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 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 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 January 2014

10 papers this month, half of which relate to the United Kingdom. We continue to move forward.

1) Characterization of opioid overdose and response in a high-risk community corrections sample: A preliminary study.

Cropsey KL, Martin S, Clark CB, McCullumsmith CB, Lane PS, Hardy S, Hendricks PS, Redmond N.

J Opioid Manag. 2013 Nov-Dec;9(6):393-400.

Comments: Valuable survey of persons in the corrections system, under community supervision. Nearly half had used opioids and 40% of those had experienced an opioid overdose. Those who had overdosed were more likely to be white, female, and have higher educational attainment; they were also much more likely to have witnessed overdose, have seen someone die of overdose, and want training in overdose prevention and management.

2) Opioids Compared to Placebo or Other Treatments for Chronic Low Back Pain: An Update of the Cochrane Review.

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

Spine (Phila Pa 1976). 2014 Jan 29. [Epub ahead of print]

Comments: A review of studies evaluating short term use of opioids for chronic lower back pain. The studies evaluated all have major shortcomings so we’re left with little new information.

3) Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy.

Adrish M, Duncalf R, Diaz-Fuentes G, Venkatram S.

Am J Case Rep. 2014 Jan 15;15:22-6

Comments: Being “down” with an overdose for a prolonged period can lead to complications such as rhabdomyolysis and nerve compression. This patient developed compartment syndrome, which is to say high pressure within the fascial compartment of the buttocks, requiring surgical intervention to spare her extremity.

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.

The Scottish Highland Overdose Prevention Programme Goes to Prison

Lisa Ross

NHS Highland Clinical Harm Reduction Nurse Specialist / Naloxone Lead

In July 2009, I started the Highland programme in Inverness, in the north of Scotland, to deliver overdose prevention services to those at risk of opiate overdose, their friends and family members, and staff working with those at risk. The program is part of the Scottish National Health Service, our universal public health care system. 

Trainees were given a supply of naloxone for intramuscular administration to take home and use in the event of witnessing an opiate overdose. The programme also included Inverness prison; those who were identified as at risk were trained whilst in prison and given a naloxone pack on their liberation date.

The Programme was rolled out after the first year throughout the Highland area. To date over 900 kits have been supplied and there have been over 200 recorded uses of naloxone with successful reversal of the overdose state. In 2012, the programme was developed to include supply of naloxone for intranasal administration.

Last year I also started to develop a network of peer trainers; one of the aims of this was to increase uptake to those at risk, particularly those who had not previously engaged with the programme. Peer trainers are ideally placed to deliver this training; after all they hold the most experience and are far more likely to engage with the identified target group.

This again included Inverness Prison; I trained a peer trainer as a trainer and he now delivers the training in prison to those at risk. The results of this have been hugely positive so far. In a short space of time he has managed to engage with more individuals and deliver the training to them than the health and addictions staff have managed throughout the year. This is even more impressive when we consider the prison is in its fourth year of delivering this intervention and supplies of naloxone were starting to decrease given that the majority of people had already been trained. Or so we thought!

There will be the opportunity for the peer trainer to continue delivering the programme upon his own liberation, working in the community with the Harm Reduction Service and the community peer trainers.

My ongoing intention for the programme is to increase the number of peer trainers throughout Highland; there is no doubt that when it comes to overdose prevention and Naloxone training; peer trainers can have the maximum impact.

Scotland's Stephen Malloy talks about why naloxone is important

Scottish naloxone website

Check out the new naloxone website from the Scottish Drugs Forum, a leader in naloxone distribution to drug users: http://naloxone.org.uk/.

Good stuff: the site is easy to navigate and includes training videos, research and materials for overdose programs.

In this video, Stephen Malloy, the national coordinator for take-home naloxone in Scotland, talks about why they created the website. 

Research: From evidence to policy: The Scottish national naloxone program

A new article tells the story of naloxone in Scotland - how it went from an idea to a national program. While the whole article is an interesting case study, some of my favorite parts are on empowerment and reductions in drug-related deaths:


"Similar to Glasgow and Lanarkshire, the qualitative feedback from those followed up in the Inverness project also highlighted increases in confidence and self-esteem among the participants who attended for a re-supply interview. Indeed, clients themselves appeared to look on the training as providing them with a degree of responsibility and seemed to relish their role as peer educators. Clients who had been trained were also hugely successful in engaging their peers with the project which complemented staff attempts to recruit participants to training sessions."


also


"Potentially, the most significant impact the Inverness pilot made locally, and indeed nationally, was the unexpected and almost immediate impact on DRD rates. In 2008, prior to the pilot starting, there were 20 DRDs [drug-related deaths] in the Inverness area covered by the pilot (Ross, personal communication, May 2011). By the end of 2009 there were 13 DRDs, 8 of which occurred prior to the pilot commencing in July. In 2010 that number had fallen to just two DRDs. Moreover, DRD figures for the wider Highland Council area (which incorporates Inverness) had fallen from 20 in 2008, to just 6 in 2010 (GRoS, 2011). While it is impossible to directly infer a causal relationship here, and attribute these falls in DRDs directly to the naloxone programme, it does present a strong case for further investigation, specifically exploring whether there are other influencing factors present, e.g. a concurrent decrease in drug availability in the area or increases in treatment provision."