman JG, Dole E, Bennett MH, Alchbli A, Duhigg D, Yonas H.
Subst Abus. 2016 Apr 19:1-6. [Epub ahead of print]
Comment: A pilot of naloxone co-prescribing.

Mueller SR, Koester S, Glanz JM, Gardner EM, Binswanger IA.
J Gen Intern Med. 2016 Oct 31. [Epub ahead of print]
Comment: Shows that naloxone for patients prescribed opioids must be appropriately framed.

Behar E, Rowe C, Santos GM, Coffa D, Turner C, Santos NC, Coffin PO.
J Gen Intern Med. 2016 Nov 4. [Epub ahead of print]
Comment: When actually implemented, providers really like adding naloxone to opioid-related care. One of five papers out of the Naloxone for Opioid Safety Evaluation of a naloxone co-prescribing study in San Francisco.


Tuesday, October 4, 2016

PubMed Update September 2016

15 papers this month.

Dodington J, Violano P, Baum CR, Bechtel K.
Pediatr Res. 2016 Sep 27. doi: 10.1038/pr.2016.193. [Epub ahead of print] Review.
Comment: Review of safety efforts in public health.

Behar E, Rowe C, Santos GM, Murphy S, Coffin PO.
Ann Fam Med. 2016 Sep;14(5):431-6. doi: 10.1370/afm.1972.
Comment: This is a partner paper to the study results reported a couple of months ago. Mixed methods interviews with 60 randomly selected patients on longterm opioid therapy for chronic pain who had been prescribed naloxone. The co-prescribing effort reached a population that was not really accessing naloxone through other community distribution sites in San Francisco. Some reported improved safety with opioids since receiving naloxone and none reported more high-risk use behaviors. About half of those who had overdosed denied “overdose” and described it as a bad reaction.

Dunn KE, Barrett FS, Yepez-Laubach C, Meyer AC, Hruska BJ, Petrush K, Berman S, Sigmon SC, Fingerhood M, Bigelow GE.
J Subst Abuse Treat. 2016 Dec;71:1-7.
Comment: Can’t access the paper, but the abstract suggests higher rates of overdose among rural drug users versus urban, while there were fewer overdose risk behaviors among rural users (potentially raising concerns about our risk behaviors, which were retrospectively developed).

Scott N, Carrotte ER, Higgs P, Cogger S, Stoové MA, Aitken CK, Dietze PM.
Drug Alcohol Depend. 2016 Sep 11;168:140-146. doi: 10.1016/j.drugalcdep.2016.08.638. [Epub ahead of print]
Comment: People who inject drugs have more psychological distress than the general population. Not surprised that intentional overdose (i.e. suicide attempt) is associated with psychological distress.

Klar SA, Brodkin E, Gibson E, Padhi S, Predy C, Green C, Lee V.
MMWR Morb Mortal Wkly Rep. 2016 Sep 23;65(37):1015-1016. doi: 10.15585/mmwr.mm6537a6.
Comment: Fentanyl in crack. Ugh.

Tuesday, September 6, 2016

PubMed Update August 2016

A robust 20 papers this month. There are some excellent manuscripts this month, including several on fentanyl. I want to draw particular attention to a few papers that will be important reads for some of you: #1 addresses concurrent use of methamphetamine with heroin, #12 explores different “types” of opioid overdose, #17 reviews the foundational papers upon which much overdose research/knowledge today is based, and #19 compares deaths due to heroin to those due to prescription opioids.

Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS.
J Stud Alcohol Drugs. 2016 Sep;77(5):774-81.
Comments: Really interesting results with regard to methamphetamine – co-use of methamphetamine increased overdose risk in San Diego but not Tijuana, suggesting that risk may have been behavioral rather than pharmacologic.

Mitchell KD, Higgins LJ.
J Addict Nurs. 2016 Jul-Sep;27(3):160-79. doi: 10.1097/JAN.0000000000000132.
Comments: Review of naloxone literature with an eye toward how it influences nursing.

Al-Tayyib AA, Koester S, Riggs P.
Addict Behav. 2016 Aug 19. pii: S0306-4603(16)30296-9. doi: 10.1016/j.addbeh.2016.08.016. [Epub ahead of print]
Comments: Those who initiated injection with prescription opioids were higher risk than those who started with heroin in the Denver Colorado’s NHBS cohort.

Kirane H, Ketteringham M, Bereket S, Dima R, Basta A, Mendoza S, Hansen H.
J Subst Abuse Treat. 2016 Oct;69:44-9. doi: 10.1016/j.jsat.2016.07.005. Epub 2016 Jul 18.
Comments: Investigators asked patients and providers how they thought things *would* change if they gave/received naloxone kits and found quite a few thought use would increase. In contrast, looking at what “did” happen suggests the opposite (see next month’s PubMed Update).

Monday, August 8, 2016

PubMed Update July 2016

11 papers this month, including an announcement that naloxone is now over-the-counter in Australia.

Evans TI, Hadland SE, Clark MA, Green TC, Marshall BD.
Harm Reduct J. 2016 Jul 26;13(1):24. doi: 10.1186/s12954-016-0113-2.
Comments: Less than half knew about it.

