PubMed Updates HAVE MOVED!!!

Hi everyone! 

Prescribe To Prevent and the Overdose Prevention Alliance have joined forces and you can now find PubMed Updates on overdose-related scientific literature here on P2P.

The URL is: http://prescribetoprevent.org/research-legal/research/

There is a signup link for emails in case you're not getting them anymore.

Happy learning!

PubMed Update December 2016 / January 2017

49 in two months. Enjoy!

1) Multiple Fentanyl Overdoses - New Haven, Connecticut, June 23, 2016.

Tomassoni AJ, Hawk KF, Jubanyik K, Nogee DP, Durant T, Lynch KL, Patel R, Dinh D, Ulrich A, D'Onofrio G.

MMWR Morb Mortal Wkly Rep. 2017 Feb 3;66(4):107-111. doi: 10.15585/mm6604a4.

Comments: Nice description of an outbreak of and public health response to insufflated fentanyl causing severe overdose.

2) Patient Simulation for Assessment of Layperson Management of Opioid Overdose With Intranasal Naloxone in a Recently Released Prisoner Cohort.

Kobayashi L, Green TC, Bowman SE, Ray MC, McKenzie MS, Rich JD.

Simul Healthc. 2017 Feb;12(1):22-27. doi: 10.1097/SIH.0000000000000182.

Comments: Interesting and rigorous way to evaluate overdose knowledge after naloxone provision.

3) Pharmacokinetics of a new, nasal formulation of naloxone.

Tylleskar I, Skulberg AK, Nilsen T, Skarra S, Jansook P, Dale O.

Eur J Clin Pharmacol. 2017 Jan 31. doi: 10.1007/s00228-016-2191-1. [Epub ahead of print]

Comments: Data from another nasal naloxone in development.

4) In response to: Do heroin overdose patients require observation after receiving naloxone?

Eggleston W, Clemency BM.

Clin Toxicol (Phila). 2017 Jan 31:1-3. doi: 10.1080/15563650.2017.1284336. [Epub ahead of print] No abstract available.

Comments: Authors note that data on the safety of discharging patients after an hour of observation may not apply in the current era of synthetic opioids.

5) Pharmacists' role in opioid overdose: Kentucky pharmacists' willingness to participate in naloxone dispensing.

Freeman PR, Goodin A, Troske S, Strahl A, Fallin A, Green TC.

J Am Pharm Assoc (2003). 2017 Jan 28. pii: S1544-3191(16)31004-4. doi: 10.1016/j.japh.2016.12.064. [Epub ahead of print]

Comments: Mixed opinions.

6) 'Naloxone works': The politics of knowledge in 'evidence-based' drug policy.

Lancaster K, Treloar C, Ritter A.

Health (London). 2017 Jan 1:1363459316688520. doi: 10.1177/1363459316688520. [Epub ahead of print]

Comments: Interesting article on whose knowledge matters.

PubMed Update October/November 2016

43 papers this round, and there are some goodies in here for sure (don't miss #38!). Given the number and varied issues addressed, I divided them up into topic areas and, given the number on naloxone, I divided up the naloxone topic areas as well.

Naloxone interventions

Primary care

1) 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 19:1-6. [Epub ahead of print]

Comment: A pilot of naloxone co-prescribing.

2) Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain.

Mueller SR, Koester S, Glanz JM, Gardner EM, Binswanger IA.

J Gen Intern Med. 2016 Oct 31. [Epub ahead of print]

Comment: Shows that naloxone for patients prescribed opioids must be appropriately framed.

3) Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain.

Behar E, Rowe C, Santos GM, Coffa D, Turner C, Santos NC, Coffin PO.

J Gen Intern Med. 2016 Nov 4. [Epub ahead of print]

Comment: When actually implemented, providers really like adding naloxone to opioid-related care. One of five papers out of the Naloxone for Opioid Safety Evaluation of a naloxone co-prescribing study in San Francisco.

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.

