Broadcast on Project Lazarus shows community-based OD prevention in action

Check out this 5 minute video on how Project Lazarus empowers community groups to take a non-judgmental and pragmatic approach to overdose prevention: doctors, cops, paramedics, faith community, schools are all included.

Our full description of Project Lazarus and results show the detailed steps we've taken to implement community-based overdose prevention.

HIV infection and risk of overdose: a systematic review and meta-analysis

A new article by Traci Green and colleagues summarizes what we know about why HIV seems to increase risk for overdose. According to their systematic review of the literature, people who use drugs and have HIV have a 74% greater risk of having an overdose than their HIV-negative counterparts. That's a pretty staggering figure.

You can read Green's article here: http://www.ncbi.nlm.nih.gov/pubmed/22112599.

I've also posted a blog on the Open Society Foundations website about why people who care about HIV should also care about overdose: http://blog.soros.org/2011/12/preventing-drug-overdose-is-key-in-fight-against-aids/.

With the funding situation the way it is, we need to invest in interventions we know work, like methadone and buprenorphine treatment, highly active antiretroviral therapy, and naloxone distribution.

Boston Globe Editorial - "In fighting heroin overdoses, a key ally is often overlooked"

Editorial

In Fighting Overdoses, A Key Ally is Often Overlooked

November 27, 2011

FEW DEATHS from heroin overdose happen alone. A friend or relative is often standing by helplessly as a victim’s skin turns blue, their pulse slows, and breathing stops. In 2008, 594 people died from accidental overdoses of heroin and other opioid drugs in Massachusetts.

That’s why a promising state pilot program that gets a life-saving overdose-reversal drug called naloxone into the hands of friends and relatives of opioid addicts should be expanded to more communities. At the same time, more first responders should carry the drug, often known by the brand name Narcan, and state and federal authorities should relax the restrictions preventing wider public access.

Since 2007, the naloxone pilot program at eight sites across the Commonwealth is credited with reversing more than 1,100 overdoses. The drug, which is squirted into the nose of overdose victims, revives them for 30 to 90 minutes, long enough to get them to an emergency room.

Naloxone is not a new drug, but had previously been confined mostly to hospitals. When the state’s program started, critics worried it would be difficult for nonprofessionals to administer naloxone - or worse, that providing it would be tantamount to official acceptance of drug abuse. But the results speak for themselves:

In Lynn, one of the pilot sites, the number of reported deaths from accidental opioid overdose fell from 22 in 2006 to only 8 in 2008. In four years, according to state statistics, naloxone distributed in Lynn was used to reverse 166 overdoses. Statewide, the program cost only $170,000 this year.

The success of a program that relies on non-professionals - and of similar programs launched in other states over the last decade - ought to prod state and federal authorities to ease some of the needless restrictions on access to the drug, which is not addictive and has no potential for abuse itself. A bill introduced this year in the Massachusetts Senate would allow doctors to write prescriptions to friends or family members of addicts; it deserves the Legislature’s support. On the federal level, the Food and Drug Administration should study whether naloxone could safely be sold over the counter, as it is in Italy.

Meanwhile, as the results of naloxone programs become clear, grass-roots pressure is growing to find other ways to get more of the drug on the streets. Last year, for instance, a group of mothers of opioid addicts pushed Quincy police to carry naloxone, leading to 45 overdose reversals since June 2010. But few other first responders carry naloxone. This makes little sense. Opioid overdoses rank with car crashes as the leading causes of accidental death in the state. There is no reason why front-line public safety officers shouldn’t be fully equipped for them.

Even if more first responders carry naloxone, the reality is that the person squirting naloxone will often be a fellow drug user. Too often, though, fellow users fear arrest and don’t take the critical next step after administering the dose - calling 911. (After the effects of naloxone wear off, a person can go back into overdose if they don’t get help.) New Mexico, New York, and Washington have all passed good Samaritan bills that would protect people who call 911 to report drug overdoses; similar legislation has been introduced in both the Massachusetts House and Senate, and should be approved.

The families of addicts often carry a heavy load, boxed in by stigma and shame, and shadowed by the constant fear that a loved one could die with the next stronger-than expected bag of heroin. Naloxone isn’t a miracle drug, and it doesn’t eliminate addiction. But greater access to naloxone would empower families, provide hope - and save lives.

http://bostonglobe.com/opinion/editorials/2011/11/27/fighting-heroin-overdoses-key-ally-often-overlooked/qo2LNWaAjvmoBWyvUCU48K/story.html

Pubmed December 2011 Update

My favorites this week includes the first two - a paper from Serbia on post-mortem evaluations and a review of a LARGE dataset describing types of prescription opioid users and their overdose risk profiles.

1) Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users.

Todorović MS, Mitrović S, Aleksandrić B, Mladjenović N, Matejić S.

Vojnosanit Pregl. 2011 Aug;68(8):639-42.

Comment: This is a really interesting paper out of Serbia. Pulmonary edema (water in the lungs) by far most common pathological finding in drug users who died suddenly, most of whom were opioid users. This makes sense and is not inconsistent with the known mechanism of death from opioids. Of note, pulmonary edema has been reported in people who were administered naloxone, but this is almost certainly due to the overdose itself rather than any toxicity from naloxone.

2) Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment.

Green TC, Black R, Grimes Serrano JM, Budman SH, Butler SF.

PLoS One. 2011;6(11):e27244. Epub 2011 Nov 2.

Comment: This one takes a while to read through, but is intensely interesting. I highly recommend taking a close look at the article, the figures and tables, and even (!) digging through the entire text. Keep in mind this is a sample seeking substance abuse treatment - this is not an analysis of the general population of people who use prescription opioid.

3) HIV infection and risk of overdose: a systematic review and meta-analysis.

Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD.

AIDS. 2011 Nov 22.

Comment: In many areas of the world, overdose is the most common cause of death among those at risk for (or infected with) HIV. This study found that HIV-seropositivity was associated with a 74% increased risk overdose death (I can't access the article to provide more detail about this).

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The next two are directed at those prescribing opioids ...

4) Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 2: special populations.

Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A.

Can Fam Physician. 2011 Nov;57(11):1269-76.

Comment: Title is really self-explanatory - recommendations for managing opioids in adolescents.

5) Management of chronic noncancer pain in depressed patients.

Barkin RL, Barkin SJ, Irving GA, Gordon A.

Postgrad Med. 2011 Sep;123(5):143-54. Review.

Comments: Another review for physicians of how to not rely so much on opioids for chronic pain.