PubMed Update November/December 2013

We close out 2013 with an impressive 25 papers in the final two months for a total count of 89 papers. Some interesting new approaches and perspectives, including a paper on the underappreciated role of adulterants, a couple of naltrexone papers, and lots of lay naloxone.

1) The Whole Is Just the Sum of Its Parts: Limited Polydrug Use Among the "Big Three" Expensive Drugs in the United States.

Caulkins JP, Everingham S, Kilmer B, Midgette G.

Curr Drug Abuse Rev. 2013 Dec 5. [Epub ahead of print]

Comments: Somewhat surprising data suggesting relatively separate markets for heroin, cocaine and methamphetamine.

2) A systematic review and meta-analysis of naltrexone implants for the treatment of opioid dependence.

Larney S, Gowing L, Mattick RP, Farrell M, Hall W, Degenhardt L.

Drug Alcohol Rev. 2013 Dec 3. doi: 10.1111/dar.12095. [Epub ahead of print]

Comments: A systematic review concluding that the data for naltrexone implants for opioid dependence are insufficient for use outside of clinical trials.

3) Trends and Regional Variation in Opioid Overdose Mortality Among Veterans Health Administration Patients, Fiscal Year 2001 to 2009.

Bohnert AS, Ilgen MA, Trafton JA, Kerns RD, Eisenberg A, Ganoczy D, Blow FC.

Clin J Pain. 2013 Nov 25. [Epub ahead of print]

Comments: What happened with opioid analgesic overdose deaths in the United States also happened in among veterans receiving care in the Veterans’ Administration.

4) The Dueling Obligations of Opioid Stewardship.

Coffin P, Banta-Green C.

Ann Intern Med. 2013 Dec 10. doi: 10.7326/M13-2781. [Epub ahead of print] No abstract available.

Comments: Commentary on the reliance on opioids and minimizing the potential harms of stewardship efforts.

5) Take-home naloxone kits preventing overdose deaths.

Eggertson L.

CMAJ. 2013 Nov 25. [Epub ahead of print] No abstract available.

Comments: This is really a news report in CMAJ about Canada’s BC naloxone program.

6) Preventing deaths from rising opioid overdose in the US - the promise of naloxone antidote in community-based naloxone take-home programs.

Straus MM, Ghitza UE, Tai B.

Subst Abuse Rehabil. 2013 Sep 2;2013(4). doi: 10.2147/SAR.S47463.

Comments: Good review of major initiatives to respond to increasing rates of opioid overdose mortality in the United States, including take-back programs, prescription drug monitoring programs, and naloxone distribution.

7) Drug-induced deaths - United States, 1999-2010.

Mack KA; National Center for Injury Prevention and Control, CDC.

MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-3.

Comments: Review of drug-related deaths of the past decade.

8) From oxycodone to heroin: Two cases of transitioning opioid use in young Australians.

Dertadian GC, Maher L.

Drug Alcohol Rev. 2013 Nov 21. doi: 10.1111/dar.12093. [Epub ahead of print]

Comments: Interesting case reports of transitions from oral prescription opioid consumption to illicit opioid injection. Unable to access for details.

9) Common causes of poisoning: etiology, diagnosis and treatment.

Müller D, Desel H.

Dtsch Arztebl Int. 2013 Oct;110(41):690-9; quiz 700. doi: 10.3238/arztebl.2013.0690. Epub 2013 Oct 11.

Comments: Interesting analysis of all acute poisonings in the German poison control center over 26 years.

10) Opiate- and Cocaine-Related Fatal Overdoses in Luxembourg from 1985 to 2011: A Study on Gender Differences.

Origer A, Lopes da Costa S, Baumann M.

Eur Addict Res. 2013 Oct 31;20(2):87-93. [Epub ahead of print]

Comments: Interesting gender-based analysis suggesting that women may be at higher risk earlier in their drug use careers.

11) Safe methadone induction and stabilization: report of an expert panel.

Baxter LE Sr, Campbell A, Deshields M, Levounis P, Martin JA, McNicholas L, Payte JT, Salsitz EA, Taylor T, Wilford BB.

J Addict Med. 2013 Nov-Dec;7(6):377-86. doi: 10.1097/01.ADM.0000435321.39251.d7.

Comments: Guidelines addressing methadone starting dose, dose escalation, and concomitant medications/drugs.

12) Opioid substitution treatment in pretrial prison detention: a case study from Geneva, Switzerland.

Favrod-Coune T, Baroudi M, Casillas A, Rieder JP, Gétaz L, Barro J, Gaspoz JM, Broers B, Wolff H.

Swiss Med Wkly. 2013 Nov 1;143:w13898. doi: 10.4414/smw.2013.13898.

Comments: No overdoses.

13) [Distribution of naloxone to prevent death from heroin overdose. Study of opioid dependent patients' attitudes to be part of the antidote program].

Håkansson A, Vedin A, Wallin C, Kral AH.

