PubMed Update July 2014

Hooray for a mere 7 paper reprieve this month.

1) Underrepresentation of Heroin Involvement in Unintentional Drug Overdose Deaths in Allegheny County, PA.

Mertz KJ, Janssen JK, Williams KE.

J Forensic Sci. 2014 Jul 16. doi: 10.1111/1556-4029.12541. [Epub ahead of print]

Comments: This manuscript presents critical and very concerning results regarding interpretation of our prescription opioid overdose epidemic. Morphine and codeine are commonly present and without 6-MAM (a third heroin metabolite) present at sufficient levels those deaths are coded as morphine and codeine. On this review of 112 such deaths, 66% met criteria for heroin involvement based on a history of heroin use (which may not be sufficient given the frequent use of other opioids among heroin users), drug paraphernalia or stamp bags, track marks, and detection of 6-MAM (generally at very low levels). Good toxicologists always check for 6-MAM so that shouldn’t be a major issue, but it is conceivable that some of these morphine/codeine cases are in fact heroin – an important caveat as we respond to the epidemic.

2) Legislative strategies other than legalizing illicit opioids may help to reduce overdose fatalities.

Trafton JA, Oliva EM.

Addiction. 2014 Aug;109(8):1243-4. doi: 10.1111/add.12585. No abstract available.

Comments: Authors argue that Good Samaritan and naloxone legislation may be effective strategies to reduce overdose.

3) Prevalence and factors associated with HIV infection among injection drug users at methadone clinics in Taipei, Taiwan.

Yen YF, Yen MY, Lin T, Li LH, Jiang XR, Chou P, Deng CY.

BMC Public Health. 2014 Jul 4;14(1):682. doi: 10.1186/1471-2458-14-682.

Comments: Again, HIV infection is associated with a history of overdose among persons who inject drugs.

4) Methadone toxicity in a poisoning referral center.

Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi-Mood N, Gheshlaghi F, Farajzadegan Z.

J Res Pharm Pract. 2013 Jul;2(3):130-4. doi: 10.4103/2279-042X.122387.

Comments: an analysis of methadone poisonings in Iran. Among 385 patients, 57.7% of cases were “intentional” and demonstrated high rates of psychiatric disorders (25.8%). Among the full cohort, 40% had opioid use disorders and 25.5% were in a methadone program.

5) Are empty methadone bottles empty? An analytic study.

Dupuy G, Cavalcanti L, Bourgogne E, Brichant-Petitjean C, Gomberoff L, Bloch V, Bellivier F, Lépine JP, Laprévote O, Vorspan F.

Harm Reduct J. 2014 Jul 2;11(1):20. doi: 10.1186/1477-7517-11-20.

Comments: There is residual methadone in take-home containers. Proper disposal or a consideration of alternative deliveries is important to minimize the risk of accidental exposures.

6) Not so fast on naloxone? There's growing support for non-paramedic use, but keep these cautions in mind.

Goodloe JM.

EMS World. 2014 May;43(5):51-2. No abstract available.

Comments: I’m unable to access this.

7) America embraces treatment for opioid drug overdose.

Alcorn T.

Lancet. 2014 Jun 7;383(9933):1957-8. No abstract available.

Comments: A summary of what’s going on in the United States regarding naloxone.