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Many health professionals have suspected it for a while, and now it’s official: a study published in October in Health Affairs, and written up by HealthDay, reports that heroin has once again become more popular than prescription opioid painkillers as the opioid of first use. (AT Forum, USA, 24.10.2017)

http://atforum.com/2017/10/heroin-once-again-more-popular-than-rx-opioids/

The first governmental account of nationwide drug deaths in 2016 shows overdose deaths growing even faster than previously thought.

Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It’s a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times’s estimate in June, which was based on earlier preliminary data. (New York Times, 02.09.2017)

https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html

Maintainence Treatment of Opioid Dependence with Tramadol.

Sarkar S, Varshney M, Patil V, Lal R.

J Neurosci Rural Pract. 2017 Aug;8(Suppl 1):S98-S101. doi: 10.4103/jnrp.jnrp_422_16.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602271/

When it comes to the opioid overdose crisis, there is a disconnect between lawmakers and the people they aim to protect, especially if those people are selling heroin. There has been a push to pass harsh penalties against those who provide fentanyl-laced heroin that results in an overdose. Here’s the problem: it’s virtually impossible to find heroin in its pure form. What’s more, people who use heroin have very little control over whether or not their products have been adulterated. (DPA – Drug Policy Alliance, USA. 30.08.2017)

http://www.drugpolicy.org/blog/because-drug-war-there-virtually-no-heroin-without-fentanyl-many-places

How the Reformulation of OxyContin Ignited the Heroin Epidemic

William N. Evans, Ethan Lieber, Patrick Power

Abstract

We attribute the recent quadrupling of heroin death rates to the August, 2010 reformulation of an oft-abused prescription opioid, Oxycontin. The new abuse-deterrent formulation led many consumers to substitute to an inexpensive alternative, heroin. Using structural break techniques and a difference-in-differences analysis, we find that opioid consumption stops rising in August, 2010, heroin deaths begin climbing the following month, and growth in heroin deaths was greater in areas more likely to substitute from opioids to heroin. The reformulation did not generate a reduction in combinedheroin and opioid mortality—each prevented opioid death was replaced with a heroin death. (01.06.2017, JEL: I12, I18, K42)

https://www3.nd.edu/~elieber/research/ELP.pdf

Research presented at the American Association for Clinical Chemistry Annual Scientific Meeting & Clinical Lab Expo indicated accuracy of a genetic risk assessment for prescription or heroin opioid addiction.  (Healio – Psychiatric Annals, 02.08.2017)

https://www.healio.com/psychiatry/addiction/news/online/%7Bcbc42077-a977-4c78-8589-179d90a7f199%7D/genetic-test-indicates-risk-for-opioid-addiction

Oxford academics say sales of synthetic opioid drug are proliferating on illicit websites, with Britain a significant player. (The Guardian, 16.10.2017)

https://www.theguardian.com/society/2017/oct/16/uk-accounts-for-largest-share-of-darknet-fentanyl-sales-in-europe

Schätzung der Anzahl der Opioid (Heroin, Methadon, Buprenorphin, Fentanyl) oder Opiat (Codein, Morphin) konsumierenden Erwachsenen in Deutschland

Projektleiter: Prof. Dr. Ludwig Kraus, Laufzeit: 01.04.2017 - 31.01.2018, Förderung: Bundesministerium für Gesundheit. Durchführung: IFT – Institut für Therapieforschung (München)

http://www.ift.de/forschung/projekte/projekte-detailansicht.html?tx_projectmanager_projectmanager%5Bproject%5D=74&tx_projectmanager_projectmanager%5Baction%5D=show&tx_projectmanager_projectmanager%5Bcontroller%5D=Project&cHash=dcb1a69166e0aef8df479ceba917d199

