Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017\u20132019

Shikhar Shrestha,Thomas J Stopka,Wilson R Palacios,Traci C Green,Jaclyn M W Hughto,Patricia Case,Brittni Reilly

doi:10.1186/s12954-021-00538-9

Abstract

BackgroundPeople who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities.MethodsWe conducted multiple rapid assessments among people who use drugs (PWUD) in eight MA communities using non-probability sampling (purposive, chain referral, respondent-driven) methods. We collected sociodemographic, substance use, overdose history, substance use treatment, and harm reduction services utilization data. We examined the prevalence of NFOD (lifetime and past year) and identified factors associated with NFOD through multivariable logistic regression analyses in a subset of 469 study participants between 2017 and 2019.ResultsThe prevalence of lifetime and last year non-fatal opioid overdose was 62.5% and 36.9%, respectively. Many of the study participants reported heroin (64%) and fentanyl (45%) use during the 30 days preceding the survey. Nonprescription buprenorphine and fentanyl use were independently associated with higher odds of lifetime NFOD, while marijuana use was associated with lower odds of lifetime NFOD (p < 0.05). Injection as the route of administration, benzodiazepine, nonprescription buprenorphine, heroin, and fentanyl use were independently associated with higher odds, while methadone use was associated with lower odds of past year NFOD (p < 0.05).ConclusionWe documented a high prevalence of past year and lifetime NFOD among PWUD in MA. Our findings provide indicators that can help inform interventions to prevent overdoses among PWUD, including overdose prevention, medication treatment, and naloxone distribution.

Highlights

In the USA, the opioid overdose epidemic has exacted an immense cost of human life, with over 400,000 lives lost over the last two decades [1]
Increase in the prescription of prescription opioids and Shrestha et al Harm Reduct J (2021) 18:93 subsequent increase in opioid overdose deaths marked the first wave of the opioid overdose epidemic [3, 4]
After adjusting for sociodemographic variables, random effects of site, and other factors, we found that nonprescription buprenorphine use and fentanyl use were significantly and independently associated with higher odds of a history lifetime non-fatal overdose (NFOD), while marijuana use was negatively and independently associated with a NFOD history (Table 3)

Summary

Introduction

In the USA, the opioid overdose epidemic has exacted an immense cost of human life, with over 400,000 lives lost over the last two decades [1]. Increase in the prescription of prescription opioids and Shrestha et al Harm Reduct J (2021) 18:93 subsequent increase in opioid overdose deaths marked the first wave of the opioid overdose epidemic [3, 4]. It was followed by second wave of the opioid overdose epidemic, characterized by the rise in heroin use and heroin-related overdose deaths in the early to mid-2010s [4, 5]. The third wave of the opioid overdose epidemic began with the surge in illicit fentanyl-related overdose in recent years [4, 6]. People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities

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Methods

Results

Discussion

Conclusion