PubMed Update April 2016

23 for this month! Lots of interesting stuff, from large-scale epidemiology to randomized controlled trials.

1) Pharmacokinetic Properties and Human Use Characteristics of an FDA Approved IntranasalNaloxone Product for the Treatment of Opioid Overdose.

Krieter P, Chiang N, Gyaw S, Skolnick P, Crystal R, Keegan F, Aker J, Beck M, Harris J.

J Clin Pharmacol. 2016 May 5. doi: 10.1002/jcph.759. [Epub ahead of print]

Comment: Details on the pharmacokinetics and usability studies for the new nasal device.

2) The use of public health infrastructure probably the best strategy for national and large-scalenaloxone distribution programmes.

Madah-Amiri D, Clausen T.

Addiction. 2016 May 3. doi: 10.1111/add.13400. [Epub ahead of print] No abstract available.

Comment: Large-scale naloxone requires public health support.

3) The Opioid Epidemic in the United States.

Wilkerson RG, Kim HK, Windsor TA, Mareiniss DP.

Emerg Med Clin North Am. 2016 May;34(2):e1-e23. doi: 10.1016/j.emc.2015.11.002. Epub 2016 Feb 17. Review.

Comment: Focuses on risk factors for problematic opioid use and naloxone.

4) Design of a randomized controlled trial of extended-release naltrexone versus daily buprenorphine-naloxone for opioid dependence in Norway (NTX-SBX).

Kunøe N, Opheim A, Solli KK, Gaulen Z, Sharma-Haase K, Latif ZE, Tanum L.

BMC Pharmacol Toxicol. 2016 Apr 28;17(1):18. doi: 10.1186/s40360-016-0061-1.

Comment: Methods paper for above planned study.

5) Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

Arelin V, Schmidt JJ, Kayser N, Kühn-Velten WN, Suhling H, Eden G, Kielstein JT.

Clin Nephrol. 2016 Apr 27. [Epub ahead of print]

Comment: Doesn’t really remove methadone, so not useful in an overdose but also not problematic for patients on methadone undergoing light-chain removal.

6) Utilizing a train-the-trainer model for multi-site naloxone distribution programs.

Madah-Amiri D, Clausen T, Lobmaier P.

Drug Alcohol Depend. 2016 Apr 14. pii: S0376-8716(16)30034-5. doi: 10.1016/j.drugalcdep.2016.04.007. [Epub ahead of print]

Comment: Title is self-explanatory.

7) Opioid-related Policies in New England Emergency Departments.

Weiner SG, Raja AS, Bittner JC, Curtis KM, Weimersheimer P, Hasegawa K, Espinola JA, Camargo CA Jr.

Acad Emerg Med. 2016 Apr 21. doi: 10.1111/acem.12992. [Epub ahead of print]

Comment: Intriguing look at ED policies in New England. 18% had an opioid screening tool, 78% used the PDMP, 41% alerted the primary doctor when prescribing opioids, 70% gave substance use treatment referrals, and 12% offered take-home naloxone.

8) Opioid Overdose Prevention in a Residential Care Setting: Naloxone Education and Distribution.

Pade P, Fehling P, Collins S, Martin L.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: Naloxone in a residential treatment program. Hopefully the first bit of data with much more to come.

9) Co-prescription of Naloxone as a Universal Precautions Model for Patients on Chronic Opioid Therapy - Observational Study.

Takeda MY, Katzman JG, Dole E, Bennett MH, Alchbli A, Duhigg D, Yonas H.

Subst Abus. 2016 Apr 19:0. [Epub ahead of print]

Comment: New Mexico study of 164 chronic pain patients on opioids who were provided naloxone. There were no overdoses.

10) Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status.

Friedman MS, Manini AF.

J Med Toxicol. 2016 Apr 15. [Epub ahead of print]

Comment: Fascinating abstract – I don’t have full access. They set up “naloxone criteria” of (1) respiratory rate <12, miotic pupils, or drug paraphernalia, and (2) altered mental status by AVPU or GCS and then looked to see if those criteria predicted a beneficial effect of naloxone. They did – with an OR of 7 and 83% sensitivity. Miotic pupils were the best predictor of a response to naloxone. Authors also found that naloxone was underutilized – in only 44.2% of cases where it may have been beneficial. This is a fascinating area, as we don’t yet understand the reasons why naloxone is or is not administered in emergency services.

