Friday, October 9, 2015

PubMed Update September 2015

Twelve this month. Enjoy!

Ries R, Krupski A, West II, Maynard C, Bumgardner K, Donovan D, Dunn C, Roy-Byrne P.
J Addict Med. 2015 Oct;9(5):417-26. doi: 10.1097/ADM.0000000000000151.
Comment: Can’t access the full article, but the abstract suggests a fascinating look into opioid-using safety net primary care patients.

Kazour F, Soufia M, Rohayem J, Richa S.
Community Ment Health J. 2015 Sep 30. [Epub ahead of print]
Comment: Most studies of heroin users find that heroin is *not* the usual method of suicide attempts. Interestingly, this study finds something quite different, with nearly half of attempts being through heroin use in Lebanon.

Roxburgh A, Hall WD, Burns L, Pilgrim J, Saar E, Nielsen S, Degenhardt L.
Med J Aust. 2015 Oct 5;203(7):299.
Comment: Interesting paper exploring deaths related to one, low-potency, opioid. Those deaths seemed to be increasing, over a third were intentional (that’s much higher than other opioids), and a remarkably high proportion were polydrug – which makes sense since it would be tough to die from codeine alone.

Kampman K, Jarvis M.
J Addict Med. 2015 Oct;9(5):358-67. doi: 10.1097/ADM.0000000000000166.
Comment: Another that I can’t access but whose abstract looks compelling.

Kharasch ED, Regina KJ, Blood J, Friedel C.
Anesthesiology. 2015 Sep 19. [Epub ahead of print]
Comment: Ah, the complexities of methadone. Genetic differences in hepatic metabolism are more prominent in oral than intravenous methadone.

Kimber J, Larney S, Hickman M, Randall D, Degenhardt L.
Lancet Psychiatry. 2015 Sep 15. pii: S2215-0366(15)00366-1. doi: 10.1016/S2215-0366(15)00366-1. [Epub ahead of print]
Comment: There is likely a mortality benefit to buprenorphine in the initiation of treatment, but after that methadone and buprenorphine are comparable. I’ll admit that I’m a bit surprised by that – I would have expected an ongoing relative benefit to buprenorphine (there was a possible benefit to buprenorphine in all-cause mortality during the treatment time). Of note for treatment programs, even if the eventual treatment is methadone, it may be possible to avert the initiation mortality risk by starting with buprenorphine because the subsequent switch to methadone doesn’t come with the mortality risk.

Sumner SA, Mercado-Crespo MC, Spelke MB, Paulozzi L, Sugerman DE, Hillis SD, Stanley C.
Prehosp Emerg Care. 2015 Sep 18:1-6. [Epub ahead of print]
Comment: Really interesting analysis of medical examiner records. They looked at opioid overdose decedents who had undergone resuscitation efforts and then looked to see if they had received naloxone during those paramedic efforts. Naloxone was given in two-thirds of cases and was much more likely to be given to younger men with evidence of illicit drug use. Should paramedics be more willing to use naloxone in settings that don’t look like a “classic heroin overdose”? Or would that have negative effects? This is a really interesting topic for emergency medicine.

Winston I, McDonald R, Tas B, Strang J.
BMJ Case Rep. 2015 Sep 14;2015. pii: bcr2015210391. doi: 10.1136/bcr-2015-210391.
Comment: I can’t access this but the abstract purports that it is the “first-ever account” of a lay person titrating naloxone to respiratory function. Not to be snooty, but that’s really old news.

Fischer B, Murphy Y, Rudzinski K, MacPherson D.
Int J Drug Policy. 2015 Aug 14. pii: S0955-3959(15)00242-X. doi: 10.1016/j.drugpo.2015.08.007. [Epub ahead of print]
Comment: Canada’s conflicted drug policy.

Michel L, Lions C, Maradan G, Mora M, Marcellin F, Morel A, Spire B, Roux P, Carrieri PM; Methaville Study Group.
Compr Psychiatry. 2015 Oct;62:123-31. doi: 10.1016/j.comppsych.2015.07.004. Epub 2015 Jul 14.
Comment: Methadone patients with HCV are at *way* higher risk for suicide. Increasingly, studies suggest that there are real mental health costs to HCV and corresponding benefits to HCV treatment.

Fulton-Kehoe D, Sullivan MD, Turner JA, Garg RK, Bauer AM, Wickizer TM, Franklin GM.
Med Care. 2015 Aug;53(8):679-85. doi: 10.1097/MLR.0000000000000384.
Comment: The increasing risk of overdose with opioid dose is likely about linear and just knowing dose or dosing frequency/duration doesn’t tell you the whole picture. Unfortunately big data just doesn’t answer the deep questions about substance use.

Ahmad SA, Scolnik D, Snehal V, Glatstein M.
Am J Ther. 2015 Jan-Feb;22(1):e14-6. doi: 10.1097/MJT.0b013e318293b0e8. Review.
Comment: I can’t access the full article, but am not surprised that naloxone doesn’t reverse clonidine toxicity.

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