Intentional Overdose Among Heroin Overdose Survivors

Heale, P.; Dietze, Paul; Fry, Craig Lindsay

doi:10.1093/jurban/jtg026

Cited by 45 publications

(28 citation statements)

References 11 publications

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“…This is consistent with recent evidence suggesting that only a small proportion of overdoses are deliberate, 14,33,45 although symptoms of depression seem to be more common among users who have suffered an overdose. 46 A larger proportion (17.4%) of participants attributed the overdoses to constitutional or health reasons, often verbalized as Bpredisposition,^Bweakness^or Blow defenses.^It has been hypothesized that poor general health status, in particular, liver or lung disease, could increase the risk of overdose, 12 and there is some evidence of an increased risk of overdose with long-term HIV infection.…”

Section: Discussionsupporting

confidence: 91%

Do Young Heroin Users in Madrid, Barcelona and Seville have Sufficient Knowledge of the Risk Factors for Unintentional Opioid Overdose?

Neira-León

Barrio²,

Brugal³

et al. 2006

J Urban Health

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To identify the self-perceived reasons for unintentional opioid overdose of young heroin users in three Spanish cities and their agreement with objective risk factors for overdose. Computer-Assisted Personal Interviews (CAPI) were held with 991 streetrecruited current heroin users aged 18-30. The general reasons for overdose and the reasons for the last overdose suffered were explored with open-ended (OEQs) and precoded questions (PCQs). Limited knowledge of overdose risk factors was defined as mention of fewer than two objective risk factors for unintentional overdose in the OEQ. Univariate, bivariate, and logistic regression methods were used. 77.8% (Seville), 64.9% (Madrid) and 57.2% (Barcelona) of participants have limited knowledge of overdose risk factors. Residence in Seville and not having attended courses or meetings on overdoses were significantly associated with limited knowledge, after adjusting for other factors. The most frequently identified general reasons in OEQ or PCQ were using heroin in large amounts (66.8%), together with tranquilizers (62.0%), adulterated (60.7%), or purer than usual (57.6%). Most reasons were selected more frequently in PCQ than in OEQ, especially rapid injection of the entire dose and using heroin shortly after using tranquilizers or alcohol, by injection, or after a period of abstinence. The results were similar for overdoses suffered by participants. Most young heroin users do not have sufficient knowledge of overdose risk factors, especially the use of heroin by injection, after a period of abstinence, or together with alcohol or methadone. Specific informational or educational programs adapted to the local context are critically needed.

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Section: Discussionsupporting

confidence: 91%

Do Young Heroin Users in Madrid, Barcelona and Seville have Sufficient Knowledge of the Risk Factors for Unintentional Opioid Overdose?

Neira-León

Barrio²,

Brugal³

et al. 2006

J Urban Health

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“…Overdose death is more likely following human immunodeficiency virus (HIV) seroconversion and among those with abnormal liver function, shortness of breath, and diarrhea, 13 suggesting that common mechanisms of overdose death (respiratory depression and cardiac arrest) 14 may be more likely in individuals with systemic comorbidities. Length of drug use, 4,15 polydrug use, 4,[16][17][18] risky drug use, 13,15,19 disrupted life circumstances, 20,21 and conflicts within social networks 19 are associated with overdose. Risk of overdose increases with periods of reduced tolerance, including release from prison 22 and naltrexone detoxification, 23 while overdose risk is decreased with agonist maintenance therapy 24 ; opioid metabolites in the hair of overdose decedents are far below the levels of active heroin users, 25,26 suggesting periods of abstinence preceding death.…”

mentioning

confidence: 99%

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Coffin¹,

Tracy²,

Bucciarelli³

et al. 2007

Academic Emergency Medicine

101

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Objectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15-64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose.Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months.Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age.Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.

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“…Our findings suggest that, with regard to overdose events, suicidal intent might be better understood as part of a continuum of intentionality, rather than as one-half of an “accidental/intentional” dichotomy (Britton, Bohnert, Wines, & Conner, 2012; Heale, Dietze, & Fry, 2003). For some veterans, it appears that apathy, especially when combined with severe physical and/or psychological pain and social isolation, can lead to a “flirting with death” scenario.…”

Section: Discussion: the Interplay Of Distal And Proximal Influences mentioning

confidence: 87%

Opioid-Involved Overdose Among Male Afghanistan/Iraq-Era U.S. Military Veterans: A Multidimensional Perspective

Bennett

Elliott

Golub

et al. 2017

Substance Use & Misuse

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Background Mirroring nationwide trends in a broad range of U.S. populations, an alarming number of Afghanistan/Iraq-era U.S. Military veterans have experienced opioid-related overdoses. A growing body of research has examined the proximal behaviors that can precipitate an overdose; considerably less is known about more distal physiological, psychosocial and structural influences on these risk behaviors. Objectives This study adopts a multidimensional approach to better understand opioid-related overdose among U.S. Military veterans, and seeks to explore not only the proximal behavioral precipitants of overdose events, but also the complex nexus of physiological, psychological, and sociological influences that undergird overdose events. Methods This qualitative examination is based on interview data from 36 male veterans who were discharged from the military after September 2001 and experienced at least one opioid-related overdose during or after military service. Participants were recruited in New York City during 2014 to share narrative accounts of their overdoses. Results Veterans’ accounts indicate that background experiences, such as self-medication for social and psychological pain, trauma, social alienation and isolation, and histories of illicit drug use, precondition the more immediate factors and behaviors that precipitate overdose (including bingeing on drugs, mixing drugs, naiveté about dosage, and ambivalence about life/death). Conclusions Findings suggest the need for comprehensive drug safety and overdose education that is sensitive to veterans’ physiological, psychological, and sociological conditions. A multidimensional understanding of the distal and proximal overdose risks faced by veterans and other vulnerable groups may help lay a foundation for more inclusive/holistic approaches to overdose prevention and education.

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Intentional Overdose Among Heroin Overdose Survivors

Cited by 45 publications

References 11 publications

Do Young Heroin Users in Madrid, Barcelona and Seville have Sufficient Knowledge of the Risk Factors for Unintentional Opioid Overdose?

Do Young Heroin Users in Madrid, Barcelona and Seville have Sufficient Knowledge of the Risk Factors for Unintentional Opioid Overdose?

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Opioid-Involved Overdose Among Male Afghanistan/Iraq-Era U.S. Military Veterans: A Multidimensional Perspective

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