Predictors and Prevention of Nonfatal Overdose Among Street-Recruited Injection Heroin Users in the San Francisco Bay Area, 1998–1999

Seal, Karen H.; Kral, Alex; Gee, Lauren; Moore, Lisa; Bluthenthal, Ricky N.; Lorvick, Jennifer; Edlin, Brian R.

doi:10.2105/ajph.91.11.1842

Cited by 178 publications

(142 citation statements)

References 38 publications

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“…Besides acute withdrawal or psychotropic treatment effects, altering of brain functions in heroin users may be related to comorbid psychiatric conditions (ex., antisocial personality disorder, depressive disorder, etc.) or other premorbid brain dysfunction (Kaplan et al, 1994;Ling et al, 1996); risky life-stile with high prevalence of non-fatal opiate overdoses (Darke et al, 1996;Seal et al, 2001), strokes (Gorelick,1990;Andersen and Skullerud, 1999), head traumas, chronic infections and malnutrition (Ling et al, 1996); cumulative effects of all psychotropic drugs abused throughout life (ex., alcohol, cannabis, cocaine, amphetamine, etc. ); and to acute or cumulative effects of substances contaminating street heroin (ex., MPTP, lead, etc.)…”

Section: Methodological Issuesmentioning

confidence: 99%

EEG spectral power and mean frequencies in early heroin abstinence

Polunina

Davydov

2004

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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The purpose of the present study was to investigate cumulative heroin effects on brain functioning by studying relationships between EEG spectral power and mean frequencies and heroin abusing history. Eyes closed resting EEG data were collected from the 19 monopolar electrode sites in 33 heroin abusers and 13 age-matched healthy volunteers. The mean age of the patients was 23.1±4.5, the duration of daily heroin abuse (DDHA) ranged from 4 to 44 months, the i.v. doses of heroin ranged from 0.04 to 1.00 g/day, the abstinence length ranged from 6 days to 4.5 months. GLM repeated measures procedure revealed a significant group effect on the distribution of the mean power spectrum between bands and mean frequencies in almost all analyzed derivations. Further analysis demonstrated that these intergroup differences were diversely related to at least three aspects of heroin taking history. Frequency shifts in alpha2 range, most prominent in frontal and central derivations, were related to duration of daily heroin consumption. Slowing of alpha1 mean frequency, most prominent in central, temporal and occipital derivations, was registered mainly in heroin addicts who abused high doses of the drug. Spectral power characteristics of brain electrical activities in our patient population were strongly predicted by abstinence length. The present results give grounds to suppose that chronic heroin taking induces neuronal oscillation frequency changes, that may contribute to the development of antisocial trends and some semantic processes disturbances in these patients. Supplementary neurophysiological deficit is characteristic for heroin addicts, who takes high doses of the drug, however, its relation to heroin abusing remains unclear. Pronounced desynchronization is observed in acute heroin withdrawal, and spectral power characteristics tend to normalize almost completely during several weeks of abstinence.

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Section: Methodological Issuesmentioning

confidence: 99%

EEG spectral power and mean frequencies in early heroin abstinence

Polunina

Davydov

2004

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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“…25,27 Since 2000, the Office of the Chief Medical Examiner (OCME) of the City and County of San Francisco annual reports document an increase in prescription opioid overdose deaths alongside a substantial decline in heroin overdose deaths from a high of 183 in 1999. 26,27,28 In this study, we sought to characterize recent shifts in opioids causing death from 2010 to 2012 in San Francisco by comparing heroin and prescription opioid overdose deaths and by examining the differences between deaths observed in geographic areas above and below the poverty line.…”

Section: Introductionmentioning

confidence: 99%

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

et al. 2015

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Drug overdose is now the leading cause of unintentional death nationwide, driven by increased prescription opioid overdoses. To better understand urban opioid overdose deaths, this paper examines geographic, demographic, and clinical differences between heroin-related decedents and prescription opioid decedents in San Francisco from 2010 to 2012. During this time period, 331 individuals died from accidental overdose caused by opioids (310 involving prescription opioids and 31 involving heroin). Deaths most commonly involved methadone (45.9 %), morphine (26.9 %), and oxycodone (21.8 %). Most deaths also involved other substances (74.9 %), most commonly cocaine (35.3 %), benzodiazepines (27.5 %), antidepressants (22.7 %), and alcohol (19.6 %). Deaths were concentrated in a small, high-poverty, central area of San Francisco and disproportionately affected African-American individuals. Decedents in high-poverty areas were significantly more likely to die from methadone and cocaine, whereas individuals from more affluent areas were more likely die from oxycodone and benzodiazepines. Heroin decedents were more likely to be within a younger age demographic, die in public spaces, and have illicit substances rather than other prescription opioids. Overall, heroin overdose death, previously common in San Francisco, is now rare. Prescription opioid overdose has emerged as a significant concern, particularly among individuals in high-poverty areas. Deaths in poor and affluent regions involve different causative opioids and co-occurring substances.

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“…[7][8][9] Polydrug use, binge drug use, alcohol use, and withdrawal symptoms have also been found to be associated with nonfatal overdose. 8,[10][11][12] Longer heroin-using career and greater heroin dependence have also been linked to nonfatal overdose. 12 Other risk factors include lifetime or recent incarceration experience, homelessness, syringe sharing, and homosexual or bisexual behavior.…”

Section: Introductionmentioning

confidence: 99%

“…12 Other risk factors include lifetime or recent incarceration experience, homelessness, syringe sharing, and homosexual or bisexual behavior. 8,9,11,13 Prior history of overdose has also been identified as a risk factor. 10,14,15 There are conflicting findings regarding the impact of age, with both younger and older age predicting nonfatal overdose in multivariate analyses.…”

Section: Introductionmentioning

confidence: 99%

“…10,14,15 There are conflicting findings regarding the impact of age, with both younger and older age predicting nonfatal overdose in multivariate analyses. 8,10,11 At least one study identified female gender as a risk factor, though gender has not generally been significant in most multivariate analysis. 7 Interventions to prevent overdose vary widely by country, state, and city.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

et al. 2011

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Opioid-involved overdose deaths are on the rise, both nationwide and in the state of Washington. In a survey of 443 participants at syringe exchanges in Seattle, Washington, 16% had overdosed in the last year. Several factors were significantly associated in bivariate analysis: lack of permanent housing; incarceration of five or more days in the past year; gender of sex partners; sharing of syringes and other injection paraphernalia; use of speedballs (cocaine and heroin together), goofballs (methamphetamine and heroin together), buprenorphine; injection use of crack cocaine and sedatives; and use of opioids with sedatives. Adjusting for other variables in multivariate logistic regression analyses, only recent incarceration and sharing of injection materials were still significantly associated with overdose. Correctional facilities, syringe exchange programs, and other agencies serving opioid injectors should include overdose prevention components in release planning and services.

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Predictors and Prevention of Nonfatal Overdose Among Street-Recruited Injection Heroin Users in the San Francisco Bay Area, 1998–1999

Abstract: Targeted interventions that decrease risk for overdose are urgently needed.

Cited by 178 publications

References 38 publications

EEG spectral power and mean frequencies in early heroin abstinence

EEG spectral power and mean frequencies in early heroin abstinence

Opioid Overdose Deaths in the City and County of San Francisco: Prevalence, Distribution, and Disparities

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

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