Three
months. 32 articles. Enough said.
Darke S,
Marel C, Mills KL, Ross J, Slade T, Burns L, Teesson M.
Drug Alcohol Depend. 2014 Sep 16. [Epub ahead of print]
Comment: This study (the ATOS) and the team
of investigators have produced some of the most powerful and useful data in
substance use research. Once again they have delved into heroin overdose by
following treatment patients 11 years out. At least 10.2% of the cohort had
died by that time and an additional 9.4% were unaccounted for. Among the 70.1%
interviewed, 67.5% had overdosed, 24.4% had experienced five or more overdoses
(again suggesting that there are “overdosers” out there who are at very
elevated risk of the event). In the past year before the follow-up visit, 4.9%
had overdosed (11.8% of those who had used heroin in that period), 95.2% of
whom had overdosed previously. Those who overdosed were more likely to report
higher levels of non-heroin opiate use, as well as benzodiazepine, cocaine, and
methamphetamine use.
Simonson
W.
Geriatr
Nurs. 2014 Sep-Oct;35(5):381-2.
Comment: A review of the role of take-home
naloxone in the form of the new autoinjector.
Rudd RA,
Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J,
Eichler BA, Fernandes JC, Fondario A, Gabella B, Hume B, Huntamer T, Kariisa M,
Largo TW, Miles J, Newmyer A, Nitcheva D, Perez BE, Proescholdbell SK, Sabel
JC, Skiba J, Slavova S, Stone K, Tharp JM, Wendling T, Wright D, Zehner AM.
MMWR Morb
Mortal Wkly Rep. 2014 Oct 3;63(39):849-54.
Comment: This report demonstrates declining prescription opioid deaths (-6.6%),
but heroin deaths increased so much (+101.7%) that the data actually
demonstrate an overall increase in
opioid overdose mortality from 2010 to 2012 (+4.3%). There is disagreement as
to what is driving the increase in heroin use and overdose. Is it an inevitable
consequence of increased availability of opioids? Or is it the result of
growing restrictions on access to those opioids? Clearly there are elements of
both, leaving us with conflicting duties when it comes to managing those
already reliant upon prescription opioids. Western medical ethics is clear on
this point: our patient is the person we treat, who may have been harmed by the
very same prescribing behavior we are now trying to change and who may be further
harmed by those changes. If we truly believe that this epidemic is “iatrogenic”
(i.e. caused by medical care, akin to a surgeon leaving scissors in an
abdomen), then we have to be extremely cautious and thoughtful in fixing the
problem and we can never abandon the patient.
Lenton S,
Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C.
Drug Alcohol Rev. 2014 Oct 1. doi: 10.1111/dar.12198. [Epub ahead of print]
Comment: It's taken an incredibly long time for take-home naloxone to reach Australia, especially given how innovative that country has been with respect to managing drug policy and overdose.
Green TC,
Bratberg J, Dauria EF, Rich JD.
R I Med J
(2013). 2014 Oct 1;97(10):29-33.
Comment: The first of three articles in
this post from Rhode Island, US, which has been facing a surge in opioid
overdose deaths and has been responding with expanded naloxone treatment
availability. This and the next two articles are free at: http://rimed.org/rimedicaljournal-2014-10.asp.