PubMed Update August 2016

A robust 20 papers this month. There are some excellent manuscripts this month, including several on fentanyl. I want to draw particular attention to a few papers that will be important reads for some of you: #1 addresses concurrent use of methamphetamine with heroin, #12 explores different “types” of opioid overdose, #17 reviews the foundational papers upon which much overdose research/knowledge today is based, and #19 compares deaths due to heroin to those due to prescription opioids.

1) Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS.

J Stud Alcohol Drugs. 2016 Sep;77(5):774-81.

Comments: Really interesting results with regard to methamphetamine – co-use of methamphetamine increased overdose risk in San Diego but not Tijuana, suggesting that risk may have been behavioral rather than pharmacologic.

2) Combating Opioid Overdose With Public Access to Naloxone.

Mitchell KD, Higgins LJ.

J Addict Nurs. 2016 Jul-Sep;27(3):160-79. doi: 10.1097/JAN.0000000000000132.

Comments: Review of naloxone literature with an eye toward how it influences nursing.

3) Prescription opioids prior to injection drug use: Comparisons and public health implications.

Al-Tayyib AA, Koester S, Riggs P.

Addict Behav. 2016 Aug 19. pii: S0306-4603(16)30296-9. doi: 10.1016/j.addbeh.2016.08.016. [Epub ahead of print]

Comments: Those who initiated injection with prescription opioids were higher risk than those who started with heroin in the Denver Colorado’s NHBS cohort.

4) Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention.

Kirane H, Ketteringham M, Bereket S, Dima R, Basta A, Mendoza S, Hansen H.

J Subst Abuse Treat. 2016 Oct;69:44-9. doi: 10.1016/j.jsat.2016.07.005. Epub 2016 Jul 18.

Comments: Investigators asked patients and providers how they thought things *would* change if they gave/received naloxone kits and found quite a few thought use would increase. In contrast, looking at what “did” happen suggests the opposite (see next month’s PubMed Update).

PubMed Update July 2016

11 papers this month, including an announcement that naloxone is now over-the-counter in Australia.

1) Factors associated with knowledge of a Good Samaritan Law among young adults who use prescription opioids non-medically.

Evans TI, Hadland SE, Clark MA, Green TC, Marshall BD.

Harm Reduct J. 2016 Jul 26;13(1):24. doi: 10.1186/s12954-016-0113-2.

Comments: Less than half knew about it.

2) Reasons for Benzodiazepine Use Among Persons Seeking Opioid Detoxification.

Stein MD, Kanabar M, Anderson BJ, Lembke A, Bailey GL.

J Subst Abuse Treat. 2016 Sep;68:57-61. doi: 10.1016/j.jsat.2016.06.008. Epub 2016 Jun 16.

Comments: Important work, as there’s an effort to also reduce benzodiazepine prescribing among people who are on opioids. Understanding the drivers of BDZ use should be helpful in structuring interventions. Anxiety and managing opioid withdrawal were two main reasons.

3) Trends in Methadone Distribution for Pain Treatment, Methadone Diversion, and Overdose Deaths - United States, 2002-2014.

Jones CM, Baldwin GT, Manocchio T, White JO, Mack KA.

MMWR Morb Mortal Wkly Rep. 2016 Jul 8;65(26):667-71. doi: 10.15585/mmwr.mm6526a2.

Comments: Interesting analysis of methadone prescribing, overdose, and diversion. It seems that efforts to reduce methadone, beginning in 2006, corresponded with reduced diversion and overdose; unfortunate that opioid overdose death overall continued to escalate.

4) Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine.

Makarenko I, Mazhnaya A, Polonsky M, Marcus R, Bojko MJ, Filippovych S, Springer S, Dvoriak S, Altice FL.

Drug Alcohol Depend. 2016 Aug 1;165:213-20. doi: 10.1016/j.drugalcdep.2016.06.011. Epub 2016 Jun 17.

Comments: Barriers to enrolling in agonist treatment in Ukraine.

PubMed Update June 2016

Summer holiday. A mere 10 articles this month!

