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Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin. Drug Alcohol Depend 2022; 236:109478. [PMID: 35588609 PMCID: PMC9235402 DOI: 10.1016/j.drugalcdep.2022.109478] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fentanyl has replaced most other non-prescribed opioids in much of North America. There is controversy over whether a hypothetical reduced efficacy of naloxone in reversing fentanyl is a major contributor to the coincident rising overdose mortality. METHODS We modified an existing Markov decision analytic model of heroin overdose and naloxone distribution to account for known risks of fentanyl by adjusting overdose risk, the likelihood of death in the event of overdose, and the proportion of cases in which available naloxone was administered in time to prevent death. We assumed near-universal survival when naloxone was administered promptly for heroin or fentanyl overdose, but allowed that to decline in sensitivity analyses for fentanyl. We varied the proportion of use that was fentanyl and adjusted the modified parameters accordingly to estimate mortality as the dominant opioid shifted. RESULTS Absent naloxone, the annual overdose death rate was 1.0% and 4.1% for heroin and fentanyl, respectively. With naloxone reaching 80% of those at risk, the overdose death rate was 0.7% and 3.6% for heroin and fentanyl, respectively, representing reductions of 26.4% and 12.0%. Monte Carlo simulations resulted in overdose mortality with fentanyl of 3.3-5.2% without naloxone and 2.6-4.9% with naloxone, with 95% certainty. Positing reduced efficacy for naloxone in reversing fentanyl resulted in 3.6% of fentanyl overdose deaths being prevented by naloxone. CONCLUSIONS Heightened risk for overdose and subsequent death, alongside the time-sensitive need for naloxone administration, fully account for increased mortality when fentanyl replaces heroin, assuming optimal pharmacologic efficacy of naloxone.
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Palmer A, Higgs P, Scott N, Agius P, Maher L, Dietze P. Prevalence and correlates of simultaneous, multiple substance injection (co-injection) among people who inject drugs in Melbourne, Australia. Addiction 2021; 116:876-888. [PMID: 32770761 DOI: 10.1111/add.15217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 08/02/2020] [Indexed: 01/30/2023]
Abstract
AIMS To estimate the prevalence of and risk factors associated with concurrent injection of multiple substances (co-injection) among a community-recruited cohort of people who inject drugs. DESIGN Cross-sectional study. SETTING Melbourne, Australia. PARTICIPANTS A sample of 720 actively injecting participants from the Melbourne Injecting Drug User Cohort Study (33% female) was extracted. MEASUREMENTS We constructed two statistical models: a logistic regression model analysing correlates of co-injection of any substance combination in the past month and a multinomial logistic regression model analysing correlates of three mutually exclusive groups: heroin-diphenhydramine co-injection only, co-injection of other substances and no co-injection. Risk factors examined included drug use characteristics, demographic characteristics, health service use, hepatitis C status, injection risk behaviours and previous experience of non-fatal overdose. FINDINGS One-third [n = 226, 31%; 95% confidence interval (CI): 28-34%] of participants reported co-injecting substances within the past month, with equal numbers of participants reporting injecting combinations of heroin-diphenhydramine (n = 121, 54%; 95% CI = 48-60%) and heroin-methamphetamine (n = 121, 54%; 95% CI = 48-60%). In logistic regression analyses, reporting co-injection of any substance combination was associated with male sex [adjusted odds ratio (aOR) = 1.80, 95% CI = 1.18-2.74, P = 0.006] and injecting daily or more frequently (aOR = 2.04, 95% CI = 1.31-3.18, P = 0.002). In multinomial logistic regression analyses, participants reporting heroin-diphenhydramine co-injection only were significantly more likely to report groin injecting [adjusted relative risk ratio (aRRR) = 6.16, 95% CI = 2.80-13.56, P < 0.001] and overdose (requiring an ambulance) in the past 12 months (aRRR = 2.81, 95% CI = 1.17-6.72, P = 0.021) compared with participants reporting no co-injection or co-injection of other substances. CONCLUSIONS A substantial proportion of people who inject drugs report co-injection of multiple substances, which is associated with a range of socio-demographic, drug use and health service use risk factors.
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Affiliation(s)
- Anna Palmer
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Public Health, La Trobe University, Plenty Rd &, Kingsbury Dr, Bundoora, VIC, 3086, Australia
| | - Nick Scott
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Paul Agius
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Lisa Maher
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Kirby Institute for Infection and Immunity, UNSW Sydney, Level 6, Wallace Wurth Building, High Street, Kensington, NSW, 2052, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
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Peppin JF, Raffa RB, Schatman ME. The Polysubstance Overdose-Death Crisis. J Pain Res 2020; 13:3405-3408. [PMID: 33364823 PMCID: PMC7751289 DOI: 10.2147/jpr.s295715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- John F Peppin
- Department of Internal Medicine, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Robert B Raffa
- Temple University School of Pharmacy, Philadelphia, PA, USA.,University of Arizona College of Pharmacy, Tucson, AZ, USA.,Neumentum, Inc., Morristown, NJ, USA.,Enalare Therapeutics, Naples, FL, USA
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine. Drugs 2020; 79:1395-1418. [PMID: 31352603 PMCID: PMC6728289 DOI: 10.1007/s40265-019-01154-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.
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Dahlem CH, Scalera M, Chen B, McCabe SE, Boyd CJ. Impact of the take ACTION Train-the-Trainer model of opioid overdose education with naloxone distribution- who benefits? Subst Abus 2019; 41:485-492. [PMID: 31638875 DOI: 10.1080/08897077.2019.1671946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Overdose education with naloxone distribution (OEND) is a key national strategy to reduce morbidity and mortality related to opioid overdoses. Train-the-trainer model has been one method to increase the pool of trainers to facilitate greater dissemination of OEND. This exploratory study seeks to (1) evaluate participant's change in knowledge and confidence, (2) examine if pre- and post-training test outcomes differed by occupation and level of experience, and (3) determine if train-the-trainer participants trained others 6 months later. Methods: Fifteen train-the-trainer sessions were delivered to staff from community organizations who served high-risk clients in four counties whose overdose death rates ranged from 11.2 to 32.8 per 100,000. Participants were administered pre- and post-training tests from September 2017 to December 2018. A follow-up survey was conducted 6 months post-training to evaluate outcomes. Final paired pre-and post-training surveys of 109 participants were used for analysis. Paired sample t-tests were used to evaluate changes in the knowledge and confidence in teaching others. One-way ANOVA compared the change scores across groups with different demographic or experiential characteristics. Kruskal-Wallis Test was used for Likert scales. Results: The one and one-half hour train-the-trainer curriculum increased participants' knowledge and confidence to teach others (p < .001). This was particularly true for participants who had no prior experience compared to those who had some experience with naloxone (p = .0003). Changes in confidence to teach others significantly improved among demographic subgroups of participants. At 6 months after completing the train-the-trainer curriculum, 14 participants had trained 243 new trainees. Conclusions: Implementing a train-the-trainer model for OEND increases knowledge and participants' confidence to teach others. This demonstrates the important potential of the train-the-trainer model to respond to the growing opioid overdose epidemic.
