Abstract
BackgroundAlthough 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.MethodsData 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.ResultsThese 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%).ConclusionsExperiencing 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.
Highlights
Previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users
When asked how to manage an overdose, responses were: perform first aid (115, 45.6%); inject salt water (109, 43.2%); perform CPR (90, 35.7%); slap (105, 41.7%); administer naloxone (16, 6.3%); or take to a hospital (74, 29.4%). In these analyses, we found a history of non-fatal overdose was common among Thai injection drug users (IDU), with more than onequarter of the sample (29.8%) reporting a previous overdose event
Our findings identify the need for enhanced education for Thai IDU to prevent and manage overdoses
Summary
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. Accidental illicit drug-related overdose is a leading cause of preventable morbidity and mortality. Fatal overdose is the primary contributor to highly elevated mortality rates among injection drug users (IDU) [1,2]. According to several studies of communityrecruited IDU, non-fatal overdose is common and associated with factors including having a prior history of overdose, recent incarceration and higher-intensity forms of drug use, such as poly-drug use [3,4,5,6]. Overdose in the previous 12 months was common among 731 IDU in Sichuan province, China, and associated with daily heroin use and an injection career of at least seven years in duration [14]
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