1) Community pharmacist knowledge, attitudes and confidence regarding naloxone for overdosereversal.

Nielsen S, Menon N, Larney S, Farrell M, Degenhardt L.

Addiction. 2016 Jul 1. doi: 10.1111/add.13517. [Epub ahead of print]

Comment: Most pharmacists in Australia would provide naloxone, but a minority feel comfortable selecting patients and educating about naloxone use and overdose.

2) Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain.

Coffin PO, Behar E, Rowe C, Santos GM, Coffa D, Bald M, Vittinghoff E.

Ann Intern Med. 2016 Jun 28. doi: 10.7326/M15-2771. [Epub ahead of print]

Comment: Naloxone can be successfully prescribed to primary care patients on longterm opioids for chronic pain, and receipt of naloxone is associated with a remarkable reduction in opioid-related emergency department visits.

3) Opioid Use Disorders.

Sharma B, Bruner A, Barnett G, Fishman M.

Child Adolesc Psychiatr Clin N Am. 2016 Jul;25(3):473-87. doi: 10.1016/j.chc.2016.03.002. Epub 2016 Apr 9. Review.

Comment: Review of opioid use disorder and treatments.

4) Predictors of seeking emergency medical help during overdose events in a provincial naloxone distribution programme: a retrospective analysis.

Ambrose G, Amlani A, Buxton JA.

BMJ Open. 2016 Jun 21;6(6):e011224. doi: 10.1136/bmjopen-2016-011224.

Comment: Respondents administering naloxone to overdoses on the street were more likely to call for medical assistance than those doing so in a private residence. This makes a lot of sense. Imaging if giving a breathing treatment for asthma in a home versus on the street – the latter setting is more likely to result in seeking assistance.

PubMed Update May 2016

19 this month. Enjoy!

1) Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme.

Tjagvad C, Skurtveit S, Linnet K, Andersen LV, Christoffersen DJ, Clausen T.

Eur Addict Res. 2016 Jun 1;22(5):249-258. [Epub ahead of print]

Comments: Patients on very high doses of methadone or also using benzodiazepines were at higher risk of death.

2) Heroin use.

Salani DA, Zdanowicz M, Joseph L.

J Psychosoc Nurs Ment Health Serv. 2016 Jun 1;54(6):30-7. doi: 10.3928/02793695-20160518-05.

Comments: Epidemiologic review.

3) Academic physicians' and medical students' perceived barriers toward bystander administered naloxone as an overdose prevention strategy.

Gatewood AK, Van Wert MJ, Andrada AP, Surkan PJ.

Addict Behav. 2016 May 17;61:40-46. doi: 10.1016/j.addbeh.2016.05.013. [Epub ahead of print]

Comments: Qualitative interviews with medical providers.

4) Patient Characteristics and Outcomes in Unintentional, Non-fatal Prescription Opioid Overdoses: A Systematic Review.

Elzey MJ, Barden SM, Edwards ES.

Pain Physician. 2016 May;19(4):215-28.

Comments: Non-fatal events are far more common, not well-predicted by risk factors, and in need of additional research.

5) Incorporation of poison center services in a state-wide overdose education and naloxone distribution program.

Doyon S, Benton C, Anderson BA, Baier M, Haas E, Hadley L, Maehr J, Rebbert-Franklin K, Olsen Y, Welsh C.

Am J Addict. 2016 Jun;25(4):301-6. doi: 10.1111/ajad.12384. Epub 2016 May 24.

Comments: Interesting case series of naloxone reversals reported to poison control. They report a 75.6% “response rate” although some of the remainder was “unknown” and was there were only 2 deaths among 78 cases, suggesting a rate closer to 97.5%. Response rate to heroin was higher than for prescription opioids. Of the 43 suspected heroin events, 31 went to the ED, 25 were discharged, and 5 required ICU care. Of 31 suspected prescription opioid 20 went to the ED, 9 were discharged, and 6 required ICU care. This is consistent with the more complicated nature of prescription opioid overdose.

