Pubmed April 2012 Update

Here we go with April 2012 ...

Mortality and causes of death among users of methadone maintenance treatment in Israel, 1999-2008.

Rosca P, Haklai Z, Goldberger N, Zohar P, Margolis A, Ponizovsky AM.

Drug Alcohol Depend. 2012 Apr 6. [Epub ahead of print]

Comment: Rate of overdose mortality was 0.22/100 person-years (i.e. 0.22%), one-quarter to one-fifth the expected rate in most studies of other cohorts

Intravenous use of illicit buprenorphine/naloxone to reverse an acute heroin overdose.

Yokell MA, Zaller ND, Green TC, McKenzie M, Rich JD.

J Opioid Manag. 2012 Jan-Feb;8(1):63-6.

Comment: Buprenorphine is a partial agonist with a ceiling effect that limits the capacity for overdose among those with a tolerance to opioids. Like naloxone, buprenorphine really likes binding to opioid receptors and kicks most other opioids out. Since buprenorphine out-competes other opioids for receptors and has a ceiling effect, administration in the setting of overdose may result in reversal of opioid overdose. That said, this wouldn't be the approach I would advocate for dissemination since (1) buprenorphine could cause overdose in an opioid user with minimal tolerance and (2) buprenorphine could cause prolonged withdrawal (for over a day) in those with a very high tolerance.

Understanding drug-related mortality in released prisoners: A review of national coronial records.

Andrews JY, Kinner SA.

BMC Public Health. 2012 Apr 4;12(1):270. [Epub ahead of print]

Comment: An interesting exploration of circumstances surrounding prisoner death post-release.

Effects of concurrent intravenous morphine sulfate and naltrexone hydrochloride on end-tidal carbon dioxide.

Goli V, Webster LR, Lamson MJ, Cleveland JM, Sommerville KW, Carter E.

Harm Reduct J. 2012 Mar 15;9(1):13. [Epub ahead of print]

Comment: An intriguing analysis of whether or not injecting the pre-formulated morphine + naltrexone actually blocks the effects of morphine. It appears to partially, but not completely, block the effect.

Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users.

Kinner SA, Milloy MJ, Wood E, Qi J, Zhang R, Kerr T.

Addict Behav. 2012 Feb 7. [Epub ahead of print]

Comment: Prior overdose, daily or binge drug use, and public injecting are associated with nonfatal overdose among recently released drug users.

Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse.

Upadhyay SP, Mallick PN, Elmatite WM, Jagia M, Taqi S.

Indian J Palliat Care. 2011 Sep;17(3):251-4.

Comment: An interesting use of a particular sedative to assist with opioid withdrawal in an intensive care unit.

Drug-related deaths with evidence of intracorporeal drug concealment at autopsy: five case reports.

Wilcher G.

Am J Forensic Med Pathol. 2011 Dec;32(4):314-8.

Comment: Intriguing review of 5 cases of drug-induced death among "body packers" or "body stuffers", including a review of that language. Interestingly, most of the deaths were due to overdose on consumed drugs rather than toxicity from rupture of drug packets.

Program report: Training family members and loved ones to respond with naloxone

By Stephen Malloy

As you’ve read on this blog, programs that train drug users to respond to opiate overdose with naloxone are expanding across the globe. An important intervention that’s often overlooked, however, is training family members and “carers” - friends, housemates, and loved ones - of drug users to use naloxone. A program in the UK is doing just that, as Stephen Malloy reports:

In July 2009 the National Treatment Agency (NTA) supported a 16 site pilot project, entitled “overdose prevention and naloxone training for families and carers.” The pilot sites, which were spread across England, recruited and trained family members/carers of people at risk of opiate-related overdose death in overdose prevention; signs and symptoms of overdose; and naloxone administration and basic life support techniques. The family member/carer was also supplied with naloxone IF the person at risk of overdose was available to give written or oral consent for the supply to be made.

A new report shows that 495 family members/carers were trained, and at the time of its writing 20 lives had been saved thanks to naloxone use (18) and basic life support (2). These results demonstrate the need a wider circle of family/carers to be engaged around overdose prevention and crucially, be supplied with naloxone.