In September 2017 CGL and Volteface convened a ‘round table’ to discuss responses to the growing threat posed by fentanyl and its analogues (often referred to as ‘fentalogues’ or ‘fentanyls’). Fentanyl and its analogues range from highly valued medicines to highly dangerous synthetic opioid drugs with little or no legitimate use in humans. The round table followed reports of at least 60 deaths linked to fentanyls in England and Wales in the previous eight months and CGL’s direct experience of managing outbreaks of fentanyl-related overdose deaths in two areas in England. (change, grow, live, UK, October 2017)

https://www.changegrowlive.org/sites/cri.org.uk/files/cgl_fentanyl_report_2017.pdf

Chronic pain and opioid misuse: a review of reviews

Pauline Voon, Mohammad Karamouzian and Thomas Kerr

Substance Abuse Treatment, Prevention, and Policy 2017, 12:36, doi.org/10.1186/s13011-017-0120-7

https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0120-7

EMCDDA. Acryloylfentanyl to be placed under control across the EU

(EMCDDA, Lissabon  29.09.2017, News Release No 8/2017)

http://www.emcdda.europa.eu/news/2017/8/acryloylfentanyl-under-control-accross-eu_en

In two dozen of the nation’s largest cities, fentanyl is becoming a major part of the national opioid crisis. (Washington Post, 15.08.2017)

https://www.washingtonpost.com/graphics/2017/national/fentanyl-overdoses/

Researchers at Florida International University's International Forensic Research Institute (IFRI) have zeroed in on a unique component of heroin that could pinpoint where it was grown, giving authorities a new tool to potentially disrupt the nation's opioid crisis.

(...) Researchers needed to find something unique in the heroin itself that could not be masked or eliminated in order to determine its point of origin – something the typical manufacturer wouldn't know to look for or care to mask. They zeroed in on the ratio of radiogenic strontium isotopes, which are naturally occurring in bedrock. Strontium isotopes can be found in different ratios among geographic regions depending upon the nature of geologic formation.

Using heroin samples of known geographic origin provided to them by the DEA, researchers were able to measure ratios of strontium isotopes in samples known to come from the four distinct regions. (phys.org, 28.09.2017)

https://phys.org/news/2017-09-discovery-authorities-track-heroin.html

Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines.

Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, Blank S, Pampati V, Abdi S, Grider JS, Kaye AD, Manchikanti KN, Cordner H, Gharibo CG, Harned ME, Albers SL, Atluri S, Aydin SM, Bakshi S, Barkin RL, Benyamin RM, Boswell MV, Buenaventura RM, Calodney AK, Cedeno DL, Datta S, Deer TR, Fellows B, Galan V, Grami V, Hansen H, Helm Ii S, Justiz R, Koyyalagunta D, Malla Y, Navani A, Nouri KH, Pasupuleti R, Sehgal N, Silverman SM, Simopoulos TT, Singh V, Solanki DR, Staats PS, Vallejo R, Wargo BW, Watanabe A, Hirsch JA.

Pain Physician. 2017 Feb;20(2S):S3-S92.

http://www.painphysicianjournal.com/current/pdf?article=NDIwMg%3D%3D&journal=103

Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use.

National Academies of Sciences, Engineering, and Medicine. 2017.

Washington, DC: The National Academies Press. doi.org/10.17226/24781.

https://www.nap.edu/download/24781

Last year saw the highest number of drug-related deaths since records began in 1993, according to data from the Office for National Statistics (ONS). More than half of these deaths involved an opiate, such as heroin. Those aged 40 to 49 years old made up the largest group dying as a result of drug poisoning. Compared with the general population, this group are dying decades before they should. (The Independent, UK, 15.08.2017)

http://www.independent.co.uk/life-style/health-and-families/drug-related-deaths-are-at-their-highest-level-in-25-years-here-s-why-a7875331.html

A deadly new drug has been found for sale in Northern Ireland.

The strong painkiller fentanyl has been found mixed in heroin seized by the PSNI.

Police believe it was linked to two deaths in Northern Ireland and more than 60 in the rest of the UK this year. (BBC,21.09.2017)

http://www.bbc.com/news/uk-northern-ireland-41341492

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.

https://www.cdc.gov/mmwr/volumes/66/wr/mm6604a4.htm

Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder.

Stein MD, Conti MT, Kenney S, Anderson BJ, Flori JN, Risi MM, Bailey GL.