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Affiliation(s)
- C H Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan, USA
| | - M Scalera
- Community Mental Health Partnership of Southeast Michigan, Ann Arbor, Michigan, USA
| | - B Chen
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan, USA
| | - S E McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan, USA.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - C J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan, School of Nursing, Ann Arbor, Michigan, USA
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Yamamoto T, Dargan PI, Dines A, Yates C, Heyerdahl F, Hovda KE, Giraudon I, Sedefov R, Wood DM. Concurrent Use of Benzodiazepine by Heroin Users-What Are the Prevalence and the Risks Associated with This Pattern of Use? J Med Toxicol 2018; 15:4-11. [PMID: 30066312 DOI: 10.1007/s13181-018-0674-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Polydrug use involving heroin and benzodiazepines is common. The potential risk of additive pharmacological effects may be associated with poorer outcomes in patients who use benzodiazepines together with heroin. The aim of this study was to determine the clinical picture of patients presenting to the emergency department following acute drug toxicity involving heroin and benzodiazepines. METHODS Exposure information, clinical data and outcome of acute drug toxicity presentations were collected between 1 October 2013 and 30 September 2014 as part of the European Drug Emergencies Network (Euro-DEN) project. The database was interrogated to identify patients who had taken heroin with or without benzodiazepine(s). RESULTS A total of 1345 presentations involving acute heroin toxicity were identified: 492 had used one or more non-heroin/benzodiazepine drug and were not further considered in this study; 662 were lone heroin users and 191 had co-used heroin with one or more benzodiazepines. Co-users were more likely than lone heroin users to have reduced respiratory rate at presentation 12.7 ± 4.9 vs 13.6 ± 4.4 (p = 0.02) and require admission to hospital 18.3 vs 9.8% (p < 0.01). There were no differences in critical care admission rates 3.1 vs 3.9% (p = 0.83) or length of stay 4 h 59 min vs 5 h 32 min (p = 0.23). The 3 most common benzodiazepines were clonazepam, diazepam, and alprazolam. No differences were observed for clinical features between the three benzodiazepines. CONCLUSION This study shows that co-use of heroin and benzodiazepines is common, although the overall outcomes between co-users of heroin and benzodiazepines and heroin-only users were similar.
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Affiliation(s)
- T Yamamoto
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - P I Dargan
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Dines
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK
| | - C Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, Mallorca, Spain
| | - F Heyerdahl
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - K E Hovda
- The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical Division, Oslo University Hospital, Oslo, Norway
| | - I Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - R Sedefov
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - D M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK. .,Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Popova S, Rehm J, Patra J. Illegal Drug-Attributable Mortality and Potential Years of Life Lost in Canada 2002: Implications for Prevention and Policy. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/009145090603300302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The article estimates the deaths and years of life lost due to use of illegal drugs in Canada in the year 2002. In 2002, for Canada, 1,695 deaths were attributable to illegal drug use, 0.8% of all deaths: 1,183 of men (1.0%) and 512 in women (0.5%). Main causes of illegal drug use-attributable death were drug overdose, suicide, and hepatitis C. In 2002 in total, 62,110 years of life were lost prematurely, 42,306 years among men and 19,805 years among women. Illegal drug use constitutes a major contributor to the burden of mortality in Canada. A mixture of prevention and harm reduction measures is proposed to reduce the burden of mortality associated with drug use.
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Dahlem CHG, King L, Anderson G, Marr A, Waddell JE, Scalera M. Beyond rescue: Implementation and evaluation of revised naloxone training for law enforcement officers. Public Health Nurs 2017; 34:516-521. [PMID: 28983963 DOI: 10.1111/phn.12365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study describes the implementation and evaluation of revised opioid overdose prevention and education of naloxone training for law enforcement officers (LEOs) that added: (1) a recovery testimony and (2) the process for deputy-initiated referrals postnaloxone administration. DESIGN AND SAMPLE Evaluation regarding the naloxone training included a pre- and postopioid overdose knowledge surveys (N = 114) and subsequent 1-year postnaloxone training outcomes. RESULTS Pre- and posttest scores for all knowledge outcome measures were statistically significant (p < .001) with favorable comments pertaining to the recovery testimony. Out of 31 individuals who received naloxone, 6 individuals (19.4%) continue to be in treatment or received some treatment services. The most common symptoms reported were unconsciousness/unresponsiveness (40.5%), abnormal breathing patterns (24.3%), and blue lips (16.2%). The majority of the calls (65.6%) were to a residential area, and the time for naloxone revival ranged <1-10 min (M = 3.48; SD = 2.27). CONCLUSION As nearly 20% of individuals sought treatment after a LEO-initiated referral, it is recommended that other agencies consider the referral process into the training. Future research will investigate the impact of the recovery testimony in reducing the stigma of addiction.
