PubMed Update September 2015

Twelve this month. Enjoy!

1) Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics.

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.

2) Suicide Risk of Heroin Dependent Subjects in Lebanon.

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.

3) Trends and characteristics of accidental and intentional codeine overdose deaths in Australia.

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.

4) American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

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.

5) Methadone Pharmacogenetics: CYP2B6 Polymorphisms Determine Plasma Concentrations, Clearance, and Metabolism.

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.

6) Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study.

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.

7) Use of Naloxone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.

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.

8) Heroin overdose resuscitation with naloxone: patient uses own prescribed supply to save the life of a peer.

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.

9) Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000.

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.

10) Suicidal risk among patients enrolled in methadone maintenance treatment: HCV status and implications for suicide prevention (ANRS Methaville).

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.

11) Opioid poisonings in Washington State Medicaid: trends, dosing, and guidelines.

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.

12) Use of naloxone for clonidine intoxication in the pediatric age group: case report and review of the literature.

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.