Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users

Kerr, Thomas; Fairbairn, Nadia; Tyndall, Mark W.; Marsh, David C.; Li, Kathy; Montaner, Joan; Wood, Evan

doi:10.1016/j.drugalcdep.2006.07.009

Cited by 293 publications

(272 citation statements)

References 38 publications

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“…8,9,11,25 Because of this finding, we analyzed post-hoc whether an incarceration of any length of time in the past year was associated with nonfatal overdose. In bivariate analysis, any incarceration was significant (p=0.033), but was not significant in the multivariate models (Model 2 AOR=1.63, CI=0.93, 2.86; Model 3 AOR=1.49, CI=0.83, 2.67).…”

Section: Discussionmentioning

confidence: 99%

“…6 Existing literature on nonfatal overdose among injection drug users (IDU), from a variety of drugs, identifies risk factors related to drug use that include heroin injection, cocaine injection, use of heroin mixed with methamphetamine ("goofballs") or heroin mixed with cocaine ("speedballs"), non-injection use of methamphetamine, and use of benzodiazepines. [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.…”

Section: Introductionmentioning

confidence: 99%

“…[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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

et al. 2022

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ImportanceIn 2021, the state of Rhode Island distributed 10 000 additional naloxone kits compared with the prior year through partnerships with community-based organizations.ObjectiveTo compare various strategies to increase naloxone distribution through community-based programs in Rhode Island to identify one most effective and efficient strategy in preventing opioid overdose deaths (OODs).Design, Setting, and ParticipantsIn this decision analytical model study conducted from January 2016 to December 2022, a spatial microsimulation model with an integrated decision tree was developed and calibrated to compare the outcomes of alternative strategies for distributing 10 000 additional naloxone kits annually among all individuals at risk for opioid overdose in Rhode Island.InterventionsDistribution of 10 000 additional naloxone kits annually, focusing on people who inject drugs, people who use illicit opioids and stimulants, individuals at various levels of risk for opioid overdose, or people who misuse prescription opioids vs no additional kits (status quo). Two expanded distribution implementation approaches were considered: one consistent with the current spatial distribution patterns for each distribution program type (supply-based approach) and one consistent with the current spatial distribution of individuals in each of the risk groups, assuming that programs could direct the additional kits to new geographic areas if required (demand-based approach).Main Outcomes and MeasuresWitnessed OODs, cost per OOD averted (efficiency), geospatial health inequality measured by the Theil index, and between-group variance for OOD rates.ResultsA total of 63 131 simulated individuals were estimated to be at risk for opioid overdose in Rhode Island based on current population data. With the supply-based approach, prioritizing additional naloxone kits to people who use illicit drugs averted more witnessed OODs by an estimated mean of 18.9% (95% simulation interval [SI], 13.1%-30.7%) annually. Expanded naloxone distribution using the demand-based approach and focusing on people who inject drugs had the best outcomes across all scenarios, averting an estimated mean of 25.3% (95% SI, 13.1%-37.6%) of witnessed OODs annually, at the lowest mean incremental cost of $27 312 per OOD averted. Other strategies were associated with fewer OODs averted at higher costs but showed similar patterns of improved outcomes and lower unit costs if kits could be reallocated to areas with greater need. The demand-based approach reduced geospatial inequality in OOD rates in all scenarios compared with the supply-based approach and status quo.Conclusions and RelevanceIn this decision analytical model study, variations in the effectiveness, efficiency, and health inequality of the different naloxone distribution expansion strategies and approaches were identified. Future efforts should be prioritized for people at highest risk for overdose (those who inject drugs or use illicit drugs) and redirected toward areas with the greatest need. These findings may inform future naloxone distribution priority settings.

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Childhood Trauma and the Inability to Access Hospital Care Among People who Inject Drugs

Randhawa

Azarbar

Dong

et al. 2018

Journal of Traumatic Stress

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Childhood traumatic experiences can disrupt attachment, influence personality development, and precipitate chronic disease. Although the repercussions of these experiences may also pose a barrier to healthcare, few studies have examined the association between childhood trauma and access to healthcare. Therefore, we sought to investigate whether a history of childhood trauma is associated with self-reported inability to access hospital care among persons who inject drugs (PWID). Data were derived from two prospective cohorts of PWID in Vancouver, Canada. We used multivariable generalized estimating equations to examine associations between five types of childhood trauma and self-reported inability to access hospital care, both overall and specifically due to perceived mistreatment by hospital staff. In total, 300 participants (18.3%) reported having tried but being unable to access hospital care in the previous 6 months at some point during the study period; the primary reason was perceived mistreatment by hospital staff (32.1%). In multivariable analyses, childhood emotional abuse was independently associated with self-reported inability to access hospital care, adjusted odds ratio (AOR) = 1.51, 95% CI [1.03, 2.20]. Childhood physical neglect was also independently associated with inability to access care due to perceived mistreatment by hospital staff, AOR = 1.80, 95% CI [1.11, 2.93]. This suggests potentially damaging consequences of early trauma in adult PWID populations. Further, this study emphasizes the need for trauma-informed models of care as well as the need to improve therapeutic alliances with survivors of childhood trauma in the PWID population.

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Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users

Cited by 293 publications

References 38 publications

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

Comparing Projected Fatal Overdose Outcomes and Costs of Strategies to Expand Community-Based Distribution of Naloxone in Rhode Island

Childhood Trauma and the Inability to Access Hospital Care Among People who Inject Drugs

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