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Affiliation(s)
| | - Lisa King
- Washtenaw County Sheriff's Office, Ann Arbor, MI, USA
| | | | | | | | - Marci Scalera
- Community Mental Health Partnership of Southeast Michigan, Ann Arbor, MI, USA
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9
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Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 46:54-60. [PMID: 28609749 DOI: 10.1016/j.drugpo.2017.05.039] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/16/2016] [Accepted: 05/12/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Illicit opioid use is associated with high rates of fatal and non-fatal opioid overdose. This study aims to compare rates of fatal and serious but non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone, and to identify risk factors for fatal opioid overdose. METHODS Opioid dependent patients treated with methadone (n=3515), buprenorphine (n=3250) or implant naltrexone (n=1461) in Western Australia for the first time between 2001 and 2010, were matched against state mortality and hospital data. Rates of fatal and non-fatal serious opioid overdoses were calculated and compared for the three treatments. Risk factors associated with fatal opioid overdose were examined using multivariate cox proportional hazard models. RESULTS No significant difference was observed between the three groups in terms of crude rates of fatal or non-fatal opioid overdoses. During the first 28days of treatment, rates of non-fatal opioid overdose were high in all three groups, as were fatal opioid overdoses in patients treated with methadone. However, no fatal opioid overdoses were observed in buprenorphine or naltrexone patients during this period. Following the first 28 days, buprenorphine was shown to be protective, particularly in terms of non-fatal opioid overdoses. After the cessation of treatment, rates of fatal and non-fatal opioid overdoses were similar between the groups, with the exception of lower rates of non-fatal opioid overdose in the naltrexone treated patients compared with the methadone treated patients. After the commencement of treatment, gender, and hospitalisations with a diagnosis of opioid poisoning, cardiovascular or mental health problems were significant predictors of subsequent fatal opioid overdose. CONCLUSIONS Rates of fatal and non-fatal opioid overdose were not significantly different in patients treated with methadone, buprenorphine or implant naltrexone. Gender and prior cause-specific hospitalisations can be used to identify patients at a high risk of fatal opioid overdose.
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Zoorob MJ, Salemi JL. Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States. Drug Alcohol Depend 2017; 173:1-9. [PMID: 28182980 DOI: 10.1016/j.drugalcdep.2016.12.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/25/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug overdose deaths have risen precipitously over the last fifteen years. Substantial geographic variation, beyond a simple rural-urban dichotomy, exists in the concentration of overdose deaths, suggesting the existence of as-yet unidentified environmental variables that predict resilience (or vulnerability) to drug overdoses. Motivated by reports highlighting the role of community fragility in the opioid epidemic, we explore whether social capital attenuates overdose death rates. METHODS We conducted an ecologic temporal trends study from 1999 to 2014 to investigate the association between mortality due to drug overdose and social capital. Data from multiple sources were compiled at the county-level to produce an analytic dataset comprising overdose mortality, social capital, and a host of potentially confounding variables indicated by the literature (N=49,664 county-years). Multinomial logistic regression was used to estimate the likelihood that a county falls in low (<4 deaths per 100,000), moderate, or high (>16 deaths per 100,000) categories of annual overdose morality. RESULTS We observed a strong and statistically significant inverse association between county-level social capital and age-adjusted mortality due to drug overdose (p<0.01). Compared to the lowest quintile of social capital, counties at the highest quintile were 83% less likely to fall in the "high-overdose" category and 75% less likely to fall in the "moderate-overdose" category. CONCLUSION This study finds large-sample evidence that social capital protects communities against drug overdose. This finding could help guide policymakers in identifying where overdose epidemics are likely to occur and how to ameliorate them.
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Affiliation(s)
- Michael J Zoorob
- Department of Government, Harvard University, 1737 Cambridge St, Cambridge, MA 02138, USA.
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA.
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Neale J, Bradford J, Strang J. Development of a proto-typology of opiate overdose onset. Addiction 2017; 112:168-175. [PMID: 27542337 DOI: 10.1111/add.13589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/15/2016] [Accepted: 08/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The time available to act is a crucial factor affecting the probable success of interventions to manage opiate overdose. We analyse opiate users' accounts of non-fatal overdose incidents to (i) construct a proto-typology of non-fatal opiate overdose onset and (ii) assess the implications for overdose management and prevention of fatalities. METHODS Re-analysis of a subset of data from a large qualitative study of non-fatal opiate overdose conducted from 1997 to 1999. Data were generated from semi-structured interviews undertaken with opiate users who had experienced a non-fatal overdose in the previous 24 hours. Forty-four participants (30 men; 14 women; aged 16-47 years) provided sufficient information for in-depth analysis. Data relating to 'memory of the moment of overdose', 'time to loss of consciousness' and 'subjective description of the overdose experience' were scrutinised using iterative categorization. FINDINGS Four types of overdose onset were identified: type A 'amnesic' (n = 8), characterized by no memory, rapid loss of consciousness and no description of the overdose experience; type B 'conscious' (n = 17), characterized by some memory, sustained consciousness and a description of the overdose in terms of feeling unwell and symptomatic; type C 'instant' (n = 14), characterized by some memory, immediate loss of consciousness and no description of the overdose experience; and type D 'enjoyable' (n = 5), characterized by some memory, rapid loss of consciousness and a description of the overdose experience as pleasant or positive. CONCLUSIONS The identification of different types of overdose onset highlights the complexity of overdose events, the need for a range of interventions and the challenges faced in managing incidents and preventing fatalities. Opiate overdose victims who retain consciousness for a sustained period and recognize the negative signs and symptoms of overdosing could summon help or self-administer naloxone, thus indicating that opiate overdose training should incorporate self-management strategies.
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Affiliation(s)
- Joanne Neale
- National Addiction Centre, King's College London, London, UK
| | - Julia Bradford
- National Addiction Centre, King's College London, London, UK
| | - John Strang
- National Addiction Centre, King's College London, London, UK
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Abstract
BACKGROUND Opioid overdoses can often be reversed with naloxone hydrochloride. Past studies on attitudes toward expanded naloxone access have surveyed drug users, family members, and providers. OBJECTIVES To explore how the general public perceives take-home or nonmedical first-responder access to naloxone to reverse opioid overdoses. Additionally, little is known about how support for expanded access is related to participant's endorsement of Individualism and Just World Belief-colloquially people getting what they deserve and deserving what they get. METHODS Lay participants completed an online survey examining concerns with and support for expanding naloxone access. Just World Belief, Individualism, and participants' dependence history were also measured. Four different hypothetical situations were considered, varying according to type of opioid (heroin versus nonmedical prescription opioid) and recipient (suburban middle class versus recent parolee). RESULTS Most participants agreed with at least some degree of expanded access. Analyses of variance indicated that type of opioid or recipient did not affect attitudes toward expansion. Pearson correlations and multiple regressions revealed that endorsement of Just World Beliefs and Individualism were associated with greater concerns with and less support for expansion. IMPORTANCE While there is general agreement with some degree of expanding naloxone access, participants' level of endorsement was influenced by their level of individualism and belief in a just world. These factors need to be considered in how to best frame messages to maximize layperson support for expansion.
