PubMed Update September 2016

15 papers this month.

1) Drugs, Guns and Cars: How Far We Have Come to Improve Safety in the United States; Yet We Still Have Far to Go.

Dodington J, Violano P, Baum CR, Bechtel K.

Pediatr Res. 2016 Sep 27. doi: 10.1038/pr.2016.193. [Epub ahead of print] Review.

Comment: Review of safety efforts in public health.

2) Primary Care Patient Experience with Naloxone Prescription.

Behar E, Rowe C, Santos GM, Murphy S, Coffin PO.

Ann Fam Med. 2016 Sep;14(5):431-6. doi: 10.1370/afm.1972.

Comment: This is a partner paper to the study results reported a couple of months ago. Mixed methods interviews with 60 randomly selected patients on longterm opioid therapy for chronic pain who had been prescribed naloxone. The co-prescribing effort reached a population that was not really accessing naloxone through other community distribution sites in San Francisco. Some reported improved safety with opioids since receiving naloxone and none reported more high-risk use behaviors. About half of those who had overdosed denied “overdose” and described it as a bad reaction.

3) Opioid Overdose Experience, Risk Behaviors, and Knowledge in Drug Users from a Rural versus an Urban Setting.

Dunn KE, Barrett FS, Yepez-Laubach C, Meyer AC, Hruska BJ, Petrush K, Berman S, Sigmon SC, Fingerhood M, Bigelow GE.

J Subst Abuse Treat. 2016 Dec;71:1-7.

Comment: Can’t access the paper, but the abstract suggests higher rates of overdose among rural drug users versus urban, while there were fewer overdose risk behaviors among rural users (potentially raising concerns about our risk behaviors, which were retrospectively developed).

4) Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia.

Scott N, Carrotte ER, Higgs P, Cogger S, Stoové MA, Aitken CK, Dietze PM.

Drug Alcohol Depend. 2016 Sep 11;168:140-146. doi: 10.1016/j.drugalcdep.2016.08.638. [Epub ahead of print]

Comment: People who inject drugs have more psychological distress than the general population. Not surprised that intentional overdose (i.e. suicide attempt) is associated with psychological distress.

5) Notes from the Field: Furanyl-Fentanyl Overdose Events Caused by Smoking Contaminated Crack Cocaine - British Columbia, Canada, July 15-18, 2016.

Klar SA, Brodkin E, Gibson E, Padhi S, Predy C, Green C, Lee V.

MMWR Morb Mortal Wkly Rep. 2016 Sep 23;65(37):1015-1016. doi: 10.15585/mmwr.mm6537a6.

Comment: Fentanyl in crack. Ugh.

6) Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines [Internet].

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Sep 02.

Comment: Buprenorphine is safe, effective, and cost-effective compared to methadone.

7) Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain.

Dunn KE, Barrett FS, Fingerhood M, Bigelow GE.

Pain Med. 2016 Sep 20. pii: pnw228. [Epub ahead of print]

Comment: Not enough of these type of studies – addressing opioid overdose experience and knowledge among patients on opioids for chronic pain. 19% had a lifetime history of opioid overdose – similar to the study #2 above, although that study found that number to double when patients were asked about “bad reactions” that were characterized by not breathing or not being able to be woken up without help after using opioids.

8) Co-prescribing naloxone does not increase liability risk.

Davis CS, Burris S, Beletsky L, Binswanger I.

Subst Abus. 2016 Sep 20:0. [Epub ahead of print]

Comment: There is no particular liability in prescribing naloxone.

9) Trends in the Distribution of Opioids in Puerto Rico, 1999-2013.

El Burai Félix S, Mack KA, Jones CM.

P R Health Sci J. 2016 Sep;35(3):165-9.

Comment: Interesting that overdose deaths aren’t increasing as Rx opioid distribution is increasing. Hmm.

10) Standing Against Addiction.

Berlin J.

Tex Med. 2016 Sep 1;112(9):49-54.

Comment: Standing orders for naloxone in Texas.

11) Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients.

Fife A, Postier A, Flood A, Friedrichsdorf SJ.

J Opioid Manag. 2016 May-Jun;12(2):123-30. doi: 10.5055/jom.2016.0324.

Comment: When we convert people from one opioid to another we use conversion ratios. When converting to methadone, kids were very under-dosed.

12) Location of fatal prescription opioid-related deaths in 12 states, 2008-2010: Implications for prevention programs.

Easterling KW, Mack KA, Jones CM.

J Safety Res. 2016 Sep;58:105-9. doi: 10.1016/j.jsr.2016.07.004. Epub 2016 Aug 7.

Comment: Most overdose deaths occur at home, more so for prescription opioid deaths.

13) Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time series analysis.

McAuley A, Bouttell J, Barnsdale L, Mackay D, Lewsey J, Hunter C, Robinson M.

Addiction. 2016 Sep 10. doi: 10.1111/add.13602. [Epub ahead of print]

Comment: Naloxone distribution was not associated with a reduction in ambulances attending opioid overdoses. There could be other explanations for this, but the authors believe it suggests that people call for emergency medical assistance just as often when naloxone is available as when it is not.

14) Take-home naloxone treatment for opioid emergencies: a comparison of routes of administration and associated delivery systems.

Elzey MJ, Fudin J, Edwards ES.

Expert Opin Drug Deliv. 2016 Sep 16:1-14. [Epub ahead of print]

Comment: Hmm ... an unambiguous endorsement - that nothing but the auto-injector should be used - coming from the makers of the auto-injector.

15) Analysis of Novel Synthetic Opioids U-47700, U-50488 and Furanyl Fentanyl by LC-MS/MS in Postmortem Casework.

Mohr AL, Friscia M, Papsun D, Kacinko SL, Buzby D, Logan BK.

J Anal Toxicol. 2016 Sep 1. [Epub ahead of print]

Comment: Synthetic opioids. Harrumph.