Illicit Drug Overdose Research Articles

P.3.a.025 Metabolic syndrome in inpatients with serious mental illness

Whether or not second-generation antipsychotics (SGAs) represent an advantage over first-generation antipsychotics (FGAs) in the treatment of schizophrenia is not certain. Effectiveness studies published in the past 10 years have not unequivocally confirmed the superiority of SGAs over FGAs. We aimed to compare quality of life in patients with schizophrenia on an FGA strategy with those on an SGA strategy.In the multicentre, randomised, double-blind Neuroleptic Strategy Study (NeSSy), we recruited participants (aged 18–65 years) with schizophrenia (ICD-10: F20.X) who required treatment initiation or a change in treatment, from 14 psychiatric university hospitals and state hospitals in Germany. Double randomisation allowed for restricted selection of a treatment within each antipsychotic drug group (FGA or SGA) for an individual patient: first, patients were assigned with a random number table to two of six possible drug pairs, each pair consisting of an FGA (haloperidol [3–6 mg] or flupentixol [6–12 mg]) given orally and an SGA (aripiprazole [10–20 mg], olanzapine [10–20 mg], or quetiapine [400–800 mg]) given orally, and the investigator then selected which pair was best suited to the patient; a second, double-blind random assignment allocated either the FGA or the SGA from the investigator-chosen pair to the patient. Treatment duration was 24 weeks. Primary outcomes were change from baseline to week 24 in quality of life (SF-36) and clinical global impression (CGI-I), analysed in all randomly assigned patients who received at least one dose of the study drug. Safety was assessed in a safety set, consisting of all randomly assigned patients who received at least one dose of the study drug, coinciding with the set of the efficacy analyses. The study is registered with ClinicalTrials.gov, number NCT01164059; German Clinical Trials Register, number DRKS00000304; WHO ICTRP, number U1111–1112–9727; and EudraCT, number 2009–010966–47.Between April 1, 2010, and May 31, 2013, 149 patients were randomly assigned, 69 to FGA treatment and 80 to SGA treatment. 136 patients received at least one dose of study drug (63 in the FGA group, 73 in the SGA group). Mean area under the curve (AUC) values of SF-36 were significantly higher in the SGA group than in the FGA group (85·1 [SD 14·7] vs 79·7 [17·3], p=0·0112). Mean AUC values for CGI-I scores decreased in both groups, but were not significantly different between the two groups (3·39 [SD 0·89] in the FGA group vs 3·26 [0·92] in the SGA group, p=0·3423). 30 (48%) of 63 patients given FGAs had at least one adverse event compared with 42 (57%) of 73 patients given an SGA (p=0·3019); the most common were nervous system disorders (18 [60%] of 30 in the FGA group vs 19 [45%] of 42 in the SGA group) and psychiatric disorders (ten [33%] vs 16 [38%]). One patient died after cessation of study drug (olanzapine), most likely as a result of an illicit drug overdose. The increase in body-mass index (BMI) was significantly higher in the SGA group than in the FGA group (p=0·0021 at week 6 and p=0·0041 at week 24).Improvement of patient-reported quality of life was significantly higher in patients with schizophrenia given SGAs than in those given FGAs, when treatment selection was individualised. This advantage, however, has to be weighed against the potential metabolic adverse effects of some SGAs.German Federal Ministry of Education and Research.

Characteristics of medication overdose presentations to the ED: how do they differ from illicit drug overdose and self-harm cases?

BackgroundMedication overdose accounts for >80% of hospital presentations for self-harm. Previous research has identified typical characteristics of medication overdose cases; however, these cases have not been well differentiated from other...

Overdose experiences among injection drug users in Bangkok, Thailand

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.