11) The toxicology of heroin-related death: estimating survival times.

Darke S, Duflou J.

Addiction. 2016 Apr 15. doi: 10.1111/add.13429. [Epub ahead of print]

Comment: 6-MAM, the best way to confirm heroin as a cause of overdose death, is only present if the death occurs in under 30 minutes. In this study, 6-MAM was present in 43% of heroin overdose cases, suggesting that most people took longer to expire.

12) Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.

Lewis DA, Park JN, Vail L, Sine M, Welsh C, Sherman SG.

Am J Public Health. 2016 Apr 14:e1-e4. [Epub ahead of print]

Comment: Distribution program increased self-efficacy.

13) Findings and lessons learnt from implementing Australia's first health service based take-home naloxone program.

Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze P, Lenton S, Kearley J, van Beek I.

Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12400. [Epub ahead of print]

Comment: First data on an Australian naloxone program. 83 people given naloxone. Among the 42% completing follow-up, 30 overdoses were successfully reversed and participants still felt informed and able to use naloxone.

14) OVERDOSED ON OPIOIDS: A deadly opioid epidemic sweeping the country has lawmakers working hard to find solutions.

Hoback J.

State Legis. 2016 Apr;42(4):9-13. No abstract available.

Comment: On a quick glance, seems a bit inflammatory.

15) Safety concerns with long-term opioid use.

Harned M, Sloan P.

Expert Opin Drug Saf. 2016 Apr 26:1-8. [Epub ahead of print]

Comment: Prospective trials are needed to evaluate longterm opioid therapy for chronic pain.

16) Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

Lee JD, Friedmann PD, Kinlock TW, Nunes EV, Boney TY, Hoskinson RA Jr, Wilson D, McDonald R, Rotrosen J, Gourevitch MN, Gordon M, Fishman M, Chen DT, Bonnie RJ, Cornish JW, Murphy SM, O'Brien CP.

N Engl J Med. 2016 Mar 31;374(13):1232-42. doi: 10.1056/NEJMoa1505409.

Comment: Pretty good data on extended-release naltrexone and low overdose risk. Unfortunately, overdose wasn’t specifically asked about, but instead was treated as any other adverse events in a clinical trial and had to be reported by the participants.

17) Overdose Deaths in West Virginia.

Yablonsky TA, Thompson GL.

W V Med J. 2016 Mar-Apr;112(2):16-7. No abstract available.

Comment: Can’t access, but there are a lot.

18) [Accidental ingestion of methadone by children and suggestions for better prevention].

Hein H, Püschel K, Schaper A, Iwersen-Bergmann S.

Arch Kriminol. 2016 Jan-Feb;237(1-2):38-46. German.

Comment: Lockboxes.

19) FASTER RESPONSE. Hospitals backing increased use of opioid antidote.

Asplund J.

Hosp Health Netw. 2016 Jan;90(1):20, 22, 2.

Comment: This is apparently about police and naloxone.

20) Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014.

Rudd RA, Aleshire N, Zibbell JE, Gladden RM.

MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1378-82. doi: 10.15585/mmwr.mm6450a3.

Comment: Really well done. Discusses opioids in a sophisticated and honest manner. Impressive work from the CDC.

21) Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.

Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF.

Ann Intern Med. 2016 Jan 5;164(1):1-9. doi: 10.7326/M15-0038. Epub 2015 Dec 29.

Comment: Patients who have an overdose usually continue to receive opioids. If opioids stop, they have a lower risk of recurrent overdose.

22) Prescription opioid related deaths in New York City: a 2 year retrospective analysis prior to the introduction of the New York State I-STOP law.

Sgarlato A, deRoux SJ.

Forensic Sci Med Pathol. 2015 Sep;11(3):388-94. doi: 10.1007/s12024-015-9699-z. Epub 2015 Aug 2.

Comment: 36.7% of decedents had a valid opioid prescription; benzos were involved in 68.4% of cases with alprazolam the most common (35.1%).

23) Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohort.

Darke S, Slade T, Ross J, Marel C, Mills KL, Tessson M.

Addict Behav. 2015 Nov;50:78-83. doi: 10.1016/j.addbeh.2015.06.030. Epub 2015 Jun 14.

Comment: Heavy drinking was associated with overdose (OR 1.6).