This is our Podcast Journal Club Pilot Episode. We will be discussing two articles chosen by Dr. Del Tredici on opiate use and misuse, and a related current events topic—safe injection sites.

Presenter: Sonya Del Tredici, MD
Host: Giselle Aerni, MD
Producer: Robert Stuntz, MD

“Harm reduction” is treatment that focuses on reducing harm from opiate use, rather than on eliminating opiate use.

Article 1: Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. Luis Sordo, Gregorio Barrio, Maria J Bravo, B Iciar Indave, Louisa Degenhardt, Lucas Wiessing. Marica Ferri, Roberto Pastor-Barriuso. BMJ 2017;357:j1550.

This article discusses mortality before, during, and after treatment of opioid use disorder with buprenorphine and methadone. It tackles one type of “harm reduction” which is substituting the risky opiate (heroin) for a less risky opiate (buprenorphine and methadone). The article shows that there are substantial reductions in mortality while using methadone and buprenorphine.

Article 2: No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone. Jones JD, Campbell A, Metz VE, Comer SD.Addict Behav. 2017 Aug;71:104-106.

Another type of harm reduction is providing opiate users and their friends and family with naloxone to use in the event of an overdose. Some people feel that this will reduce the fear of overdose, and thus encourage more drug use. This article discusses whether or not patients who are given naloxone (to treat overdose) use opiates more risky ways. It showed that when given naloxone and trained how to use it, their risky drug-using behavior did not increase.

Current Events Topic: We discussed that opening of a “safe injection site” in Philadelphia, where opiate users could go to use their opiates in a safe, clean site where clean needles would be provided, medically-trained staff would be there in the case of overdose, and to offer entrance into treatment and other social services if the patient were interested. You can read more about it in this article from the Pew Trust. For background, you could also look at this article from the NY Times about Kensington (where the proposed safe injection site will be) that has been called “The Wal-Mart of heroin.” The United States Attorney opposes the safe injection site.