Drug Alcohol Depend. 2017 Aug 5;179:325-329. doi: 10.1016/j.drugalcdep.2017.07.007.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/28841495

Opioid, Addiction. [Updated 2017 Aug 20].

Huecker MR, Cummins D.

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-.

https://www.ncbi.nlm.nih.gov/books/NBK448203/

Opioids for cancer pain - an overview of Cochrane reviews.

Wiffen PJ, Wee B, Derry S, Bell RF, Moore RA.

Cochrane Database Syst Rev. 2017 Jul 6;7:CD012592. doi: 10.1002/14651858.CD012592.pub2. Review.

Abstract

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012592.pub2/abstract;jsessionid=437108CFF4D2E456DF2C326190AF17D4.f04t01

A novel non-opioid protocol for medically supervised opioid withdrawal and transition to antagonist treatment.

Rudolf G, Walsh J, Plawman A, Gianutsos P, Alto W, Mancl L, Rudolf V.

Am J Drug Alcohol Abuse. 2017 Aug 10:1-8. doi: 10.1080/00952990.2017.1334209.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/28795846

Opioids in the Frame of New Psychoactive Substances Network: A Complex Pharmacological and Toxicological Issue.

Ventura L, Carvalho F, Dinis-Oliveira RJ.

Curr Mol Pharmacol. 2017 Jul 4. doi: 10.2174/1874467210666170704110146.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/28676005

Efficacy of Tramadol Extended-Release for Opioid WithdrawalA Randomized Clinical Trial.

Dunn KE, Tompkins DA, Bigelow GE, Strain EC.

JAMA Psychiatry. 2017;74(9):885–893. doi:10.1001/jamapsychiatry.2017.1838

Abstract

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2642924

Contrary to recent news reporting, there are no fentanyl analogues resistant to Naloxone. News reports indicated a “new” fentanyl analogue, acrylfentanyl, was “extremely powerful” and implied it resisted Naloxone’s effects.

However, acrylfentanyl binds to the same receptors within the human body as fentanyl, meaning correctly administered Naloxone is effective against it. (US Department of Homeland Security, 11.07.2017)

https://drive.google.com/file/d/0B4VhZtoliXjMdG91Q0hnTm1tLVlnZEc2TDZBUDBzZWdvZkNR/view?mc_cid=789b1c66dc&mc_eid=%5BUNIQID&mc_cid=473cb50e0c&mc_eid=5d5993ab16

Opium stillt Schmerzen, indem es Ionenkanäle in schmerzempfindlichen Zellen blockiert – daher empfehlen sich diese Kanäle als Ansatzpunkte einer Schmerzbehandlung, die ohne Opiumverabreichung auskommt. Das zeigt eine Forschungsgruppe aus der Marburger Universitätsmedizin gemeinsamen mit deutschen und amerikanischen Beteiligten in einer aktuellen Studie. Das Team um den Biologen Professor Dr. Johannes Oberwinkler klärte das Zusammenwirken von Molekülen auf, die an der Schmerzempfindung beteiligt sind. Die Ergebnisse sind soeben im Forschungsmagazin „e-Life“ erschienen. (Philipps-Universität Marburg, 04.09.2017)

https://idw-online.de/de/news680391

Fentanyl drug profile

EMCDDA, Portugal, 2017

http://www.emcdda.europa.eu/publications/drug-profiles/fentanyl

Anti-nociceptive action of peripheral mu-opioid receptors by G-beta-gamma protein-mediated inhibition of TRPM3 channels.

Dembla S, Behrendt M, Mohr F, Goecke C, Sondermann J, Schneider FM, Schmidt M, Stab J, Enzeroth R, Leitner MG, Nuñez-Badinez P, Schwenk J, Nürnberg B, Cohen A, Philipp SE, Greffrath W, Bünemann M, Oliver D, Zakharian E, Schmidt M, Oberwinkler J.

Elife. 2017 Aug 15;6. pii: e26280. doi: 10.7554/eLife.26280.

https://elifesciences.org/articles/26280