Stein MD, Kanabar M, Anderson BJ, Lembke A, Bailey GL.
J Subst Abuse Treat. 2016 Sep;68:57-61. doi: 10.1016/j.jsat.2016.06.008. Epub 2016 Jun 16.
Comments: Important work, as there’s an effort to also reduce benzodiazepine prescribing among people who are on opioids. Understanding the drivers of BDZ use should be helpful in structuring interventions. Anxiety and managing opioid withdrawal were two main reasons.

Jones CM, Baldwin GT, Manocchio T, White JO, Mack KA.
MMWR Morb Mortal Wkly Rep. 2016 Jul 8;65(26):667-71. doi: 10.15585/mmwr.mm6526a2.
Comments: Interesting analysis of methadone prescribing, overdose, and diversion. It seems that efforts to reduce methadone, beginning in 2006, corresponded with reduced diversion and overdose; unfortunate that opioid overdose death overall continued to escalate.

Makarenko I, Mazhnaya A, Polonsky M, Marcus R, Bojko MJ, Filippovych S, Springer S, Dvoriak S, Altice FL.
Drug Alcohol Depend. 2016 Aug 1;165:213-20. doi: 10.1016/j.drugalcdep.2016.06.011. Epub 2016 Jun 17.
Comments: Barriers to enrolling in agonist treatment in Ukraine.

Thursday, July 14, 2016

PubMed Update June 2016

Summer holiday. A mere 10 articles this month!

Nielsen S, Menon N, Larney S, Farrell M, Degenhardt L.
Addiction. 2016 Jul 1. doi: 10.1111/add.13517. [Epub ahead of print]
Comment: Most pharmacists in Australia would provide naloxone, but a minority feel comfortable selecting patients and educating about naloxone use and overdose.

Coffin PO, Behar E, Rowe C, Santos GM, Coffa D, Bald M, Vittinghoff E.
Ann Intern Med. 2016 Jun 28. doi: 10.7326/M15-2771. [Epub ahead of print]
Comment: Naloxone can be successfully prescribed to primary care patients on longterm opioids for chronic pain, and receipt of naloxone is associated with a remarkable reduction in opioid-related emergency department visits.

Sharma B, Bruner A, Barnett G, Fishman M.
Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87. doi: 10.1016/j.chc.2016.03.002. Epub 2016 Apr 9. Review.
Comment: Review of opioid use disorder and treatments.

Ambrose G, Amlani A, Buxton JA.
BMJ Open. 2016 Jun 21;6(6):e011224. doi: 10.1136/bmjopen-2016-011224.
Comment: Respondents administering naloxone to overdoses on the street were more likely to call for medical assistance than those doing so in a private residence. This makes a lot of sense. Imaging if giving a breathing treatment for asthma in a home versus on the street – the latter setting is more likely to result in seeking assistance.

Sunday, June 12, 2016

PubMed Update May 2016

19 this month. Enjoy!

Tjagvad C, Skurtveit S, Linnet K, Andersen LV, Christoffersen DJ, Clausen T.
Eur Addict Res. 2016 Jun 1;22(5):249-258. [Epub ahead of print]
Comments: Patients on very high doses of methadone or also using benzodiazepines were at higher risk of death.

Salani DA, Zdanowicz M, Joseph L.
J Psychosoc Nurs Ment Health Serv. 2016 Jun 1;54(6):30-7. doi: 10.3928/02793695-20160518-05.
Comments: Epidemiologic review.

Gatewood AK, Van Wert MJ, Andrada AP, Surkan PJ.
Addict Behav. 2016 May 17;61:40-46. doi: 10.1016/j.addbeh.2016.05.013. [Epub ahead of print]
Comments: Qualitative interviews with medical providers.

Elzey MJ, Barden SM, Edwards ES.
Pain Physician. 2016 May;19(4):215-28.
Comments: Non-fatal events are far more common, not well-predicted by risk factors, and in need of additional research.

Doyon S, Benton C, Anderson BA, Baier M, Haas E, Hadley L, Maehr J, Rebbert-Franklin K, Olsen Y, Welsh C.
Am J Addict. 2016 Jun;25(4):301-6. doi: 10.1111/ajad.12384. Epub 2016 May 24.
Comments: Interesting case series of naloxone reversals reported to poison control. They report a 75.6% “response rate” although some of the remainder was “unknown” and was there were only 2 deaths among 78 cases, suggesting a rate closer to 97.5%. Response rate to heroin was higher than for prescription opioids. Of the 43 suspected heroin events, 31 went to the ED, 25 were discharged, and 5 required ICU care. Of 31 suspected prescription opioid 20 went to the ED, 9 were discharged, and 6 required ICU care. This is consistent with the more complicated nature of prescription opioid overdose.

Fisher R, O'Donnell D, Ray B, Rusyniak D.
Prehosp Emerg Care. 2016 May 24:1-6. [Epub ahead of print]
Comments: About a 65% response rate among 117 administrations and 1 combative individual.

