PubMed Update January 2014

10 papers this month, half of which relate to the United Kingdom. We continue to move forward.

1) Characterization of opioid overdose and response in a high-risk community corrections sample: A preliminary study.

Cropsey KL, Martin S, Clark CB, McCullumsmith CB, Lane PS, Hardy S, Hendricks PS, Redmond N.

J Opioid Manag. 2013 Nov-Dec;9(6):393-400.

Comments: Valuable survey of persons in the corrections system, under community supervision. Nearly half had used opioids and 40% of those had experienced an opioid overdose. Those who had overdosed were more likely to be white, female, and have higher educational attainment; they were also much more likely to have witnessed overdose, have seen someone die of overdose, and want training in overdose prevention and management.

2) Opioids Compared to Placebo or Other Treatments for Chronic Low Back Pain: An Update of the Cochrane Review.

Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC.

Spine (Phila Pa 1976). 2014 Jan 29. [Epub ahead of print]

Comments: A review of studies evaluating short term use of opioids for chronic lower back pain. The studies evaluated all have major shortcomings so we’re left with little new information.

3) Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy.

Adrish M, Duncalf R, Diaz-Fuentes G, Venkatram S.

Am J Case Rep. 2014 Jan 15;15:22-6

Comments: Being “down” with an overdose for a prolonged period can lead to complications such as rhabdomyolysis and nerve compression. This patient developed compartment syndrome, which is to say high pressure within the fascial compartment of the buttocks, requiring surgical intervention to spare her extremity.

4) Would legalizing illicit opioids reduce overdose fatalities? Implications from a natural experiment.

Darke S, Farrell M.

Addiction. 2014 Jan 24. doi: 10.1111/add.12456. [Epub ahead of print]

Comments: If anyone is reading this, this article should lead to some discussion. It is hard to argue with the recent United States experience with broad availability of opioid analgesics and resultant four-fold increase in opioid overdose death rates. When OxyContin was the choice longacting agent, that was the offender, then providers shifted to prescribing methadone and that became the principal offender, then the offender switched to whichever longacting opioid became the dominant prescribed opioid in a given community. When those communities stop prescribing opioids, heroin tops the charts. While there is room for a lively debate and this paper does not help us solve the current US crisis, the central conclusion that merely making opioids widely available at a known dose and free of adulterants would not reduce overdose mortality on a community or national level seems valid. That said, it is conceivable that such availability reduces mortality among those already dependent on opioids – complicating any assessment.

5) Reducing drug related deaths: a pre-implementation assessment of knowledge,barriers and enablers for naloxone distribution through general practice.

Matheson C, Pflanz-Sinclair C, Aucott L, Wilson P, Watson R, Malloy S, Dickie E, McAuley A.

BMC Fam Pract. 2014 Jan 15;15(1):12.

Comments: A survey of general practitioners in Scotland demonstrating mixed knowledge and interest in overdose prevention. Many seemed to feel this was a specialist service rather than one that a generalist should provide. Those with more experience with drug use were generally more supportive.

6) Commentary on Williams et al. (2014): Family matters-new resources for managing opioid overdose with take-home naloxone.

Tait RJ, Lenton S.

Addiction. 2014 Feb;109(2):260-1.

Comments: A commentary on the OOKS and OOAS overdose scales produced in the UK.

7) Unintentional opioid overdose deaths in New York City, 2005-2010: A place-based approach to reduce risk.

Siegler A, Tuazon E, Bradley O'Brien D, Paone D.

Int J Drug Policy. 2013 Nov 8. pii: S0955-3959(13)00178-3. [Epub ahead of print]

Comments: I’ve been anxiously awaiting the papers coming out of New York. They’ve done a great job dedicating resources to tracking and attempting to reduce opioid overdose mortality. Please keep writing!

8) Does take-home naloxone reduce non-fatal overdose?

Bennett T, Holloway K, Bird SM.

Lancet. 2014 Jan 11;383(9912):124-5.

Comments: The title doesn’t really match the text, but this is a very nice brief analysis of non-fatal overdose events in Wales. 47% of opioid injectors had overdosed and 15% had overdosed in the preceding 12 months, with a median 2 overdose events during that period. Data such as these are invaluable in generating event-level estimates of opioid overdose occurrence and outcome.

9) Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000-2011.

Handley SA, Flanagan RJ.

Clin Toxicol (Phila). 2014 Jan 7. [Epub ahead of print]

Comments: Nice trend analysis of poisoning deaths in England and Wales demonstrating a fairly stable number of opioid related deaths over that period.

10) [Long-acting naltrexone--a new way out of opiate addiction?].

Stavseth LS, Kunøe N, Tanum L.

Tidsskr Nor Laegeforen. 2013 Nov 12;133(21):2231-2. Norwegian.

Comments: This appears to be a letter but that’s all I can tell!