PubMed Update August 2013

16 papers today – this is getting to be a big job. Naloxone, fentanyl, methadone, stars, pain, Central Asia, primary care, injection facilities, personal stories …

1) Notes from the field: acetyl fentanyl overdose fatalities - rhode island, march-may 2013.

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep. 2013 Aug 30;62(34):703-4.

Comment: The evidence of synthetic fentanyl was difficult to detect and concerning to many as heralding a possible repeat of the 2006/2007 fentanyl-tainted heroin overdose outbreak.

2) Methadone induced sensorineural hearing loss.

Saifan C, Glass D, Barakat I, El-Sayegh S.

Case Rep Med. 2013;2013:242730. doi: 10.1155/2013/242730. Epub 2013 Jul 29.

Comment: In this case the patient was restarted on methadone and the sensorineural hearing loss was permanent.

3) Opioids compared to placebo or other treatments for chronic low-back pain.

Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC.

Cochrane Database Syst Rev. 2013 Aug 27;8:CD004959. doi:

Comment: There are no quality data to support long-term management of non-cancer pain with opioids.

4) Cory monteith dies of a heroin overdose at age 31.

Willens JS.

Pain Manag Nurs. 2013 Sep;14(3):125. doi: 10.1016/j.pmn.2013.07.004. No abstract available.

Comment: The Glee star.

Overdose in Eastern Europe and Central Asia

The Eurasian Harm Reduction Network, which represents harm reduction groups in Central and Eastern Europe and Central Asia, recently launched a newsletter, and the first issue covers overdose in the region. You can download the English edition here, and the Russian here.


The whole issue is worth reading. It starts off with an article by OPA's own Dan Bigg on overdose as a fundamental, uniting issue in harm reduction. Other pieces present an overview of what we know about overdose in a region that stretches from the Afghan border to the heart of Europe, stories by people who have been saved from overdose by naloxone or used it on others, a story about a great overdose project in Tomsk, Russia, and much more.

News: Article on naloxone in "Small Fixes" section of the NY Times

There has been a lot of attention to opiate overdose prevention and naloxone in the press lately! Here's the latest piece from the New York Times, which makes mention of the fact that it's not only the U.S. that distributes naloxone to drug users - lots of other countries have programs too.

http://www.nytimes.com/2011/09/27/health/27overdose.html?ref=health

Kits Using Naloxone Revive Addicts After Opiate Overdose

By JASCHA HOFFMAN

Next to car crashes, opiate overdoses are the leading cause of accidental death in the United States. In Europe, a lethal overdose occurs every hour. In poorer countries the problem is harder to measure, but in some places it is most likely even worse. When a person overdoses on opiates, his breathing becomes shallow and may eventually stop. Friends may be afraid to call an ambulance for fear of arrest. In remote areas, an ambulance may come too late, after oxygen deprivation has caused brain damage or death. Yet naloxone, a medicine that blocks opiate receptors, can revive even the most catatonic drug users. Used for decades by surgeons and paramedics, the drug has been shown to work when administered by bystanders in American cities. Recently groups in Eastern Europe and Central Asia have been distributing “overdose rescue kits,” which usually contain two doses of naloxone and two syringes. These groups may operate in a legal gray area by training addicts and their families to administer the drug themselves in the event of an overdose. Aside from saving lives, the kits give addicts a reason to return to treatment centers, where they may receive H.I.V. testing or counseling. In China, hot line operators dispatch rescue kits via motorcycle to desperate callers. In Afghanistan, an overdose rescue program relies on the same “skilled injectors” whom addicts pay to shoot them up with heroin. A shot of naloxone runs about $6 in the United States, but in most other countries the cost is below $2 and can be as little as a quarter. Global distribution of the drug as a nasal spray may make the kits even more practical.