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 September 2015

Twelve this month. Enjoy!

1) Correlates of Opioid Use in Adults With Self-Reported Drug Use Recruited From Public Safety-Net Primary Care Clinics.

Ries R, Krupski A, West II, Maynard C, Bumgardner K, Donovan D, Dunn C, Roy-Byrne P.

J Addict Med. 2015 Oct;9(5):417-26. doi: 10.1097/ADM.0000000000000151.

Comment: Can’t access the full article, but the abstract suggests a fascinating look into opioid-using safety net primary care patients.

2) Suicide Risk of Heroin Dependent Subjects in Lebanon.

Kazour F, Soufia M, Rohayem J, Richa S.

Community Ment Health J. 2015 Sep 30. [Epub ahead of print]

Comment: Most studies of heroin users find that heroin is *not* the usual method of suicide attempts. Interestingly, this study finds something quite different, with nearly half of attempts being through heroin use in Lebanon.

3) Trends and characteristics of accidental and intentional codeine overdose deaths in Australia.

Roxburgh A, Hall WD, Burns L, Pilgrim J, Saar E, Nielsen S, Degenhardt L.

Med J Aust. 2015 Oct 5;203(7):299.

Comment: Interesting paper exploring deaths related to one, low-potency, opioid. Those deaths seemed to be increasing, over a third were intentional (that’s much higher than other opioids), and a remarkably high proportion were polydrug – which makes sense since it would be tough to die from codeine alone.

4) American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

Kampman K, Jarvis M.

J Addict Med. 2015 Oct;9(5):358-67. doi: 10.1097/ADM.0000000000000166.

Comment: Another that I can’t access but whose abstract looks compelling.

5) Methadone Pharmacogenetics: CYP2B6 Polymorphisms Determine Plasma Concentrations, Clearance, and Metabolism.

Kharasch ED, Regina KJ, Blood J, Friedel C.

Anesthesiology. 2015 Sep 19. [Epub ahead of print]

Comment: Ah, the complexities of methadone. Genetic differences in hepatic metabolism are more prominent in oral than intravenous methadone.

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.

PubMed Update May 2013

Here is the May 2013 roundup with 7 papers and some extra kudos to the authors for important steps forward in data or practice.

1) Ethanol Reversal of Cellular Tolerance to Morphine in Rat Locus Coeruleus Neurons.

Llorente J, Withey S, Rivero G, Cunningham M, Cooke A, Saxena K, McPherson J, Oldfield S, Dewey W, Bailey C, Kelly E, Henderson G.

Mol Pharmacol. 2013 May 28. [Epub ahead of print]

Comments: Intriguing analysis of ethanol and morphine, suggesting that alcohol may enhance the effects of morphine. Could this account for some of the risk of combining opioids with alcohol?

2) Hypoglycemia during rapid methadone dose escalation.

Moryl N, Pope J, Obbens E.

J Opioid Manag. 2013 Jan-Feb;9(1):29-34. doi: 10.5055/jom.2013.0144.

Comments: One of a handful of issues with methadone dosing that may have factored into the challenges encountered by providers and patients with this drug when used for pain.

3) Benzodiazepine use during buprenorphine treatment for opioid dependence: Clinical and safety outcomes.

Schuman-Olivier Z, Hoeppner BB, Weiss RD, Borodovsky J, Shaffer HJ, Albanese MJ.

Drug Alcohol Depend. 2013 May 17. doi:pii: S0376-8716(13)00133-6. 10.1016/j.drugalcdep.2013.04.006. [Epub ahead of print]

Comments: For patients on any opioid medications, benzodiazepines are associated with an increased risk of overdose. This study of 328 buprenorphine maintenance patients didn’t find an association with benzodiazepine prescriptions and overdose, but did find an association with more frequent emergency department visits and injury-related ED visits. We may never learn if benzodiazepines are causal in this pathway or merely a marker, but these data do contribute to the overall concern.

4) The relationship between age and risky injecting behaviours among a sample of Australian people who inject drugs.

Horyniak D, Dietze P, Degenhardt L, Higgs P, McIlwraith F, Alati R, Bruno R, Lenton S, Burns L.

Drug Alcohol Depend. 2013 May 9. doi:pii: S0376-8716(13)00116-6. 10.1016/j.drugalcdep.2013.03.021. [Epub ahead of print]

Comments: More excellent work from this team. I particularly appreciate the estimate of the reduction in overdose risk with age. In a mathematical model of overdose, we estimated a 50% reduction in the risk of overdose over 10 years of use, whereas this paper suggests the figure is closer to 20% - data that will be very helpful in future iterations.

5) Reducing the Health Consequences of Opioid Addiction in Primary Care.

Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD.

Am J Med. 2013 May 8. doi:pii: S0002-9343(13)00138-1. 10.1016/j.amjmed.2012.11.031. [Epub ahead of print]

Comments: Congratulations to this team on producing what I think are the first primary care guidelines in the scientific literature recommending overdose prevention and naloxone for at-risk patients.

6) Acute Pain Control Challenges with Buprenorphine/Naloxone Therapy in a Patient with Compartment Syndrome Secondary to McArdle's Disease: A Case Report and Review.

McCormick Z, Chu SK, Chang-Chien GC, Joseph P.

Pain Med. 2013 May 3. doi: 10.1111/pme.12135. [Epub ahead of print]

Comments: Less an overdose article per se, but a paper that pays attention to the overdose issue when titrating opioids.

7) Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders.

Green TC, Bowman SE, Zaller ND, Ray M, Case P, Heimer R.

Subst Use Misuse. 2013 May;48(7):558-67. doi: 10.3109/10826084.2013.787099.

Comments: A qualitative look at providers feelings about providing naloxone to “drug users” and, separately, to “pain patients.” This is a great and useful analysis – and honestly surprisingly positive across the board. The major concern raised seemed to be that naloxone not be the only thing done to try to reduce overdose. This is a pretty dramatic shift in attitudes since earlier evaluations of provider opinion on lay naloxone (Beletsky et al 2007, Coffin et al 2003).