Etiological characterization of acute poisonings in the emergency department

Introduction:An investigation of emergency department (ED) poisonings was conducted to characterize poisoning demographics and evaluate correlations with select co-morbidities.Methods:The study population evaluated consisted of 649 poisoning cases admitted between 2004 and 2007 to an inner-city, level 1 emergency department.Results:Ethnicity, age, and gender had a substantial impact on the population distribution as poisoning cases were predominantly African Americans (79.9%) between 36 and 45 years old with a 1:3 male to female ratio. Intentional illicit drug overdose was the most prevalent cause of poisoning, heroin being the most frequent substance found in 35.4% (n = 230) of cases, followed by cocaine overdose at 31.7% (n = 206), concomitant heroin and cocaine overdose at 4.3% (n = 28), multiple drug poisoning at 5.5% (n = 36), and antidepressant/antipsychotic poisoning at 6% (n = 39). Significant correlations were found between heroin poisoning and asthma (F = 20.29, DF = 1, P = 0.0001), cocaine poisoning and hypertension (F = 33.34, DF = 1, P = 0.0001), and cocaine poisoning and cardiovascular disease (F = 35.34, DF = 1, P = 0.0001). A change in the pattern of illicit drug use from injection to inhalation was detected and the resulting increase of inhalation and insufflation of illicit substances may partially explain the correlation found between heroin use and asthma.Conclusions:These results provide supporting evidence that deliberate poisoning with illicit drugs remains a serious healthcare issue that significantly aggravates co-morbidities and raises treatment costs by increasing both the rate of hospitalization and hospital length of stay.

The context of illicit drug overdose deaths in British Columbia, 2006

BackgroundIllicit drug overdose deaths (IDD) relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC) in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified.MethodsIDD data was obtained through the BC Coroners Office and entered into SPSS (version 14). Fisher's exact and Pearson's χ2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates.ResultsWe identified 223 IDD in BC; 54 (24%) occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver) were older (mean age 43.9 vs. 39.2 years; p < 0.01) and more likely to be male (90.7% vs. 77.5%; p = 0.03). Provincially Aboriginal ethnicity was reported for 19 deaths; 13 (30.2%) of 43 females and 6 (3.3%) of 180 males (p = < 0.001).Cocaine was identified in 80.3%, opiates 59.6%, methadone 13.9%, methamphetamine/amphetamine 6.3%, and alcohol in 22.9% of deaths. Poly-substance use was common, 2 substances were identified in 43.8% and 3 or more in 34.5% of deaths. Opiates were more frequently identified in Vancouver compared to outside Vancouver (74.1% vs. 55.0%) p = 0.015.ConclusionCollaboration with the Coroner's office allowed us to analyze IDD in detail including place of death; cocaine, opiates and poly-substance use were commonly identified. Poly-substance use should be explored further to inform public health interventions.

The Need for an Evidence-Based Approach to Controlling Opium Production in Afghanistan

Through both scientific evaluation (1), and the wisdom of experience (2), Western nations have learned that illicit drug markets are notoriously difficult to control from the supply side. A recent World Customs Organization report found that even post-September 11 security measures have had a "negligible" impact on the influx of illicit drugs into the United States (3). In Canada, we recently observed that a 100-kg heroin seizure, Canada's largest in history, had no impact on the supply of heroin on the streets where the seizure occurred (3). The inability of law enforcement to control illicit drug markets has led to international calls for greater incorporation of scientific evidence of effectiveness into illicit drug policies (4,5). The heroin trade has serious international public health implications. In North America, injection drug use accounts for approximately one in four cases of human immunodeficiency virus (HIV), and in some areas where the virus is spreading rapidly, such as Russia, more than 80% of all HIV transmissions result from this behavior (6). In addition to HIV, hepatitis C virus is spread efficiently through the sharing of used needles, and the prevalence of hepatitis C is generally much higher than HIV among injection drug users (7). Illicit drug overdose deaths from injection drug use are also among the leading causes of mortality in many large North American cities (8). In this context, the United Nations Office on Drugs and Crime (UNODC) reported in 2006 that Afghanistan's opium poppy crops are the source of 92% of the world's supply of heroin and that this figure is projected to increase in the coming years (9). Within Afghanistan, the booming illicit drug industry makes up

Death of a female addict due to heroin and cocaine overdoses: a case report with multiparameter evaluation

This study undertook a multiparameter evaluation of the death of a 21-year-old woman known to be an abuser of heroin and cocaine. The toxicological analysis of multiple postmortem specimens such as blood and hair was carried out using liquid chromatography atmospheric pressure chemical ionization tandem mass spectrometry (LC-APCI-MS-MS). The blood specimens of the deceased showed the presence of opium components such as morphine and its glucuronides together with cocaine and benzoylecgonine. The detected xenobiotic levels probably explained the cause of her death resulting from combined action of unintentional illicit drug overdose. By analysis of four 2-cm long hair segments, a heroin-cocaine addiction for at least 8 months antemortem was able to be documented; the presence of 6-monoacetylmorphine (6-MAM), cocaine, and benzoylecgonine was demonstrated. The histopathological findings of lesions of the internal organs of the deceased were consistent with long heroin and cocaine abuse. The use of multiple parameters, such as blood and hair segments as matrices and drug metabolites such as 6-MAM, morphine, glucuronides, and benzoylecgonine as target compounds, gave a well-defined outline of her death.