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13
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Darke S, Duflou J. The toxicology of heroin-related death: estimating survival times. Addiction 2016; 111:1607-13. [PMID: 27082514 DOI: 10.1111/add.13429] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/05/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The feasibility of intervention in heroin overdose is of clinical importance. The presence of 6-monoacetyl morphine (6MAM) in the blood is suggestive of survival times of less than 20-30 minutes following heroin administration. The study aimed to determine the proportions of cases in which 6MAM was present, and compare concentrations of secondary metabolites and circumstances of death by 6MAM status. DESIGN Analysis of cases of heroin-related death presenting to the Department of Forensic Medicine Sydney, 1 January 2013-12 December 2014. SETTING Sydney, Australia. CASES A total of 145 cases. The mean age was 40.5 years and 81% were male. MEASUREMENTS Concentrations of 6MAM, free morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). Circumstances of death included bronchopneumonia, apparent sudden collapse, location and other central nervous system (CNS) depressants. FINDINGS 6MAM was detected in 43% [confidence interval (CI) = 35-51%] of cases. The median free morphine concentration of 6MAM-positive cases was more than twice that of cases without 6MAM (0.26 versus 0.12 mg/l). 6MAM-positive cases also had lower concentrations of the other major heroin metabolites: M3G (0.05 versus 0.29 mg/l), M6G (0.02 versus 0.05 mg/l) with correspondingly lower M3G/morphine (0.54 versus 2.71) and M6G/morphine (0.05 versus 0.50) ratios. Significant independent correlates of 6MAM were a higher free morphine concentration [odds ratio (OR) = 1.7], a lower M6G/free morphine ratio (OR = 0.5) and signs of apparent collapse (OR = 6.7). CONCLUSIONS In heroin-related deaths in Sydney, Australia during 2013 and 2014, 6- monoacetyl morphine was present in the blood in less than half of cases, suggesting that a minority of cases had survival times after overdose of less than 20-30 minutes. The toxicology of heroin metabolites and the circumstances of death were consistent with 6- monoacetyl morphine as a proxy for a more rapid death.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.,Department of Forensic Medicine Sydney, NSW Health Pathology, Sydney Medical School, University of Sydney, NSW, Australia
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Neale J. Experiences of Illicit Drug Overdose: An Ethnographic Study of Emergency Hospital Attendances. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145099902600308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To date there are few available data relating to drug users' views and experiences of illicit drug overdose. This paper provides in-depth information relating to the experience of overdose that might help to inform and improve prevention of the problem and responses to it. Research was conducted in five hospitals in two Scottish cities during 1997 and 1998. Data were collected from (i) semistructured interviews with 74 drug users who had overdosed in the previous 48 hours and (ii) fieldnotes written during non-participant observation in the hospital setting. Analysis was undertaken using grounded theory (Glaser & Strauss, 1967) and was assisted by the computer software package WinmaxPro. Issues considered relate to the overdose incident; subsequent recovery; treatment received; and behavior in the hospital setting. The findings are discussed and some implications for policy and practice are considered.
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Chronister KJ, Lintzeris N, Jackson A, Ivan M, Dietze PM, Lenton S, Kearley J, van Beek I. Findings and lessons learnt from implementing Australia's first health service based take-home naloxone program. Drug Alcohol Rev 2016; 37:464-471. [PMID: 27071354 DOI: 10.1111/dar.12400] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/30/2015] [Accepted: 02/05/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Opioid overdose prevention programs providing take-home naloxone have been expanding internationally. This paper summarises findings and lessons learnt from the Overdose Prevention and Emergency Naloxone Project which is the first take-home naloxone program in Australia implemented in a health care setting. METHODS The Project intervention provided education and take-home naloxone to opioid-using clients at Kirketon Road Centre and The Langton Centre in Sydney. The evaluation study examined uptake and acceptability of the intervention; participants' knowledge and attitudes regarding overdose and participants' experience in opioid overdose situations six months after the intervention. Participants completed baseline, post-training and follow-up questionnaires regarding overdose prevention and management which were analysed using repeated measures analysis of variance. RESULTS Eighty-three people participated in the intervention, with 35 (42%) completing follow-up interviews-51% reporting using naloxone with 30 overdoses successfully reversed. There were significant improvements in knowledge and attitudes immediately following training with much retained at follow-up, particularly regarding feeling informed enough (97%) and confident to inject naloxone (100%). DISCUSSION Take-home naloxone programs can be successfully implemented in Australian health settings. Barriers to uptake, such as lengthy processes and misperceptions around interest in overdose prevention, should be addressed in future program implementation.
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Affiliation(s)
- Karen J Chronister
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Division of Addiction Medicine, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Anthony Jackson
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - Mihaela Ivan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, UNSW Australia, Sydney, Australia
| | | | - Simon Lenton
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - John Kearley
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia
| | - Ingrid van Beek
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, Australia.,School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, Australia
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McAuley A, Aucott L, Matheson C. Exploring the life-saving potential of naloxone: A systematic review and descriptive meta-analysis of take home naloxone (THN) programmes for opioid users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1183-8. [DOI: 10.1016/j.drugpo.2015.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
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Jones JD, Atchison JJ, Madera G, Metz VE, Comer SD. Need and utility of a polyethylene glycol marker to ensure against urine falsification among heroin users. Drug Alcohol Depend 2015; 153:201-6. [PMID: 26051158 PMCID: PMC4509811 DOI: 10.1016/j.drugalcdep.2015.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/24/2015] [Accepted: 05/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deceptive methods of falsifying urine samples are of concern for anyone who relies on accurate urine toxicology results. A novel method to combat these efforts utilizes polyethylene glycol (PEG) markers administered orally prior to providing a urine sample. By using various PEG combinations to create a tracer capsule of unique composition, each urine sample can be matched to that individual. The goal of this study was to determine the effectiveness of using the PEG marker system among active heroin users screening for research studies. METHODS Upon each screening visit, participants (N=55) were randomized to provide an unobserved urine sample, or the PEG tracer procedure was used. LCMS analysis was used to distinguish the PEG combinations, and allowed us to provide a unique qualitative analysis of patterns of drug use (N=168, total urine specimens). RESULTS The unique composition of the tracer capsules was accurately detected in 83.5% of the urine specimens. Analyses of inconsistencies implicated a number of possible attempts at fraudulence (11.4%) and investigator/lab error (5.1%). Among this sample, the concurrent use of multiple classes of psychoactive drugs was more common than not, though concomitant drug use was often underreported. CONCLUSION Urine drug testing should be the minimum standard for obtaining information about drug use as self-report was unreliable even in a situation where there were no perceived adverse consequences for full disclosure. In cases where there are significant pressures for individuals to falsify these data, more protective collection methods such as the PEG marker system should be considered.