Monday, May 9, 2016

PubMed Update April 2016

23 for this month! Lots of interesting stuff, from large-scale epidemiology to randomized controlled trials.

Krieter P, Chiang N, Gyaw S, Skolnick P, Crystal R, Keegan F, Aker J, Beck M, Harris J.
J Clin Pharmacol. 2016 May 5. doi: 10.1002/jcph.759. [Epub ahead of print]
Comment: Details on the pharmacokinetics and usability studies for the new nasal device.

Madah-Amiri D, Clausen T.
Addiction. 2016 May 3. doi: 10.1111/add.13400. [Epub ahead of print] No abstract available.
Comment: Large-scale naloxone requires public health support.

Wilkerson RG, Kim HK, Windsor TA, Mareiniss DP.
Emerg Med Clin North Am. 2016 May;34(2):e1-e23. doi: 10.1016/j.emc.2015.11.002. Epub 2016 Feb 17. Review.
Comment: Focuses on risk factors for problematic opioid use and naloxone.

Wednesday, April 20, 2016

PubMed Update March 2016

23 this month.

McDonald R, Strang J.
Addiction. 2016 Mar 30. doi: 10.1111/add.13326. [Epub ahead of print] Review.
Comments: Take-home naloxone meets all Bradford Hill criteria for causality in reducing opioid overdose mortality. Incidence of fatality among overdoses in the setting of take-home naloxone was 0.8%.

Loreck D, Brandt NJ, DiPaula B.
J Gerontol Nurs. 2016 Apr 1;42(4):10-5. doi: 10.3928/00989134-20160314-04.
Comments: A review of the U.S. situation and treatments for opioid use disorder.

Darke S, Marel C, Mills KL, Ross J, Slade T, Tessson M.
Drug Alcohol Depend. 2016 May 1;162:206-10. doi: 10.1016/j.drugalcdep.2016.03.010. Epub 2016 Mar 18.
Comments: Heroin use is associated with 25-50 years of life lost. Over half of deaths and nearly two-thirds of years of life lost were due to opioid overdose.

Olsson MO, Bradvik L, Öjehagen A, Hakansson A.
Drug Alcohol Depend. 2016 May 1;162:176-81. doi: 10.1016/j.drugalcdep.2016.03.009. Epub 2016 Mar 17.
Comments: Accidental overdose death and suicide are distinct entities, with distinct predictive variables. This is important.

Saucier CD, Zaller N, Macmadu A, Green TC.
Drug Alcohol Depend. 2016 May 1;162:211-8. doi: 10.1016/j.drugalcdep.2016.03.011. Epub 2016 Mar 19.
Comments: Harm reduction programs training law enforcement, a critical step forward.

Tuesday, March 22, 2016

PubMed Update February 2016

Ten articles for February 2016.

[No authors listed]
ED Manag. 2016 Feb;28(2):13-9.
Comments: Review of the new CDC opioid prescribing guidelines.

Lenton SR, Dietze PM, Jauncey M.
Med J Aust. 2016 Mar 7;204(4):146-7. No abstract available.
Comments: Naloxone can now be over the counter in Australia, but there’s some work to be done in product design.

King R.
NASN Sch Nurse. 2016 Mar;31(2):96-101. doi: 10.1177/1942602X16628890.
Comments: Naloxone for school nurses in Delaware.

Agahi M, Shakoori V, Marashi SM.
Sultan Qaboos Univ Med J. 2016 Feb;16(1):e113-4. doi: 10.18295/squmj.2016.16.01.022. Epub 2016 Feb 2. No abstract available.
Comments: Long QT interval is a side effect of high methadone doses.

Wednesday, February 17, 2016

PubMed Update November 2015 - January 2016

We have 35 articles for your viewing this time, with apologies for the delay in getting this out. Thanks to Traci Green for offering to help out and for reviewing this post.


Becker WC, Merlin JS, Manhapra A, Edens EL.
Addict Sci Clin Pract. 2016 Jan 28;11(1):3. doi: 10.1186/s13722-016-0050-0.
Comment: Fascinating article. Worth a read if you’re interested in management of pain and opioids.

Harocopos A, Allen B, Paone D.
Int J Drug Policy. 2015 Dec 29. pii: S0955-3959(15)00374-6. doi: 10.1016/j.drugpo.2015.12.021. [Epub ahead of print]
Comment: Great to see some of the path from prescription opioids to heroin. Makes sense that first step is moving from a drug co-formulated with acetaminophen.

Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg A, Bernstein E.
Acad Emerg Med. 2016 Jan 27. doi: 10.1111/acem.12910. [Epub ahead of print]
Comment: To get EDs to enhance practices will require pressure from the top.

4) Internal Medicine Resident Knowledge, Attitudes and Barriers to Naloxone Prescription in Hospital and Clinic Settings.
Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L.
Subst Abus. 2016 Jan 28:0. [Epub ahead of print]
Comment: Nice article from Baltimore finding that young physicians are ready and willing to prescribe naloxone, but aren’t routinely doing so yet.

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.