Nonfatal Overdose Among a Cohort of Street-Involved Youth

Limited data exist concerning patterns of nonfatal illicit drug overdoses among street-involved youth. We therefore evaluated factors associated with nonfatal overdose among a cohort of street-involved youth in Vancouver, Canada. Our findings indicate that nonfatal overdose was common among street-involved youth in our setting, and was associated with various forms of drug use, including methamphetamine use.

C.09.01 Perspectives on how schizophrenia has impacted patient lives and those of their families

Whether or not second-generation antipsychotics (SGAs) represent an advantage over first-generation antipsychotics (FGAs) in the treatment of schizophrenia is not certain. Effectiveness studies published in the past 10 years have not unequivocally confirmed the superiority of SGAs over FGAs. We aimed to compare quality of life in patients with schizophrenia on an FGA strategy with those on an SGA strategy.In the multicentre, randomised, double-blind Neuroleptic Strategy Study (NeSSy), we recruited participants (aged 18–65 years) with schizophrenia (ICD-10: F20.X) who required treatment initiation or a change in treatment, from 14 psychiatric university hospitals and state hospitals in Germany. Double randomisation allowed for restricted selection of a treatment within each antipsychotic drug group (FGA or SGA) for an individual patient: first, patients were assigned with a random number table to two of six possible drug pairs, each pair consisting of an FGA (haloperidol [3–6 mg] or flupentixol [6–12 mg]) given orally and an SGA (aripiprazole [10–20 mg], olanzapine [10–20 mg], or quetiapine [400–800 mg]) given orally, and the investigator then selected which pair was best suited to the patient; a second, double-blind random assignment allocated either the FGA or the SGA from the investigator-chosen pair to the patient. Treatment duration was 24 weeks. Primary outcomes were change from baseline to week 24 in quality of life (SF-36) and clinical global impression (CGI-I), analysed in all randomly assigned patients who received at least one dose of the study drug. Safety was assessed in a safety set, consisting of all randomly assigned patients who received at least one dose of the study drug, coinciding with the set of the efficacy analyses. The study is registered with ClinicalTrials.gov, number NCT01164059; German Clinical Trials Register, number DRKS00000304; WHO ICTRP, number U1111–1112–9727; and EudraCT, number 2009–010966–47.Between April 1, 2010, and May 31, 2013, 149 patients were randomly assigned, 69 to FGA treatment and 80 to SGA treatment. 136 patients received at least one dose of study drug (63 in the FGA group, 73 in the SGA group). Mean area under the curve (AUC) values of SF-36 were significantly higher in the SGA group than in the FGA group (85·1 [SD 14·7] vs 79·7 [17·3], p=0·0112). Mean AUC values for CGI-I scores decreased in both groups, but were not significantly different between the two groups (3·39 [SD 0·89] in the FGA group vs 3·26 [0·92] in the SGA group, p=0·3423). 30 (48%) of 63 patients given FGAs had at least one adverse event compared with 42 (57%) of 73 patients given an SGA (p=0·3019); the most common were nervous system disorders (18 [60%] of 30 in the FGA group vs 19 [45%] of 42 in the SGA group) and psychiatric disorders (ten [33%] vs 16 [38%]). One patient died after cessation of study drug (olanzapine), most likely as a result of an illicit drug overdose. The increase in body-mass index (BMI) was significantly higher in the SGA group than in the FGA group (p=0·0021 at week 6 and p=0·0041 at week 24).Improvement of patient-reported quality of life was significantly higher in patients with schizophrenia given SGAs than in those given FGAs, when treatment selection was individualised. This advantage, however, has to be weighed against the potential metabolic adverse effects of some SGAs.German Federal Ministry of Education and Research.

