Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d138203e194">Aim</h5> <p id="P1">To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d138203e199">Design</h5> <p id="P2">Longitudinal study.</p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d138203e204">Setting</h5> <p id="P3">Tijuana, Mexico.</p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d138203e209">Participants</h5> <p id="P4">Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men.</p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d138203e214">Measurements</h5> <p id="P5">Primary independent variables were reported recent (i.e., past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. </p> </div><div class="section"> <a class="named-anchor" id="S6">  </a> <h5 class="section-title" id="d138203e219">Findings</h5> <p id="P6">From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin in combination with methamphetamine and tranquilizers were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event (Adjusted Odds Ratio [AOR]: 1.76; 95% Confidence Interval [CI]: 1.04–2.96). Odds of overdose also independently increased for each additional injection per day (AOR: 1.05; 95% CI: 1.02–1.08), recent tranquilizer use (AOR: 1.92; 95% CI: 1.41–2.61), and using hit doctors (AOR: 1.68; 95% CI: 1.29–2.18), and decreased with age (AOR: 0.97 per year, 95% CI: 0.95–0.99). </p> </div><div class="section"> <a class="named-anchor" id="S7">  </a> <h5 class="section-title" id="d138203e224">Conclusions</h5> <p id="P7">Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose.</p> </div>

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

Nadia Fairbairn, Keqin Kathy Li, Thomas Kerr … (2007)

Non-fatal overdose is a major determinant of morbidity among injection drug users (IDU). We sought to evaluate factors associated with non-fatal overdose among IDU in Vancouver. We examined non-fatal overdose among participants in the Vancouver Injection Drug Users Study. Correlates of non-fatal overdose occurring between 1996 and 2004 were identified using generalized estimating equations (GEE). There were 1587 participants included in this analysis, including 576 (36%) women. At baseline, 750 (47%) reported a history of non-fatal overdose. In total, 985 reports of non-fatal overdose were made during follow-up by 519 (32.7%) participants. In multivariate GEE analyses, factors independently associated with non-fatal overdose included: heroin injection (AOR=2.67), cocaine injection (AOR=2.01), benzodiazepine use (AOR=2.00), requiring help injecting (AOR=1.58), binge drug use (AOR=1.52), homelessness (AOR=1.38), alcohol use (AOR=1.32), street injecting (AOR=1.22), non-injectable opiate use (AOR=1.16), speedball use (AOR=1.15), and recent incarceration (AOR=1.14). Younger age (AOR=0.99) and methadone use (AOR=0.51) were protective. We found that non-fatal overdose was common among local IDU. Non-fatal overdose was associated with several factors that may be amenable to intervention, including opiate and stimulant use, and the characteristic of requiring help with injecting. These findings indicate the need for the ongoing development of structural interventions to address this common cause of morbidity among IDU.

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Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study.

J. Strang (2003)

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Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999.

K H Seal, A H Kral, L Gee … (2001)

This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. Of the 1427 participants, 684 (48%) had had an overdose, 466 (33%) had experienced 2 or more overdose events, and 182 (13%) had had a recent overdose. In multiple logistic regression, being younger (adjusted odds ratio [OR] for each year of increasing age = 0.95; 95% confidence interval [CI] = 0.94, 0.97), having been arrested 3 or more times in the past year (adjusted OR = 2.50; 95% CI = 1.61, 3.87), drinking 4 or more alcoholic drinks per day (adjusted OR = 2.05; 95% CI = 1.37, 3.05), and having participated in methadone detoxification during the past year (adjusted OR = 1.47; 95% CI = 1.03, 2.09) were independently associated with recent overdose. Being homeless; identifying as gay, lesbian, bisexual, or transgender; having spent 5 or more years in prison or jail; and having engaged in sex work also were associated with recent overdose. Targeted interventions that decrease risk for overdose are urgently needed.