6) Police Officers Can Safely and Effectively Administer Intranasal Naloxone.

Fisher R, O'Donnell D, Ray B, Rusyniak D.

Prehosp Emerg Care. 2016 May 24:1-6. [Epub ahead of print]

Comments: About a 65% response rate among 117 administrations and 1 combative individual.

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.

PubMed Update March 2016

23 this month.

1) Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria.

McDonald R, Strang J.

Addiction. 2016 Mar 30. doi: 10.1111/add.13326. [Epub ahead of print] Review.

Comments: Take-home naloxone meets all Bradford Hill criteria for causality in reducing opioid overdose mortality. Incidence of fatality among overdoses in the setting of take-home naloxone was 0.8%.

2) Managing Opioid Abuse in Older Adults: Clinical Considerations and Challenges.

Loreck D, Brandt NJ, DiPaula B.

J Gerontol Nurs. 2016 Apr 1;42(4):10-5. doi: 10.3928/00989134-20160314-04.

Comments: A review of the U.S. situation and treatments for opioid use disorder.

3) Years of potential life lost amongst heroin users in the Australian Treatment Outcome Study cohort, 2001-2015.

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

Drug Alcohol Depend. 2016 May 1;162:206-10. doi: 10.1016/j.drugalcdep.2016.03.010. Epub 2016 Mar 18.

Comments: Heroin use is associated with 25-50 years of life lost. Over half of deaths and nearly two-thirds of years of life lost were due to opioid overdose.

4) Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.

Olsson MO, Bradvik L, Öjehagen A, Hakansson A.

Drug Alcohol Depend. 2016 May 1;162:176-81. doi: 10.1016/j.drugalcdep.2016.03.009. Epub 2016 Mar 17.

Comments: Accidental overdose death and suicide are distinct entities, with distinct predictive variables. This is important.

5) An Initial evaluation of law enforcement overdose training in Rhode Island.

Saucier CD, Zaller N, Macmadu A, Green TC.

Drug Alcohol Depend. 2016 May 1;162:211-8. doi: 10.1016/j.drugalcdep.2016.03.011. Epub 2016 Mar 19.

Comments: Harm reduction programs training law enforcement, a critical step forward.

PubMed Update February 2016

Ten articles for February 2016.

1) As opioid overdose deaths reach record highs, call for systematic changes grows louder.

[No authors listed]

ED Manag. 2016 Feb;28(2):13-9.

Comments: Review of the new CDC opioid prescribing guidelines.

2) Australia reschedules naloxone for opioid overdose.

Lenton SR, Dietze PM, Jauncey M.

Med J Aust. 2016 Mar 7;204(4):146-7. No abstract available.

Comments: Naloxone can now be over the counter in Australia, but there’s some work to be done in product design.

3) Science Over Stigma: Saving Lives-Implementation of Naloxone Use in the School Setting.

King R.

NASN Sch Nurse. 2016 Mar;31(2):96-101. doi: 10.1177/1942602X16628890.

Comments: Naloxone for school nurses in Delaware.

4) Electrocardiogram Abnormality Associated with Methadone Overdose.

Agahi M, Shakoori V, Marashi SM.

Sultan Qaboos Univ Med J. 2016 Feb;16(1):e113-4. doi: 10.18295/squmj.2016.16.01.022. Epub 2016 Feb 2. No abstract available.

Comments: Long QT interval is a side effect of high methadone doses.

PubMed Update November 2015 - January 2016

We have 35 articles for your viewing this time, with apologies for the delay in getting this out. Thanks to Traci Green for offering to help out and for reviewing this post.

1) Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic.

Becker WC, Merlin JS, Manhapra A, Edens EL.

Addict Sci Clin Pract. 2016 Jan 28;11(1):3. doi: 10.1186/s13722-016-0050-0.

Comment: Fascinating article. Worth a read if you’re interested in management of pain and opioids.

2) Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City.

Harocopos A, Allen B, Paone D.

