PubMed July 2012 Update

LOTS of great articles this month (10 total)! Let’s start with an updated chart of the number of scientific opioid overdose articles each year from 1980 through 2011 …

1. Injection Drug Users Trained by Overdose Prevention Programs: Responses to Witnessed Overdoses 
Lankenau SE, Wagner KD, Silva K, Kecojevic A, Iverson E, McNeely M, Kral AH.

J Community Health. 2012 Jul 31. [Epub ahead of print]

Comments: An exciting article from a mixed methods study of Los Angeles area naloxone recipients. The authors note the possible need for booster sessions after naloxone distribution – an interesting idea that plays into the possible behavioral effect of naloxone. Hopefully this is the first of many such analyses.

2. Using poison center exposure calls to predict methadone poisoning deaths

Dasgupta N, Davis J, Jonsson Funk M, Dart R.

PLoS One. 2012;7(7):e41181. Epub 2012 Jul 19.

Comments: Intriguing analysis of calls to poison control centers. The number of methadone calls was associated with overall methadone mortality, although the calls tended to be from younger, and more often female, individuals that may not have required medical attention. How about a state-by-state breakdown of Google Methadone Trends?

3. Prevalence and correlates for nonmedical use of prescription opioids among urban and rural residents

Wang KH, Becker WC, Fiellin DA.

Drug Alcohol Depend. 2012 Jul 20. [Epub ahead of print]

Comments: Based on the 2008-2009 National Survey on Drug Use and Health, authors looked at nonmedical use of prescription opioids by county. Overall use rates were similar in urban and rural counties, with high rates of psychological distress and non-medical use of other prescription drugs.

4. Canada's highest court unchains injection drug users; Implications for harm reduction as standard of healthcare

Small D.

Harm Reduct J. 2012 Jul 20;9(1):34. [Epub ahead of print]

Comments: A review of the 2011 Supreme Court of Canada decision supporting the Vancouver supervised injection facility.

5. Tramadol-induced apnea

Hassanian-Moghaddam H, Farajidana H, Sarjami S, Owliaey H.

Am J Emerg Med. 2012 Jul 16. [Epub ahead of print]

Comments: Tramadol is an opioid-like drug that has been involved in some overdose events. The risks for a tramadol overdose are poorly understood. I’m not sure how much this paper adds.

6. American Society of Interventional Pain Physicians (ASIPP) Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain: Part 2 - Guidance

Manchikanti L, Abdi S, Atluri S, et al.

Pain Physician. 2012 Jul;15(3 Suppl):S67-S116.

Comments: There are some nice summaries of current understanding related to prescription opioid overdose in this long paper. Although there is brief mention of the idea of using buprenorphine/naloxone combinations for opioid dependent persons with chronic pain, no mention is made of dispensing naloxone. Of note there is a contradiction in the paper: on page S74 authors write that the evidence that prescription drug monitoring programs reduce overdose is “poor”, then in the recommendation for such programs state that the evidence is “good to fair.”

7. Fatal overdose after ingestion of a transdermal fentanyl patch in two non-human primates

Deschamps JY, Gaulier JM, Podevin G, Cherel Y, Ferry N, Roux FA.

Vet Anaesth Analg. 2012 Jul 13. doi: 10.1111/j.1467-2995.2012.00749.x. [Epub ahead of print]

Comments: Two primates were given fentanyl patches for post-operative anesthesia, they of course ate the patches, and they died. I’ll leave further comments to you.

8. Management of opioid analgesic overdose

Boyer EW.

N Engl J Med. 2012 Jul 12;367(2):146-55. Review. No abstract available.

Comments: A review of management of opioid analgesic overdose in emergency departments or hospitals.

9. ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy

ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine.

Obstet Gynecol. 2012 May;119(5):1070-6.

Comments: A nice summary supporting established recommendations for opioid agonist maintenance therapy in pregnancy, noting both that tapering pregnant women off of opioids is dangerous and unnecessary and that breastfeeding is okay for women on agonist therapy.

10. 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 Jun;37(6):691-6. Epub 2012 Feb 7.

Comments: More great data from Vancouver! Large cohort (N=2,515) of drug users; one-third had a non-fatal overdose in the past 6 months. Overdose was associated with more frequent use and more polydrug use. Older age was protective, which is interesting and supports the emerging concept that some drug users overdose … and some do not. Their findings around HIV and overdose risk are difficult to interpret and frankly require further evaluation. Those recently incarcerated were about twice as likely to report recent overdose.