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Affiliation(s)
- Jermaine D Jones
- Division of Substance Abuse, New York State Psychiatric Institute/College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Jared J Atchison
- Translational Research Training Program in Addiction at City College of New York & Sophie Davis School of Biomedical Education, 160 Convent Avenue, New York, NY 10032, USA
| | - Gabriela Madera
- Division of Substance Abuse, New York State Psychiatric Institute/College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Verena E Metz
- Division of Substance Abuse, New York State Psychiatric Institute/College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
| | - Sandra D Comer
- Division of Substance Abuse, New York State Psychiatric Institute/College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA
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18
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Dahlem CHY, Horstman MJ, Williams BC. Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic. J Am Assoc Nurse Pract 2015; 28:11-8. [PMID: 25809544 DOI: 10.1002/2327-6924.12249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
Abstract
PURPOSE To describe the development, implementation, and preliminary evaluation of Opioid Overdose Response Protocol using intranasal (IN) naloxone in a homeless shelter. DATA SOURCES Opioid Overdose Response Protocol and training curriculum were developed using the Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution (OEND) flow chart, the American Heart Association (AHA) simplified adult basic life support algorithm, and resources through Harms Reduction Coalition. CONCLUSIONS Intranasal naloxone offers a safe and effective method for opioid reversal. To combat the rising incidence of opioid overdose, IN naloxone should be made available at homeless shelters and other facilities with high frequency of opioid overdose, including the training of appropriate staff. This project has demonstrated the effective training and implementation of an Opioid Overdose Response Protocol, based on feedback received from cardiopulmonary resuscitation (CPR) trained nonhealthcare staff. Nurse practitioners (NPs), with our focus on patient care, prevention, and education, are well suited to the deployment of this life-saving protocol. IMPLICATIONS FOR PRACTICE NPs are in critical positions to integrate opioid overdose prevention education and provide naloxone rescue kits in clinical practices.
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Affiliation(s)
| | - Molly J Horstman
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Section of General Internal Medicine and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Brent C Williams
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Wasted, overdosed, or beyond saving – To act or not to act? Heroin users’ views, assessments, and responses to witnessed overdoses in Malmö, Sweden. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:92-9. [DOI: 10.1016/j.drugpo.2014.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 02/06/2014] [Accepted: 07/11/2014] [Indexed: 11/18/2022]
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20
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Monteil-Ganiere C, Gaulier JM, Chopineaux D, Barrios L, Pineau A, Dailly É, Clément R. Fatal anoxia due to rachacha consumption: Two cases reported. Forensic Sci Int 2014; 245:e1-5. [DOI: 10.1016/j.forsciint.2014.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/13/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
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21
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Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal in Russian cities. J Med Econ 2013; 16:1051-60. [PMID: 23730942 DOI: 10.3111/13696998.2013.811080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of distributing naloxone to illicit opioid users for lay overdose reversal in Russian cities. METHOD This study adapted an integrated Markov and decision analytic model to Russian cities. The model took a lifetime, societal perspective, relied on published literature, and was calibrated to epidemiologic findings. RESULTS For each 20% of heroin users reached with naloxone distribution, the model predicted a 13.4% reduction in overdose deaths in the first 5 years and 7.6% over a lifetime; on probabilistic analysis, one death would be prevented for every 89 naloxone kits distributed (95% CI = 32-260). Naloxone distribution was cost-effective in all deterministic and probabilistic sensitivity analyses and cost-saving if resulting in a reduction in overdose events. Naloxone distribution increased costs by US$13 (95% CI = US$3-US$32) and QALYs by 0.137 (95% CI = 0.022-0.389) for an incremental cost of US$94 per QALY gained (95% CI = US$40-US$325). In a worst-case scenario where overdose was rarely witnessed and naloxone was rarely used, minimally effective, and expensive, the incremental cost was US$1987 per QALY gained. If national expenditures on drug-related HIV, tuberculosis, and criminal justice were applied to heroin users, the incremental cost was US$928 per QALY gained. CONCLUSIONS Naloxone distribution to heroin users for lay overdose reversal is highly likely to reduce overdose deaths in target communities and is robustly cost-effective, even within the constraints of this conservative model.
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Affiliation(s)
- Phillip O Coffin
- Substance Use Research Unit, San Francisco Department of Public Health, San Francisco, CA, USA
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22
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Distribution of opiates in femoral blood and vitreous humour in heroin/morphine-related deaths. Forensic Sci Int 2013; 226:152-9. [DOI: 10.1016/j.forsciint.2013.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 11/28/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
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Gjersing L, Jonassen KV, Biong S, Ravndal E, Waal H, Bramness JG, Clausen T. Diversity in causes and characteristics of drug-induced deaths in an urban setting. Scand J Public Health 2013; 41:119-25. [PMID: 23302498 PMCID: PMC3621508 DOI: 10.1177/1403494812472007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. METHODS Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006-2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. RESULTS Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. CONCLUSIONS The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.