Int J Drug Policy. 2015 Dec 29. pii: S0955-3959(15)00374-6. doi: 10.1016/j.drugpo.2015.12.021. [Epub ahead of print]

Comment: Great to see some of the path from prescription opioids to heroin. Makes sense that first step is moving from a drug co-formulated with acetaminophen.

3) Emergency Department-Based Opioid Harm Reduction: moving physicians from willing to doing.

Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg A, Bernstein E.

Acad Emerg Med. 2016 Jan 27. doi: 10.1111/acem.12910. [Epub ahead of print]

Comment: To get EDs to enhance practices will require pressure from the top.

4) Internal Medicine Resident Knowledge, Attitudes and Barriers to Naloxone Prescription in Hospital and Clinic Settings.

Wilson JD, Spicyn N, Matson P, Alvanzo A, Feldman L.

Subst Abus. 2016 Jan 28:0. [Epub ahead of print]

Comment: Nice article from Baltimore finding that young physicians are ready and willing to prescribe naloxone, but aren’t routinely doing so yet.

PubMed Update October 2015

28 in a month.

1) Clinical Presentation and the Outcome of Therapy in a Cohort of Patients with Methadone Toxicity in Iran.

Eizadi-Mood N, Yaraghi A, Sharifian Z, Feizi A, Hedaiaty M, Sabzghabaee AM.

Mater Sociomed. 2015 Aug;27(4):276-9. doi: 10.5455/msm.2015.27.276-279.

Comments: Some interesting data on methadone toxicity in Iran. Length of stay was 33 hours (median). 90.3% survived. There were several complications. GCS on admission predicted survival. Useful data for economic modeling …

2) Overdose prevention for prisoners in New York: a novel program and collaboration.

Zucker H, Annucci AJ, Stancliff S, Catania H.

Harm Reduct J. 2015 Nov 5;12(1):51. doi: 10.1186/s12954-015-0084-8.

PMID: 26541987 Free Article

Comments: Early report describing the establishment of a prison naloxone program in NY. Some of the most important work happening in this area…

3) Response to "Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review".

Winstanley EL, Clark A, Wilder CM.

J Addict Med. 2015 Dec;9(6):503-4. doi: 10.1097/ADM.0000000000000160. No abstract available.

Comments: Can’t access. Meh.

4) Quality Assessment Errors and Study Misclassification Threaten Systematic Review Validity: Community Opioid Overdose Prevention and Naloxone Distribution Programs Review: Re: Clark AK, Wilder CM, Winstanley EL. A systematic review of community opioid overdose prevention and naloxone distribution programs. J Addict Med 2014 May-June;8(3): 153-163.

Orkin AM, Bingham K, Buick JE, Klaiman M, Leece P, Kouyoumdjian F.

J Addict Med. 2015 Dec;9(6):502-3. doi: 10.1097/ADM.0000000000000161. No abstract available.

Comments: Also can’t access.

5) Implementation of an inpatient opioid overdose prevention program.

Clark A, Winstanley EL, Martsolf DS, Rosen M.

Addict Behav. 2015 Oct 8;53:141-145. doi: 10.1016/j.addbeh.2015.10.006. [Epub ahead of print] No abstract available.

Comments: Authors report on development of an electronic book on overdose prevention for use in addiction treatment settings.

6) Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods.

Ashrafioun L, Gamble S, Herrmann M, Baciewicz G.

Subst Abus. 2015 Oct 29:0. [Epub ahead of print]

Comments: Those trained in intranasal naloxone were more confident than those trained in injectable. That is odd, as studies suggest that injectable is easier than intranasal.

7) Methadone related deaths compared to all prescription related deaths.

Lev R, Petro S, Lee A, Lee O, Lucas J, Castillo EM, Egnatios J, Vilke GM.

Forensic Sci Int. 2015 Oct 22;257:347-352. doi: 10.1016/j.forsciint.2015.09.021. [Epub ahead of print]

Comments: The lack of data from methadone maintenance programs makes it quite challenging to interpret some of the methadone-related mortality data.

8) Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users.

