Phillip Coffin

Thanks for publishing this! We’ve really been counting stimulant deaths wrong - adjusting our thinking to consider stimulant toxicities as more like alcohol rather than opioids is tough, but results in a menu of interventions that is far more appropriate

Commentary on Stam et al.: The substantial and dynamic contribution of opioid potency to total overdose risk Click on the article title to read more.

Dr Coffin published a commentary in Addiction this week noting that high and variable opioid potency has a dynamic impact on overdose risk, limiting the impact of our traditional overdose prevention strategies.

Check out the full publication here:

Identification of Behavioral, Clinical, and Psychological Antecedents of Acute Stimulant Poisoning: Development and Implementation of a Mixed Methods Psychological Autopsy Study - PubMed In developing and implementing PA research on fatal stimulant poisoning, we noted the importance of recruitment language regarding cause of death and condolences with collateral informants. Compassion...

CSUH conducted a highly innovative study to better understand deaths attributed to stimulants. Lots more to come!

Outpatient Low-Dose Initiation of Buprenorphine for People Using Fentanyl This cohort study assesses rates of successful buprenorphine initiation and retention among adults who use fentanyl receiving a low-dose buprenorphine initiation protocol in the outpatient setting to ...

During the pandemic, doctors tried microdosing buprenorphine to help fentanyl users avoid withdrawal and start treatment. A UC San Francisco study found this low-dose approach worked only 34% of the time, with most patients unable to reach a full dose despite gradual increases over several days.

Test-Retest Reliability of a Timeline Follow-back Method to Assess Opioid Use and Treatment - PubMed The adapted TLFB had very high reliability for self-reported opioid and MOUD use over 120 days. For less frequent outcomes, including overdose, a higher frequency or larger sample size is needed to as...

CSUH collaborated with Boston Medical Center to demonstrate the reliability of self-reported substance use data over a 4-month lookback period!

Stimulant use and opioid-related harm in patients on long-term opioids for chronic pain - PubMed Despite no association between a stimulant-positive UDT and subsequent opioid-related harm, there was an association with subsequent LTOT discontinuation, with heterogeneity across clinical groups. De...

Study of 600 opioid patients: Stimulant use didn’t boost emergencies or deaths, yet those positive were nearly three times as likely to have treatment stopped. Researchers urge discussing substance use rather than automatically halting opioids.

Thematic analysis of medical examiner narratives to understand the socio-spatial context, recency of drug use, and likely mechanism of stimulant toxicity deaths Drug toxicity as a cause of death is challenging to establish and may be based on limited evidence, especially in deaths attributed to stimulants. We …

New CSUH paper published in Drug and Alcohol Dependence:

Many stimulant-only drug deaths are witnessed and often linked to heart issues, unlike opioid cases. Analyzing medical examiner records helps uncover patterns and improve prevention efforts.

Everything in moderation, even naloxone Click on the article title to read more.

In this commentary, Dr Coffin clarifies the role of naloxone in reversing overdose, and notes that more is not necessarily better.

I agree Maia. The methodology looks fairly solid. One could argue billing codes don’t really differentiate (or aren’t deployed by clinicians in a way that differentiates) between use and problematic use. But still higher than I would have thought.

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