Lakartidningen. 2013 Jul 17-Aug 6;110(29-31):1340-2. Swedish. No abstract available.

Comments: Unable to access, but it would be fascinating to see the Swedish response to lay naloxone.

14) Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran.

Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A.

Clin Toxicol (Phila). 2013 Sep-Oct;51(8):777-82. doi: 10.3109/15563650.2013.830732. Epub 2013 Aug 23.

Comments:

15) Project Lazarus: an innovative community response to prescription drug overdose.

Brason FW 2nd, Roe C, Dasgupta N.

N C Med J. 2013 May-Jun;74(3):259-61. No abstract available.

Comments: Unable to access.

16) Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.

Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM.

Can J Public Health. 2013 Apr 18;104(3):e200-4.

Comments: Report from the first 8 months of naloxone trainings in Toronto!

17) The pathogenetic role of adulterants in 5 cases of drug addicts with a fatal outcome.

Barbera N, Busardò FP, Indorato F, Romano G.

Forensic Sci Int. 2013 Apr 10;227(1-3):74-6. doi: 10.1016/j.forsciint.2012.08.041. Epub 2012 Sep 20.

Comments: Fascinating paper on the role of dextromethorphan, built upon evidence that dextromethorphan – an NMDA-recepter antagonist – decreases the expiratory phase of respiration and magnifies the respiratory depression induced by morphine. While adulterants may be more important than we’ve previously realized, how does one translate that to overdose prevention in the field?

18) Deadly heroin or the death of heroin - overdoses caused by illicit drugs of abuse in Budapest, Hungary between 1994 and 2012.

Horvath M, Dunay G, Csonka R, Keller E.

Neuropsychopharmacol Hung. 2013 Dec;15(4):253-9.

Comments: Very exciting to see a review of drug overdose deaths in Budapest, Hungary. The number of deaths is remarkably low, with just 464 deaths in 18 years (299 opioid-related). Surprisingly 58% of the deaths were heroin alone, a finding the authors suggest means that use patterns are distinct in Budapest.

19) [Factors associated with overdose-caused mortality of HIV-positive patients who were on methadone maintenance treatment program].

Cui N, Cao XB, Wang CH, Luo W, Pang L, Rou KM, Wu ZY.

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Oct;34(10):961-3. Chinese.

Comments: Interesting analysis from China with the suggestion that adherence to methadone maintenance reduces overdose mortality.

20) Survey of naloxone legal status in opioid overdose prevention and treatment.

Hewlett L, Wermeling DP.

J Opioid Manag. 2013 Sep-Oct;9(5):369-77. doi: 10.5055/jom.2013.0179.

Comments: Review of naloxone access laws in the United States. There was so much activity in 2013, that this article is already a bit out of date!

21) Mortality among Methadone Maintenance Clients in China: A Six-Year Cohort Study.

Cao X, Wu Z, Li L, Pang L, Rou K, Wang C, Luo W, Yin W, Li J, McGoogan JM; National Methadone Maintenance Treatment Program Working Group.

PLoS One. 2013 Dec 12;8(12):e82476. doi: 10.1371/journal.pone.0082476.

Comments: Overdose was the leading cause of death among methadone patients, four times more likely among those with HIV, and longer time in methadone treatment reduced overdose mortality risk.

22) Associations among Pain, Non-Medical Prescription Opioid Use, and Drug Overdose History.

Bonar EE, Ilgen MA, Walton M, Bohnert AS.

Am J Addict. 2014 Jan;23(1):41-7. doi: 10.1111/j.1521-0391.2013.12055.x. Epub 2013 Jun 14.

Comments: Analysis among substance users at a treatment center of pain, non-medical prescription opioid use, and overdose.

23) 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: This is a fascinating analysis that I’ve been waiting to see (AJPH does tend to take a while to publish!). However, what happened in NYC with opioid overdose may or may not be reflective of what happened in other areas of the country. NYC saw a clear increase in overdose on Staten Island, among those using prescription opioids, while heroin deaths were decreasing citywide. Staten Island then had an increase in heroin deaths as many transitioned to heroin and there were no services in place to limit the harms of heroin. In other areas there is less of a clear trend.

24) 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-Dec;37(9):629-35. doi: 10.1093/jat/bkt085.

Comments: Again demonstrating the limited utility of drug concentration in opioid overdose deaths.

25) Naltrexone in the treatment of opioid-dependent pregnant women: the case for a considered and measured approach to research.

Jones HE, Chisolm MS, Jansson LM, Terplan M.

Addiction. 2013 Feb;108(2):233-47. doi: 10.1111/j.1360-0443.2012.03811.x. Epub 2012 Apr 4. Review.

Comments: The research field of obstetrics is generally way behind the rest of medicine. Because we are so concerned over the health of pregnant women and the well-being of the embryos and fetuses they carry, we tend to rely on decades of experience and new approaches progress glacially. As the authors point out, given the numerous potential downsides of naltrexone for opioid dependence, we are not near the point of recommending this therapy for pregnant women at this time – or even researching it directly.