McAuley A, Aucott L, Matheson C.

Int J Drug Policy. 2015 Oct 1. pii: S0955-3959(15)00306-0. doi: 10.1016/j.drugpo.2015.09.011. [Epub ahead of print]

Comments: 9% of kits were likely to be used for overdose rescue. That looks like a rather low number, but it’s over a 3-month period. I suspect the annual rate is closer to 20% +/- 5%.

9) Legal changes to increase access to naloxone for opioid overdose reversal in the United States.

Davis CS, Carr D.

Drug Alcohol Depend. 2015 Oct 22. pii: S0376-8716(15)01695-6. doi: 10.1016/j.drugalcdep.2015.10.013. [Epub ahead of print]

Comments: Great paper, title says it all.

10) Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin.

Jolley CJ, Bell J, Rafferty GF, Moxham J, Strang J.

PLoS One. 2015 Oct 23;10(10):e0140995. doi: 10.1371/journal.pone.0140995. eCollection 2015.

Comments: I like this study. The physiology of “overdose” is totally fascinating and nowhere near as simple as it seems.

11) Hair testing in postmortem diagnosis of substance abuse: An unusual case of slow-release oral morphine abuse in an adolescent.

Baillif-Couniou V, Kintz P, Sastre C, Pok PP, Chèze M, Pépin G, Leonetti G, Pelissier-Alicot AL.

J Forensic Leg Med. 2015 Sep 4;36:172-176. doi: 10.1016/j.jflm.2015.08.014. [Epub ahead of print]

Comments: Morphine overdose in an adolescent in France. It’s news there because they don’t see people dying of prescription opioids like in the U.S.

12) Effects of acute and repeated administration of oxycodone and naloxone-precipitated withdrawal on Intracranial Self-Stimulation (ICSS) in rats.

Wiebelhaus JM, Walentiny DM, Beardsley PM.

J Pharmacol Exp Ther. 2015 Oct 21. pii: jpet.115.228940. [Epub ahead of print]

Comments: Oxycodone works like other opioids.

13) Risk factors associated with benzodiazepine use among people who inject drugs in an urban Canadian setting.

Tucker D, Hayashi K, Milloy MJ, Nolan S, Dong H, Kerr T, Wood E.

Addict Behav. 2015 Oct 9;52:103-107. doi: 10.1016/j.addbeh.2015.10.002. [Epub ahead of print]

Comments: Benzo use is associated with lots of risk factors for negative health outcomes, including blood-borne virus transmission, among drug users.

14) Commentary on Gjersing & Bretteville-Jensen (2015): EMS-treated opioid overdose-an important opportunity for saving lives.

Dailey M.

Addiction. 2015 Nov;110(11):1775-6. doi: 10.1111/add.13093. No abstract available.

Comments: Nice commentary, pointing out the opportunities for intervention among those who contact the medical system with an overdose.

15) Flumazenil, naloxone and the 'coma cocktail'.

Sivilotti ML.

Br J Clin Pharmacol. 2015 Aug 7. doi: 10.1111/bcp.12731. [Epub ahead of print] Review.

Comments: Fascinating differences between benzo and opioid-induced respiratory depression. Benzos cause apnea usually because the upper airway is blocked or collapses – so respiratory support is the need – and the antidote can lead to seizures. Opioids are different and naloxone much safer.

16) Opioid Therapy and Sleep Disorders: Risks and Mitigation Strategies.

Cheatle MD, Webster LR.

Pain Med. 2015 Oct;16 Suppl 1:S22-6. doi: 10.1111/pme.12910. Review.

Comments: Opioids might be dangerous with sleep disorders.

17) More than just someone to inject drugs with: Injecting within primary injection partnerships.

Morris MD, Bates A, Andrew E, Hahn J, Page K, Maher L.

Drug Alcohol Depend. 2015 Nov 1;156:275-81. doi: 10.1016/j.drugalcdep.2015.09.025. Epub 2015 Sep 30.

Comments: Injection partnerships can have divergent benefits and risks.

