Sunday, June 23, 2013

Preview Cut Now Available: "Reach for Me: Fighting to End the American Drug Overdose Epidemic"

Late last year we posted about seeking people to interview for a short documentary film about access to naloxone in the United States. The results are now available in a preview (aka not-quite-final-but-almost) cut of Reach for Me: Fighting to End the American Drug Overdose Epidemic.  Please have a look and tell us what you think! 

The film explores the interconnected issues of naloxone pricing and production shortages, public funding support (or more often lack thereof), and other factors affecting access to overdose prevention tools. It features interviews with leading experts and advocates from around the country, including California, Minnesota, New York, North Carolina, Oregon, Washington, DC, and Wisconsin. 

The point, for us, is to use Reach for Me as a platform for building awareness, understanding, and support for overdose prevention programs. To that end, over the next couple weeks we'll be rolling out the final version of the film, a short (c. 3 minute) version, along with a website and Facebook and Twitter pages. The film will be freely available on DVD (follow this link to request up to 20 copies) and online for streaming or download. We'll also be making available the full interviews with the nearly 30 people who participated. Stay tuned!
Elizabeth Owens of VOCAL New York
in a scene from Reach for Me

The film was directed by Greg Scott, and produced by Matt Curtis and Erin Scott, with an assist from Eliza Wheeler, and was produced under the aegis of Sawbuck Productions. We'd like to thank everyone involved, and especially the Open Society Foundations for their financial support and the Harm Reduction Coalition for allowing us to film during their excellent biennial conference. 

Saturday, June 15, 2013

Chicago Recovery Alliance and Gateway Foundation 

Begin Opioid OD Prevention in Cook County Jail

On Tuesday June 11, 2013, Ashley Tsang (a UChicago Medical Student and Schweitzer Fellow) and Dan Bigg, CRA's Director met with Mike Colombatto, PsyD Program Administrator at Gateway Foundation's Treatment System at Cook County Jail regarding integrating opioid overdose at the Jail.  Ashley concluded from research that non-dependent opioid users leaving corrections had over 100 times the risk of death through overdose as ordinary citizens.

A quick meeting of the minds was had and Ashley and Dan began trainings at Cook County Jail's Gateway Treatment System's two programs (Day Treatment and Pre-Release residential settings).

The OD trainings on June 13 and 14, 2013 were very well received showing the majority of individuals there had been around opioid overdose and nearly a third had been around a fatal such OD.

Plans are to continue these trainings and improve the process of making OD preventative options readily available to all tolerance-lessened individuals and those around opioid users under IL's OD Program law (20 ILCS 301/5-23) which allows lay persons to become OD Responders and carry and use naloxone via injection.

We are delighted with this life affirming progress in Chicago and thank our colleagues in Pittsburgh, Rhode Island, and San Francisco among others for their guidance and other assistance with this effort.

Tuesday, June 11, 2013

PubMed Update May 2013

Here is the May 2013 roundup with 7 papers and some extra kudos to the authors for important steps forward in data or practice.

Llorente J, Withey S, Rivero G, Cunningham M, Cooke A, Saxena K, McPherson J, Oldfield S, Dewey W, Bailey C, Kelly E, Henderson G.
Mol Pharmacol. 2013 May 28. [Epub ahead of print]

Comments: Intriguing analysis of ethanol and morphine, suggesting that alcohol may enhance the effects of morphine. Could this account for some of the risk of combining opioids with alcohol?

Moryl N, Pope J, Obbens E.
J Opioid Manag. 2013 Jan-Feb;9(1):29-34. doi: 10.5055/jom.2013.0144.

Comments: One of a handful of issues with methadone dosing that may have factored into the challenges encountered by providers and patients with this drug when used for pain.

Schuman-Olivier Z, Hoeppner BB, Weiss RD, Borodovsky J, Shaffer HJ, Albanese MJ.
Drug Alcohol Depend. 2013 May 17. doi:pii: S0376-8716(13)00133-6. 10.1016/j.drugalcdep.2013.04.006. [Epub ahead of print]

Comments: For patients on any opioid medications, benzodiazepines are associated with an increased risk of overdose. This study of 328 buprenorphine maintenance patients didn’t find an association with benzodiazepine prescriptions and overdose, but did find an association with more frequent emergency department visits and injury-related ED visits. We may never learn if benzodiazepines are causal in this pathway or merely a marker, but these data do contribute to the overall concern.

Horyniak D, Dietze P, Degenhardt L, Higgs P, McIlwraith F, Alati R, Bruno R, Lenton S, Burns L.
Drug Alcohol Depend. 2013 May 9. doi:pii: S0376-8716(13)00116-6. 10.1016/j.drugalcdep.2013.03.021. [Epub ahead of print]

Comments: More excellent work from this team. I particularly appreciate the estimate of the reduction in overdose risk with age. In a mathematical model of overdose, we estimated a 50% reduction in the risk of overdose over 10 years of use, whereas this paper suggests the figure is closer to 20% - data that will be very helpful in future iterations.

Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD.
Am J Med. 2013 May 8. doi:pii: S0002-9343(13)00138-1. 10.1016/j.amjmed.2012.11.031. [Epub ahead of print]

Comments: Congratulations to this team on producing what I think are the first primary care guidelines in the scientific literature recommending overdose prevention and naloxone for at-risk patients.

McCormick Z, Chu SK, Chang-Chien GC, Joseph P.
Pain Med. 2013 May 3. doi: 10.1111/pme.12135. [Epub ahead of print]

Comments: Less an overdose article per se, but a paper that pays attention to the overdose issue when titrating opioids.

Green TC, Bowman SE, Zaller ND, Ray M, Case P, Heimer R.
Subst Use Misuse. 2013 May;48(7):558-67. doi: 10.3109/10826084.2013.787099.

Comments: A qualitative look at providers feelings about providing naloxone to “drug users” and, separately, to “pain patients.” This is a great and useful analysis – and honestly surprisingly positive across the board. The major concern raised seemed to be that naloxone not be the only thing done to try to reduce overdose. This is a pretty dramatic shift in attitudes since earlier evaluations of provider opinion on lay naloxone (Beletsky et al 2007, Coffin et al 2003).