Fluctuations in heroin purity and the incidence of fatal heroin overdose

Heroin Overdose: Research and Evidence-Based Intervention

“…Research, however, has failed to support this view. 28,[42][43][44] In the United States, Desmond et al 43 reported a nonsignificant correlation between heroin potency and number of deaths, while Ruttenber and Luke 28 found heroin purity accounted for only 24% of the variance in heroin overdose fatalities. In Europe, Risser et al 44 found no relationship between the purity of heroin seizures and number of heroin-related deaths.…”

“…In Australia, variations in heroin purity accounted for only a third of the variance in overdose deaths. 42 Overall, heroin purity appears to have only a moderate relationship to heroinrelated fatalities. It should also be noted that harmful contaminants are rarely detected in either syringes or the bodies of overdose cases; instead, relatively innocuous substances such as caffeine and sucrose are most commonly detected at autopsy.…”

Intentional Overdose Among Heroin Overdose Survivors

“…Previous research has shown that there are many factors that contribute to heroin overdose, such as differing metabolic rates, recent changes in patterns of use affecting tolerance, use in combination with other drugs or alcohol, and the purity of the heroin used. 3,4 However, investigation of these factors in the absence of information about the user's state of mind immediately prior to the overdose in question assumes that the event was accidental.…”

The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland

“…Tolerance to respiratory depression in people who inject heroin can develop quickly with chronic use, but can be lost quickly in withdrawal, making the judgement of lethal doses hard to predict (Mars, et al, 2015;Strang, et al, 2003). Street heroin with variable purity levels and price due to the variances of supply, make it harder to identify a lethal dosage, particularly after heroin shortages when the 'normal' quality resumes (Darke, Hall, Weatherburn, & Lind, 1999;Travis, 2011;Unick, Rosenblum, Mars, & Ciccarone, 2014). …”