18) A True Antidote.

Berlin J.

Tex Med. 2015 Oct 1;111(10):41-7.

Comments: Naloxone in Texas!

19) The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs.

Lake S, Hayashi K, Buxton J, Milloy MJ, Dong H, Wood E, Montaner J, Kerr T.

Drug Alcohol Depend. 2015 Nov 1;156:297-303. doi: 10.1016/j.drugalcdep.2015.09.026. Epub 2015 Sep 30.

Comments: Interesting analysis – injecting prescription opioids didn’t by itself increase overdose risk. Injecting of both prescription opioids and heroin did, however. So there is probably some protection offered by the known doses and constituents in prescription opioids.

20) Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature.

Martins SS, Sampson L, Cerdá M, Galea S.

Am J Public Health. 2015 Nov;105(11):e29-49. doi: 10.2105/AJPH.2015.302843.

Comments: Nice summary of global data looking at some basic overdose results. Mean/median rate of witnessed overdose in a drug user’s lifetime = 73/70%. Lifetime prevalence of experienced overdose was mean of 45.4% and median of 47%. Population-based overdose mortality rates varied from 0.4-46.6 / 100,000 person years (note, this is population based).

21) An Overdose Antidote Goes Mainstream.

Humphreys K.

Health Aff (Millwood). 2015 Oct 1;34(10):1624-7. doi: 10.1377/hlthaff.2015.0934.

Comments: Review of naloxone based on summer 2015 FDA meeting.

22) Is immunotherapy an opportunity for effective treatment of drug addiction?

Zalewska-Kaszubska J.

Vaccine. 2015 Oct 2. pii: S0264-410X(15)01369-9. doi: 10.1016/j.vaccine.2015.09.079. [Epub ahead of print] Review.

Comments: Really interesting idea – use antibodies against drugs, like cocaine, to manage overdose on those drugs. Excellent.

23) Involvement of Opioid Receptors in the Lipid Rescue of Bupivacaine-Induced Cardiotoxicity.

Partownavid P, Sharma S, Li J, Umar S, Rahman S, Eghbali M.

Anesth Analg. 2015 Aug;121(2):340-7. doi: 10.1213/ANE.0000000000000788.

Comments: Opioid receptors are required for rescuing people from the cardiac toxicity of bupivacaine overdose.

24) New drugs of abuse.

Rech MA, Donahey E, Cappiello Dziedzic JM, Oh L, Greenhalgh E.

Pharmacotherapy. 2015 Feb;35(2):189-97. doi: 10.1002/phar.1522. Epub 2014 Dec 4. Review.

Comments: Desomorphine. Blech.

25) What we know, and don't know, about the impact of state policy and systems-level interventions on prescription drug overdose.

Haegerich TM, Paulozzi LJ, Manns BJ, Jones CM.

Drug Alcohol Depend. 2014 Dec 1;145:34-47. doi: 10.1016/j.drugalcdep.2014.10.001. Epub 2014 Oct 14. Review.

Comments: Not much.

26) Access to harm reduction and HIV-related treatment services inside Indian prisons: experiences of formerly incarcerated injecting drug users.

Chakrapani V, Kamei R, Kipgen H, Kh JK.

Int J Prison Health. 2013;9(2):82-91. doi: 10.1108/17449201311326952.

Comments: Access is … no there.

27) Low Expression of D2R and Wntless Correlates With High Motivation for Heroin.

Tacelosky DM, Alexander DN, Morse M, Hajnal A, Berg A, Levenson R, Grigson PS.

Behav Neurosci. 2015 Oct 26. [Epub ahead of print]

Comments: Holding drug exposure constant, reducing dopamine D2 receptors or that other thing (Wntless) results in more opioid craving.

28) The misuse and abuse of prescription medications: part 1 current trends.

Allread V, Paul S.

MD Advis. 2014 Fall;7(4):12-20. Review.

Comments: Can’t access. Review for New Jersey and rest of US regarding prescription opioids and heroin use.