Pubmed April 2012 Update

Here we go with April 2012 ...

Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999-2008.

Rosca P, Haklai Z, Goldberger N, Zohar P, Margolis A, Ponizovsky AM.

Drug Alcohol Depend. 2012 Apr 6. [Epub ahead of print]

Comment: Rate of overdose mortality was 0.22/100 person-years (i.e. 0.22%), one-quarter to one-fifth the expected rate in most studies of other cohorts

Intravenous use of illicit buprenorphine/naloxone to reverse an acute heroin overdose.

Yokell MA, Zaller ND, Green TC, McKenzie M, Rich JD.

J Opioid Manag. 2012 Jan-Feb;8(1):63-6.

Comment: Buprenorphine is a partial agonist with a ceiling effect that limits the capacity for overdose among those with a tolerance to opioids. Like naloxone, buprenorphine really likes binding to opioid receptors and kicks most other opioids out. Since buprenorphine out-competes other opioids for receptors and has a ceiling effect, administration in the setting of overdose may result in reversal of opioid overdose. That said, this wouldn't be the approach I would advocate for dissemination since (1) buprenorphine could cause overdose in an opioid user with minimal tolerance and (2) buprenorphine could cause prolonged withdrawal (for over a day) in those with a very high tolerance.

Understanding drug-related mortality in released prisoners: A review of national coronial records.

Andrews JY, Kinner SA.

BMC Public Health. 2012 Apr 4;12(1):270. [Epub ahead of print]

Comment: An interesting exploration of circumstances surrounding prisoner death post-release.

Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide.

Goli V, Webster LR, Lamson MJ, Cleveland JM, Sommerville KW, Carter E.

Harm Reduct J. 2012 Mar 15;9(1):13. [Epub ahead of print]

Comment: An intriguing analysis of whether or not injecting the pre-formulated morphine + naltrexone actually blocks the effects of morphine. It appears to partially, but not completely, block the effect.

Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users.

Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T.

Addict Behav. 2012 Feb 7. [Epub ahead of print]

Comment: Prior overdose, daily or binge drug use, and public injecting are associated with nonfatal overdose among recently released drug users.

Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse.

Upadhyay SP, Mallick PN, Elmatite WM, Jagia M, Taqi S.

Indian J Palliat Care. 2011 Sep;17(3):251-4.

Comment: An interesting use of a particular sedative to assist with opioid withdrawal in an intensive care unit.

Drug-related deaths with evidence of intracorporeal drug concealment at autopsy: five case reports.

Wilcher G.

Am J Forensic Med Pathol. 2011 Dec;32(4):314-8.

Comment: Intriguing review of 5 cases of drug-induced death among "body packers" or "body stuffers", including a review of that language. Interestingly, most of the deaths were due to overdose on consumed drugs rather than toxicity from rupture of drug packets.