Pubmed May 2011 Update

[This PubMed update will be a regular post to keep abreast of the latest research. The articles are selected from an automated PubMed search for “heroin overdose”.

Today’s post describes two articles pertaining to prescription opioids (or “opioid analgesics”), of growing interest particularly in developed countries with high rates of opioid prescription for pain management.

1) Pharmaceutical opioid analgesic and heroin dependence: How do treatment-seeking clients differ in Australia?

Nielsen S, Bruno R, Lintzeris N, Fischer J, Carruthers S, Stoové M.

Drug Alcohol Rev. 2011 May;30(3):291-299.

Comments: This review of individuals seeking treatment in Australia found that, compared to heroin users, prescription opioid users were roughly 10% less likely to report a history of overdose and over twice as likely to report initial use for pain control. Demographics, overall health, and history of injection drug use (IDU) were similar for the two groups. The authors admit that the treatment system is oriented toward IDUs which might explain the similarity of these two groups and limits generalizability. Notably, this to determine the relative risk of overdose among prescription opioid users compared to heroin users.

2) The prescription drug epidemic in the United States: A perfect storm.

Maxwell JC.

Drug Alcohol Rev. 2011 May;30(3):264-70.

Comments: This appears to be a thorough and thoughtful review for anyone interested in the issues around prescription opioid abuse in the United States (I can’t access the full article at this time). Data sources include patient surveys, emergency department visits, and mortality and toxicology. Clinical and policy responses are also discussed, including clinician training, risk assessments, treatment agreements, prescription drug monitoring programs, and options for disposal of leftover medication. The author notes the concern that responses could raise many barriers to appropriate pain treatment and yet fail to decrease abuse.