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Affiliation(s)
- Linn Gjersing
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
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24
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Understanding drug-related mortality in released prisoners: a review of national coronial records. BMC Public Health 2012; 12:270. [PMID: 22475069 PMCID: PMC3464778 DOI: 10.1186/1471-2458-12-270] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 04/04/2012] [Indexed: 11/21/2022] Open
Abstract
Background The prisoner population is characterised by a high burden of disease and social disadvantage, and ex-prisoners are at increased risk of death following release. Much of the excess mortality can be attributed to an increased risk of unnatural death, particularly from drug overdose; however, relatively few studies have investigated the circumstances surrounding drug-related deaths among released prisoners. This study aimed to explore and compare the circumstances of death for those who died from accidental drug-related causes to those who died from all other reportable causes. Methods A nationwide search of the Australian National Coroners Information System (NCIS) was conducted to identify reportable deaths among ex-prisoners from 2000 to 2007. Using a structured coding form, NCIS records for these cases were interrogated to explore causes and circumstances of death. Results Coronial records for 388 deceased ex-prisoners were identified. Almost half of these deaths were a result of accidental drug-related causes (45%). The majority of accidental drug-related deaths occurred in a home environment, and poly-substance use at or around the time of death was common, recorded in 72% of drug-related deaths. Ex-prisoners who died of accidental drug-related causes were on average younger and less likely to be Indigenous, born in Australia, married, or living alone at or around the time of death, compared with those who died from all other reportable causes. Evidence of mental illness or self-harm was less common among accidental drug-related deaths, whereas evidence of previous drug overdose, injecting drug use, history of heroin use and history of drug withdrawal in the previous six months were more common. Conclusions Drug-related deaths are common among ex-prisoners and often occur in a home (vs. public) setting. They are often associated with use of multiple substances at or around the time of death, risky drug-use patterns, and even among this markedly disadvantaged group, extreme social disadvantage. These findings reflect the complex challenges facing prisoners upon release from custody and indicate a need to consider drug overdose within the wider framework of ex-prisoner experiences, so that preventive programmes can be appropriately structured and targeted.
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25
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Bohnert ASB, Tracy M, Galea S. Characteristics of drug users who witness many overdoses: implications for overdose prevention. Drug Alcohol Depend 2012; 120:168-73. [PMID: 21839588 PMCID: PMC3229655 DOI: 10.1016/j.drugalcdep.2011.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs. METHODS Participants in New York City, who were age 18 and older with heroin and/or cocaine use in the past two months, were administered structured interviews (n=1184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information. RESULTS In a multivariable negative binomial regression model, those persons who were male (IRR [Incidence Rate Ratio]=1.7, CI [95% Confidence Interval]=1.4,2.2), had experienced homelessness (IRR=1.9, CI=1.4,2.6), had used heroin (IRR=2.0, CI=1.3,3.2), had overdosed themselves (IRR=1.9, CI=1.6,2.4), or had attended Narcotics Anonymous (IRR=1.3, CI=1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio]=0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses. CONCLUSIONS Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed. Individuals who have witnessed many overdoses are likely key targets of overdose response training.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, United States.
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26
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Andrews JY, Forsyth S, Wade J, Kinner SA. Sensitivity of a national coronial database for monitoring unnatural deaths among ex-prisoners in Australia. BMC Res Notes 2011; 4:450. [PMID: 22029485 PMCID: PMC3221471 DOI: 10.1186/1756-0500-4-450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 10/27/2011] [Indexed: 12/04/2022] Open
Abstract
Background The period immediately after release from custody is a time of marked vulnerability and increased risk of death for ex-prisoners. Despite this, there is currently no routine, national system for monitoring ex-prisoner mortality in Australia. This study subsequently aimed to evaluate the sensitivity of Australia's National Coroners Information System (NCIS) for identifying reportable deaths among prisoners and ex-prisoners. Findings Prisoner and ex-prisoner deaths identified through an independent search of the NCIS were compared with 'gold standard' records of prisoner and ex-prisoner deaths, generated from a national monitoring system and a state-based record linkage study, respectively. Of 294 known deaths in custody from 2001-2007, an independent search of the NCIS identified 229, giving a sensitivity of 77.9% (72.8%-82.3%). Of 677 known deaths among ex-prisoners from 2001-2007, an independent search of the NCIS identified 37, giving a sensitivity of 5.5% (4.0-7.4%). Ex-prisoner deaths that were detected were disproportionately drug-related, occurring within the first four weeks post-release, among younger prisoners and among those with more than two prior prison admissions. Conclusions Although a search of the NCIS detected the majority of reportable deaths among prisoners, it was only able to detect a small minority of reportable deaths among ex-prisoners. This suggests that the NCIS is not effective for monitoring mortality among ex-prisoners in Australia. Given the elevated rates of mortality among ex-prisoners in Australia and elsewhere, there remains an urgent need to establish a process for routine monitoring of ex-prisoner mortality, preferably through record linkage.
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Affiliation(s)
- Jessica Y Andrews
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, VIC Australia.
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Shand FL, Degenhardt L, Slade T, Nelson EC. Sex differences amongst dependent heroin users: histories, clinical characteristics and predictors of other substance dependence. Addict Behav 2011; 36:27-36. [PMID: 20833480 DOI: 10.1016/j.addbeh.2010.08.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 07/06/2010] [Accepted: 08/04/2010] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND AIMS To examine differences in the characteristics and histories of male and female dependent heroin users, and in the clinical characteristics associated with multiple substance dependence diagnoses. DESIGN AND METHODS 1513 heroin dependent participants underwent an interview covering substance use and dependence, psychiatric history, child maltreatment, family background, adult violence and criminal history. Family background, demographic and clinical characteristics were analysed by sex. Ordinal regression was used to test for a relationship between number of substance dependence diagnoses and other clinical variables. RESULTS Women were more likely to experience most forms of child maltreatment, to first use heroin with a boyfriend or partner, to experience ongoing adult violence at the hands of a partner, and to have a poorer psychiatric history than men. Males had more prevalent lifetime substance dependence diagnoses and criminal histories and were more likely to meet the criteria for ASPD. Predictors of multiple substance dependence diagnoses for both sexes were mental health variables, antisocial behaviour, childhood sexual abuse, victim of adult violence, younger age at first cannabis use and overdose. As the number of dependence diagnoses increased, clinical and behavioural problems increased. Childhood emotional neglect was related to increasing dependence diagnoses for females but not males, whereas PTSD was a significant predictor for males but not females. DISCUSSION AND CONCLUSIONS Mental health problems, other substance dependence, childhood and adult trauma were common in this sample, with sex differences indicating different treatment needs and possible different pathways to heroin dependence for men and women.
