Narcana vs Death

An amazing mural conceived of and painted by Erin Ruch and Mikey Reger, artists with Mission Minicomix, in Clarion Alley, the Mission District of San Francisco.

PubMed Update October 2013

A slight reprieve from the onslaught, only 6 articles this month – some of which are really interesting.

1) The Toxicology Investigators Consortium Case Registry-The 2012 Experience.

Wiegand T, Wax P, Smith E, Hart K, Brent J.

J Med Toxicol. 2013 Nov 1. [Epub ahead of print]

Comments: Fascinating TocIC Registry, including cases that were attended to by boarded medical toxicologists (so this would represent a tiny subset of the type of accidental drug overdoses we generally discuss on this site). I’m unable to access the full article.

2) Acute coronary syndrome after methadone overdose in an opiate-naive patient.

De Cuyper A, Lambert M, Hantson P.

Acta Clin Belg. 2013 May-Jun;68(3):250-1. No abstract available.

Comments: Unable to access and no abstract available.

3) Delayed post-hypoxic leukoencephalopathy: case report with a review of disease pathophysiology.

Meyer MA.

Neurol Int. 2013 Jul 22;5(3):e13. doi: 10.4081/ni.2013.e13.

Comments: There was a similar review we discussed in 2012. This is a devastating white matter neurologic disease that has been reported after severe opioid overdoses; tends to occur days to weeks after the event.

4) Revisiting the role of the urban environment in substance use: the case of analgesic overdose fatalities.

Cerdá M, Ransome Y, Keyes KM, Koenen KC, Tardiff K, Vlahov D, Galea S.

Am J Public Health. 2013 Dec;103(12):2252-60. doi: 10.2105/AJPH.2013.301347. Epub 2013 Oct 17.

Comments: Fascinating analysis of opioid analgesic overdose fatalities in New York City from 2000-2006, compared to heroin overdose deaths and non-overdose unintentional deaths. Opioid analgesic deaths basically fit in the middle in terms of neighborhood wealth and social structure, between heroin deaths (lower income, socially fragmented) and non-overdose deaths (higher income, less fragmented). This article is also the first academic publication I’ve seen that demonstrates the unique geographic nature of opioid analgesic overdose mortality in NYC – Staten Island is an epicenter, a location that was historically essentially exempt from heroin overdose death.

5) Opioid overdose mortality in kansas, 2001-2011: toxicologic evaluation of intent.

Okic M, Cnossen L, Crifasi JA, Long C, Mitchell EK.

J Anal Toxicol. 2013 Nov;37(9):629-35. doi: 10.1093/jat/bkt085.

Comments: Analysis of opioids in deaths in Kansas, including drug concentrations. The most notable finding is that there is a very wide range of concentrations in overdose deaths involving these agents, a result consistent with decades of toxicological literature suggesting that tolerance plays a big role on risk for overdose and subsequent death.

6) Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes.

Williams AV, Marsden J, Strang J.

Addiction. 2013 Sep 17. doi: 10.1111/add.12360. [Epub ahead of print]

Comments: Authors randomized family members to receive just information versus a 60-minute training. They found that family members who went through the training scored higher on the standardized knowledge and attitude scales authors had previously published. Of note, naloxone was administered in witnessed overdose events for 3 out of 92 who just received information and 5 out of 95 who received the 60-minute training. This raises the very different question of what is sufficient for non-medical personnel to safely and effectively administer naloxone in the community? Information alone may be the answer to that question. While in-depth trainings are fantastic when available and accessible, requiring such activities can easily become an unnecessary obstacle to dissemination of the intervention … perhaps similar to historic requirements for extensive counseling and consent processes prior to HIV testing.