PubMed Update April 2013

10 papers this time. Good stuff.

1. Take-Home Emergency Naloxone to Prevent Heroin Overdose Deaths after Prison Release: Rationale and Practicalities for the N-ALIVE Randomized Trial.

Strang J, Bird SM, Parmar MK.

J Urban Health. 2013 May 1. [Epub ahead of print]

Comment: Really interesting article on the design of the N-ALIVE trial of naloxone provision to prisoners pre-release.

2. Determination of dextromethorphan and levomethorphan in seized heroin samples by enantioselective HPLC and electronic CD.

Tedesco D, Di Pietra AM, Rossi F, Garagnani M, Del Borrello E, Bertucci C, Andrisano V.

J Pharm Biomed Anal. 2013 Apr 6;81-82C:76-79. doi: 10.1016/j.jpba.2013.03.024. [Epub ahead of print]

Comment: Methods paper demonstrating methorphan in some heroin samples involved in overdose death.

3. All-cause mortality in criminal justice clients with substance use problems-A prospective follow-up study.

Hakansson A, Berglund M.

Drug Alcohol Depend. 2013 Apr 24. doi:pii: S0376-8716(13)00109-9. 10.1016/j.drugalcdep.2013.03.014. [Epub ahead of print]

Comments: Another analysis of post-release mortality among prisoners, in which the largest group (39%) of deaths were due to accidental or undetermined intent poisoning.

4. Changing law from barrier to facilitator of opioid overdose prevention.

Davis C, Webb D, Burris S.

J Law Med Ethics. 2013 Mar;41 Suppl 1:33-6. doi: 10.1111/jlme.12035.

Comments: Excellent analysis of naloxone and Good Samaritan legislation.

5.  Gender and strain contributions to the variability of buprenorphine-related respiratory toxicity in mice.

Alhaddad H, Cisternino S, Saubamea B, Schlatter J, Chiadmi F, Risède P, Smirnova M, Cochois-Guégan V, Tournier N, Baud FJ, Mégarbane B.

Toxicology. 2013 Mar 8;305:99-108. doi: 10.1016/j.tox.2013.01.013. Epub 2013 Jan 29.

Comments: An analysis of mechanisms for buprenorphine-induced respiratory depression by mouse gender and strain.

6. Use and efficacy of nebulized naloxone in patients with suspected opioid intoxication.

Baumann BM, Patterson RA, Parone DA, Jones MK, Glaspey LJ, Thompson NM, Stauss MP, Haroz R.

Am J Emerg Med. 2013 Mar;31(3):585-8. doi: 10.1016/j.ajem.2012.10.004. Epub 2013 Jan 21.

Comments: Now naloxone can be administered IV, IM, SC, IN, or via nebulizer. I still see limited utility for the nebulizer route, as the medication is used to treat respiratory depression.

7. Diversity in causes and characteristics of drug-induced deaths in an urban setting.

Gjersing L, Jonassen KV, Biong S, Ravndal E, Waal H, Bramness JG, Clausen T.

Scand J Public Health. 2013 Mar;41(2):119-25. doi: 10.1177/1403494812472007. Epub 2013 Jan 9.

Comments: Overview of epidemiologic characteristics of 231 overdose deaths in Norway.

8. The Toxicology Investigators Consortium Case Registry--the 2011 experience.

Wiegand TJ, Wax PM, Schwartz T, Finkelstein Y, Gorodetsky R, Brent J; Toxicology Investigators Consortium Case Registry Investigators.

J Med Toxicol. 2012 Dec;8(4):360-77. doi: 10.1007/s13181-012-0264-9.

Comments: Interesting analysis of a relatively new dataset including cases evaluated by medical toxicologists from multiple sites. Opioids were a leading issue (although this is a set of referred cases and opioid overdose rarely requires referral, so the contribution of opioids to overdose events should be very much underestimated in this cohort).

9. Early antidote use associated with noninvasive ventilation in prehospital treatment of methadone intoxication.

Gonzva J, Prunet B, Deniel C, Benner P, Toppin F, Brun PM.

Am J Emerg Med. 2013 Feb;31(2):448.e5-6. doi: 10.1016/j.ajem.2012.06.015. Epub 2012 Aug 31. No abstract available.

Comments: This is an intriguing report. Early use of naloxone (by paramedics in this case) may result in less need for intubation, even if patients continue to experience respiratory distress. This suggests that faster administration of pre-hospital naloxone may reduce the need for invasive interventions.

10. Methadone toxicity and possible induction and enhanced elimination in a premature neonate.

George M, Kitzmiller JP, Ewald MB, O'Donell KA, Becter ML, Salhanick S.

J Med Toxicol. 2012 Dec;8(4):432-5. doi: 10.1007/s13181-012-0249-8.

Comments: Methadone pharmaco-kinetics/dynamics are really complicated.