Heroin Overdose Deaths Research Articles

Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico.

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.

Prevention programmes to reduce heroin overdose deaths

Prevention programmes to reduce heroin overdose deaths

Should heroin users be detained under a mental health act when they overdose on heroin?

Background and Objectives: Australia is in the midst of an epidemic of deaths due to overdose of heroin. More than 700 young Australians die each year because they use too much heroin, often after taking other drugs as well as heroin. A recent review of mortality among heroin users suggested that up to 25% of heroin overdose deaths could be suicides. While hundreds die each year from overdosing on heroin thousands of heroin users overdose and recover, either without specific medical help or after being treated by medical or paramedical staff or both. A common story from ambulance officers and emergency department staff is that after being treated for overdose of heroin, many, perhaps most patients, abruptly leave the scene of their treatment. This outcome means that a comprehensive assessment and management of their heroin and other drug use, and mental state is very difficult. The purpose of this paper is to review ethical arguments for detaining heroin users who overdose to enable a comprehensive assess...

Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?

Objective. Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice. Methods. The authors retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME'S) cases in which opioid overdoses contributed to the cause of death. The records of all patients who were found dead in public or private residences or died in emergency departments of reasons other than natural causes or progression of disease, are forwarded to the ME office. ME cases associated with opiate use as a cause of death were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and, when available, ethnicity. Results. There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose. Conclusions. Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.

Use of Capture-Recapture to Estimate the Prevalence of Opiate Addiction in Barcelona, Spain, 1989

It is difficult to obtain accurate prevalence estimates of opiate addiction with direct methods. The capture-recapture method has been used to estimate the prevalence of hidden populations, including opiate addicts. In this study, we applied capture-recapture, including log-linear modeling, to estimate the prevalence of opiate addicts in Barcelona, Spain. Anonymous identification data from three 1989 sources (hospital emergency rooms, treatment admissions, and heroin overdose deaths) in Barcelona were used to obtain population samples. For prevalence estimation, two strategies were followed: 1) emergency room data only, divided into trimesters; and 2) all three sources used simultaneously. Estimates based only on emergency room data were lower than estimates obtained by the simultaneous analysis of all three data sources; the latter estimates gave narrower confidence intervals (6,324-7,414 addicts), giving a prevalence for Barcelona in 1989 of between 8.5 and 9.9 opiate addicts per 1,000 residents aged 15-44 years. The estimated prevalence varied by sex and age group and was highest in males aged 15-29 years (between 17.1 and 21.2). At least 42% had contacted one or more of the services studied, although only one in seven had been admitted for treatment during 1989. Capture-recapture is the election method for prevalence estimation when direct methods are not feasible.

Street heroin potency and deaths from overdose in San Antonio.

Disagreement over the mechanism of death in so-called heroin overdose has been noted in the medical literature for more than a decade. We studied the relationship between the potency of street heroin and the frequency of heroin overdose deaths in San Antonio in order to test the "pharmacologic overdose" hypothesis. We found a small, nonsignificant correlation (r=+.13) between monthly mean heroin dose and monthly number of heroin overdose deaths over a 5-year period. This low correlation contradicts findings of previous studies in Washington, D.C. and Atlanta, conducted over shorter periods of time, in which high positive correlations were found. The low correlation does not support the pharmacologic overdose hypothesis. Since there were confounding variables, the data do not refute the hypothesis. These variables include the use of alcohol and other depressants, hidden suicide, and reduced opioid drug tolerance due to institutional treatment.