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.