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Affiliation(s)
- Fiona L Shand
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Merrall ELC, Kariminia A, Binswanger IA, Hobbs MS, Farrell M, Marsden J, Hutchinson SJ, Bird SM. Meta-analysis of drug-related deaths soon after release from prison. Addiction 2010; 105:1545-54. [PMID: 20579009 PMCID: PMC2955973 DOI: 10.1111/j.1360-0443.2010.02990.x] [Citation(s) in RCA: 431] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The transition from prison back into the community is particularly hazardous for drug-using offenders whose tolerance for heroin has been reduced by imprisonment. Studies have indicated an increased risk of drug-related death soon after release from prison, particularly in the first 2 weeks. For precise, up-to-date understanding of these risks, a meta-analysis was conducted on the risk of drug-related death in weeks 1 + 2 and 3 + 4 compared with later 2-week periods in the first 12 weeks after release from prison. METHODS English-language studies were identified that followed up adult prisoners for mortality from time of index release for at least 12 weeks. Six studies from six prison systems met the inclusion criteria and relevant data were extracted independently. RESULTS These studies contributed a total of 69 093 person-years and 1033 deaths in the first 12 weeks after release, of which 612 were drug-related. A three- to eightfold increased risk of drug-related death was found when comparing weeks 1 + 2 with weeks 3-12, with notable heterogeneity between countries: United Kingdom, 7.5 (95% CI: 5.7-9.9); Australia, 4.0 (95% CI: 3.4-4.8); Washington State, USA, 8.4 (95% CI: 5.0-14.2) and New Mexico State, USA, 3.1 (95% CI: 1.3-7.1). Comparing weeks 3 + 4 with weeks 5-12, the pooled relative risk was: 1.7 (95% CI: 1.3-2.2). CONCLUSIONS These findings confirm that there is an increased risk of drug-related death during the first 2 weeks after release from prison and that the risk remains elevated up to at least the fourth week.
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Affiliation(s)
| | - Azar Kariminia
- National Centre in HIV Epidemiology and Clinical ResearchSydney, NSW, Australia
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado at Denver School of MedicineDenver, CO, USA,Denver Health Medical CenterDenver, CO, USA
| | - Michael S Hobbs
- School of Population Health, The University of Western AustraliaCrawley, WA, Australia
| | - Michael Farrell
- National Addiction Centre, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College LondonLondon, UK
| | - John Marsden
- National Addiction Centre, Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College LondonLondon, UK
| | - Sharon J Hutchinson
- Health Protection ScotlandGlasgow, UK,Department of Statistics and Modelling Science, Strathclyde UniversityGlasgow, UK
| | - Sheila M Bird
- MRC Biostatistics UnitCambridge, UK,Department of Statistics and Modelling Science, Strathclyde UniversityGlasgow, UK
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Baldacchino A, Crome IB, Zador D, McGarrol S, Taylor A, Hutchison S, Fahey T, Hickman M, Kidd B. Recording of clinical information in a Scotland-wide drug deaths study. J Psychopharmacol 2010; 24:1289-98. [PMID: 19351800 DOI: 10.1177/0269881109103797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to analyse the nature and extent of data extracted from case files of deceased individuals in contact with services 6 months prior to drug deaths in Scotland during 2003. A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug-related deaths was undertaken, using a data linkage process. All contacts made with services in the 6 months prior to death were identified. Information on clinical and social circumstances obtained from social care, specialist drug treatment, mental health, non-statutory services, the Scottish Prison Service and Criminal Records Office was collated. More than 70% (n = 237) were seen 6 months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems, for example, ethnicity (49%), living accommodation (66%), education and income (52%) and dependent children (73%). Medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17% and life events in 26%. This paucity of information was a feature of treatment plans and progress recorded. The 237 drug deaths were not a population unknown to services. Highly relevant data were missing. Improved training to promote in-depth recording and effective monitoring may result in better understanding and reduction of drug deaths.
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Affiliation(s)
- A Baldacchino
- Centre for Addiction Research and Education Scotland (CARES), Division of Molecular and Translational Medicine, College of Medicine, Nursing and Dentistry, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK.
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30
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Milloy MJ, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Overdose experiences among injection drug users in Bangkok, Thailand. Harm Reduct J 2010; 7:9. [PMID: 20465842 PMCID: PMC2880311 DOI: 10.1186/1477-7517-7-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 05/13/2010] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. Methods Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. Results These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). Conclusions Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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Meng Z, Liu C, Hu X, Ma Y. Irregular morphine administration affects the retention but not acquisition of conditioned place preference in rats. Brain Res 2010; 1311:86-92. [DOI: 10.1016/j.brainres.2009.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 11/20/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
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Dasgupta N, Sanford C, Albert S, Wells Brason F. Opioid Drug Overdoses: A Prescription for Harm and Potential for Prevention. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609348462] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article reviews the burden of accidental poisonings from opioid overdoses in the United States, describes several current federal- and state-level prevention strategies, and illustrates several approaches taken to prevent deaths from opioid overdoses and reduce emergency department visits for chronic pain. One approach, Project Lazarus in North Carolina, is a community-based, secondary prevention program that trains medical care providers to coprescribe naloxone with opioids and provide education to patients who are at risk of opioid overdoses and to their families and peers.
