Non-fatal overdose and subsequent drug treatment among injection drug users

Abstract

Overdose is a leading cause of death among illicit drug users. 924 injection drug users (IDUs) in Baltimore, Maryland, were interviewed to characterize overdose events and determine the circumstances under which they lead to drug treatment. Overall, 366 (39.7%) reported at least one non-fatal drug overdose. Most (96.2%) used heroin on the day of their last overdose and almost half (42.6%) used heroin and alcohol but few (4.1%) used tranquilizers or benzodiazepines. Five percent were in drug treatment when the overdose occurred and 7.1% had been incarcerated two weeks prior. One in four IDUs (26.2%) sought drug treatment within 30 days after their last overdose of whom 75% enrolled. Speaking with someone about drug treatment after the overdose was associated with treatment seeking (AOR 5.22; 95% CI: 3.12, 8.71). Family members were the most commonly cited source of treatment information (53.7%) but only those who spoke with spouses, crisis counselors and hospital staff were more likely to seek treatment. Not being ready for treatment (69.6%) and not viewing drug use as a problem (30.7%) were the most common reasons for not seeking treatment and being placed on a waiting list was the most common reason for not subsequently enrolling in treatment (66.7%). Of the IDUs treated by emergency medical technicians, emergency room staff, or hospital staff, only 17.3%, 26.2% and 43.2% reported getting drug treatment information from those sources, respectively. Interventions that provide drug treatment information and enhance motivation for treatment in the medical setting and policies that reduce barriers to treatment entry among motivated drug users are recommended.

Patterns of Nonfatal Heroin Overdose Over a 3-Year Period: Findings From the Australian Treatment Outcome Study

“…Studies internationally report lifetime overdose histories ranging between one to two-thirds of heroin users. [4][5][6][7][8][9][10][11][12][13][14][15] To date, however, only two published studies have examined overdose longitudinally, both of which examined short-term (12 months) follow-up. 9,15 These studies demonstrated declines in overdose over a 12-month period, reductions that were associated with drug treatment.…”

Evidence-Based Treatment of Opioid-Dependent Patients

“…Heroin overdose is also one of the leading causes for seeking clinical (mainly emergency department) treatment of heroin addicts, of whom about 1 in 4 enter drug treatment within 30 days after the last overdose (22). This has led to interventions where emergency department personnel are trained to provide drug-treatment information and enhance motivation for treatment.…”

Individual and system influences on waiting time for substance abuse treatment

“…In part, this is related to substance abusers' limited tolerance for treatment wait time, with longer waits associated with higher rates of pretreatment attrition (Festinger, Lamb, Kountz, Kirby, & Marlowe, 1995;Hser, Maglione, Polinsky, & Anglin, 1998;Kaplan & Johri, 2000). Among injection drug abusers who attempted to enter treatment, the majority (66.7%) did not go because they were placed on a waiting list (Pollini, McCall, Mehta, Vlahov, & Strathdee, 2006). Waiting time also affects treatment retention, although its effect is inconsistent.…”

“…Substance users who wait for treatment services are less likely to enter treatment and often continue to use drugs, placing them at heightened risk for health complications such as overdose and exposure to infectious diseases such as hepatitis and HIV (Chawdhary et al, 2007;Festinger et al, 1995;Hser et al, 1998;Pollini et al, 2006). As an example, 35% of opiate abusers on a waiting list at the time of clinic intake reported resuming or initiating intravenous drug use by the time they were finally admitted to treatment (Schottenfeld et al, 1993).…”