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Hughes CE. Capitalising upon political opportunities to reform drug policy: A case study into the development of the Australian “Tough on Drugs-Illicit Drug Diversion Initiative”. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2009; 20:431-7. [DOI: 10.1016/j.drugpo.2008.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 11/21/2008] [Accepted: 12/07/2008] [Indexed: 11/16/2022]
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Winstock A, Sheridan J, Lovell S, Cummins M, Strang J. Availability of overdose resuscitation facilities: a survey of drug agencies in England and Wales. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.3109/14659890009053072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fatovich DM, Bartu A, Daly FFS. A PROSPECTIVE STUDY OF NON‐FATAL HEROIN OVERDOSE. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890802040773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Best D, Gossop M, Lehmann P, Harris J, Strang J. The relationship between overdose and alcohol consumption among methadone maintenance patients. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.3109/14659899909052894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hando J, Darke S, O'brien S, Maher L, Hall W. The Development of an early Warning System to Detect Trends in Illicit Drug use in Australia: The Illicit Drug Reporting System. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359808993294] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Keen J, Oliver P. Commissioning pharmacological treatments for drug users: a brief review of the evidence base. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000075906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bohnert ASB, Tracy M, Galea S. Circumstances and witness characteristics associated with overdose fatality. Ann Emerg Med 2009; 54:618-24. [PMID: 19540622 DOI: 10.1016/j.annemergmed.2009.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/22/2009] [Accepted: 05/05/2009] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Emergency physicians have an opportunity to provide overdose fatality prevention interventions to individuals at risk for experiencing or witnessing an overdose to reduce fatality. The present study uses data about the most recent overdose observed by a sample of inner-city drug users to determine the circumstances of overdose that are associated with overdose fatality. METHODS Participants (n=690) aged 18 years or older were recruited with targeted street outreach. All participants had used heroin or cocaine in the previous 2 months and had witnessed at least 1 overdose. Survey data included the circumstances of the last overdose witnessed, including actions taken, drug use behavior, the location of the event, and whether or not the overdose was fatal (the outcome measure). RESULTS One hundred fifty-two (21.7%) of the witnessed overdoses were fatal. Witness powdered cocaine use (adjusted odds ratio=1.6; 95% confidence interval [CI] 1.0 to 2.6) and injection drug history (adjusted odds ratio=0.5; 95% CI 0.3 to 0.9) were associated with the last witnessed overdose being fatal. Witnessed overdoses that occurred in public or abandoned buildings compared with homes were more likely to be fatal (adjusted odds ratio=1.9; 95% CI 1.0 to 3.5), as were overdoses in which witnesses sought outside medical help (adjusted odds ratio=1.5; 95% CI 1.0 to 2.1). CONCLUSION Future prevention interventions may fruitfully target users of powdered cocaine, drug users without a history of injecting, and individuals who use drugs in public or abandoned buildings for brief interventions on responding when witnessing an overdose to reduce mortality.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA.
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SUNJIC SANDRA, ZADOR DEBORAH. Methadone syrup-related deaths in New South Wales, Australia, 1990-95. Drug Alcohol Rev 2009. [DOI: 10.1080/09595239996275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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DARKE SHANE, ROSS JOANNE. Heroin-related deaths in regional New South Wales, 1992-96. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230096129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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DARKE SHANE, ROSS JOANNE. Heroin-related deaths in South Western Sydney, Australia, 1992-96. Drug Alcohol Rev 2009. [DOI: 10.1080/09595239996743] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lenton S, Hargreaves K. A trial of naloxone for peer administration has merit, but will the lawyers let it happen? Drug Alcohol Rev 2009; 19:365-369. [DOI: 10.1080/713659423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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BYRNE ANDREW. Nine-year follow-up of 86 consecutive patients treated with methadone in general practice, Sydney, Australia. Drug Alcohol Rev 2009. [DOI: 10.1080/713659314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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WICKES WENDYA, DARKE SHANE, ROSS JOANNE. Clobazam maintenance among methadone maintenance patients with problematic benzodiazepine use: five case studies. Drug Alcohol Rev 2009; 19:401-405. [DOI: 10.1080/713659419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Strang J, Griffiths P, Powis B, Fountain J, Williamson S, Gossop M. Which drugs cause overdose among opiate misusers? Study of personal and witnessed overdoses. Drug Alcohol Rev 2009. [DOI: 10.1080/09595239996383] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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KERR DEBRA, DIETZE PAUL, KELLY ANNEMAREE, JOLLEY DAMIEN. Improved response by peers after witnessed heroin overdose in Melbourne. Drug Alcohol Rev 2009; 28:327-30. [DOI: 10.1111/j.1465-3362.2009.00029.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maher L, Ho HT. Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia. Harm Reduct J 2009; 6:6. [PMID: 19397811 PMCID: PMC2679730 DOI: 10.1186/1477-7517-6-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/27/2009] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ethnic Vietnamese injecting drug users (IDUs) in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory. METHODS Observational fieldwork and in-depth interviews were conducted between 2001 and 2006 in neighbourhoods characterised by high proportions of Asian background IDUs and street-based drug markets. Eligibility criteria for the study were: 1) ethnic Vietnamese cultural background; 2) aged 16 years and over and; 3) injected drugs in the last 6 months. RESULTS Participants commonly attempted to treat heroin overdose by withdrawing blood (rút máu) from the body. Central to this practice are cultural beliefs about the role and function of blood in the body and its relationship to illness and health. Participants' beliefs in blood were strongly influenced by understandings of blood expressed in traditional Chinese and Vietnamese medicine. Many participants perceived Western drugs, particularly heroin, as "hot" and "strong". In overdose situations, it was commonly believed that an excessive amount of drugs (particularly heroin) entered the bloodstream and traveled to the heart, making the heart work too hard. Withdrawing blood was understood to reduce the amount of drugs in the body which in turn reduced the effects of drugs on the blood and the heart. CONCLUSION The explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and discussed.
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Affiliation(s)
- Lisa Maher
- National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Hien T Ho
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- Hanoi School of Public Health, Hanoi, Vietnam
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Abstract
AIMS This paper reviews available literature regarding the effectiveness, safety and utility of intranasal (i.n.) naloxone for the treatment of heroin overdose. METHODS Scientific literature in the form of published articles during the period January 1984 to August 2007 were identified by searching several databases including Medline, Cinahl and Embase for the following terms: naloxone, narcan, intranasal, nose. The data extracted included study design, patient selection, numbers, outcomes and adverse events. RESULTS Reports of the pharmacological investigation and administration of i.n. naloxone for heroin overdose are included in this review. Treatment of heroin overdose by administration of i.n. naloxone has been introduced as first-line treatment in some jurisdictions in North America, and is currently under investigation in Australia. CONCLUSION Currently there is not enough evidence to support i.n. naloxone as first-line intervention by paramedics for treatment of heroin overdose in the pre-hospital setting. Further research is required to confirm its clinical effectiveness, safety and utility. If proved effective, the i.n. route may be useful for drug administration in community settings (including peer-based administration), as it reduces risk of needlestick injury in a population at higher risk of blood-borne viruses. Problematically, naloxone is not manufactured currently in an ideal form for i.n. administration.
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Affiliation(s)
- Debra Kerr
- Joseph Epstein Centre for Emergency Medicine Research, The University of Melbourne, Australia.
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