It's time for Canadian community early warning systems for illicit drug overdoses

Although fatal and non-fatal overdoses represent a significant source of morbidity and mortality, current systems of surveillance and communication in Canada provide inadequate measurement of drug trends and lack a timely response to drug-related hazards. In order for an effective early warning system for illicit drug overdoses to become a reality, a number of elements will be required: real-time epidemiologic surveillance systems for illicit drug trends and overdoses, inter-agency networks for gathering data and disseminating alerts, and mechanisms for effectively and respectfully engaging with members of drug using communities. An overdose warning system in an urban area like Vancouver would ideally be imbedded within a system that monitors drug trends and overdoses by incorporating qualitative and quantitative information obtained from multiple sources. Valuable information may be collected and disseminated through community organizations and services associated with public health, emergency health services, law enforcement, medical laboratories, emergency departments, community-based organizations, research institutions and people with addiction themselves. The present paper outlines considerations and conceptual elements required to guide implementation of such systems in Canadian cities such as Vancouver.

Harm reduction by a “user-run” organization: A case study of the Vancouver Area Network of Drug Users (VANDU)

The Downtown Eastside of Vancouver has experienced ongoing epidemics of HIV infection and illicit drug overdoses since the mid 1990s. In 1997, in response to the emerging health crisis among injection drug users (IDU) and government inaction, individuals gathered in Vancouver to form a drug user-run organization. This group eventually became known as the Vancouver Area Network of Drug Users (VANDU). Because of the growing interest in drug user organizations, this case study was conducted to document the genesis, structure, and activities of VANDU. In accordance with VANDU's philosophy of “user involvement and empowerment,” we employed a community-based case study methodology to achieve these aims. The findings demonstrate that through years of activism, advocacy, and public education, VANDU has repeatedly voiced the concerns of drugs users in public and political arenas. VANDU has also performed a critical public health function by providing care and support programmes that are responsive to immediate needs of their peers. This study indicates that greater efforts should be made to promote the formation of drug user organizations, and that health authorities and policy makers should explore novel methods for incorporating the activities of drug user organizations within existing public health, education, and policy making frameworks.

Distribution of deaths by unintentional illicit drug overdose in Italy based on periodicity over time, 1984–2000

Aim: To assess whether substance-abusing people have a higher risk of dying from unintentional acute intoxication in specific periods of the year. Methods: A total of 15 792 deaths (males=14 259; females=1533) were ascertained to be due to unintentional acute intoxication by illicit drugs in Italy in the study period (1984–2000). Distribution of deaths by month was studied with circular statistics techniques, based on the maximization of mean vector length (MMVL) method. The Rayleigh test was used to verify the hypothesis of uniform distribution of the events across some relevant periods. Density estimates for significant periodicities were derived with the kernel method for circular variables. Results: Over the study period there was a steady increase in the number of deaths by overdose in Italy, affecting both genders, but more evident among males. The monthly distribution of deaths over the study period followed an uneven trend, with a slightly higher risk in the period between December and January, and in August, in both genders. The monthly distribution of deaths due to unintentional acute intoxication by illicit drugs appears influenced by non-casual oscillations following a thrice-yearly cycle, interlaced with a significantly more evident 6-monthly recurrence. Conclusions: There does seem to be a higher risk of dying from unintentional overdose in specific periods of the year. Better knowledge of the factors affecting the risk of mortality among substance-abusing people—due to changes in environmental or biological rhythms—could allow prediction of negative events, hence their prevention.

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.

Deaths by unintentional illicit drug overdose in Italy, 1984–2000

Aim: To determine whether there has been an increase in deaths by overdose in Italy, as elsewhere in the Western world, over the past fifteen years. Method: This study's conclusions are based on analysis of official data on overdose deaths attributed to illicit drug addiction and abuse (ICD-9 codes 304 and 305) from 1984 to 2000, drawn from two archives of drug abuse information: the Direzione Centrale per i Servizi Antidroga (DADE) of the Italian Ministry of the Interior (1984–2000), and the Health Statistics held at the Italian Central Statistics Institute (ISTAT) (1984–1997). Mortality rates have been calculated for both genders in the following age groups: 15–24, 25–34, and 35–44 years. Results: Official data indicate that there has been a steady increase in the number of deaths by overdose in Italy over recent 15 years. This trend has affected both genders, but is more evident among males. Over the whole period females had consistently lower overdose rates than males. In both genders the age group 35–44 was subject to the highest mortality rate increase over the study period, however, the highest overdose rates for both males and females were observed in the 25–34 age group. Consistently higher rates were witnessed in the northern regions of Italy with an overall increase across all latitudes. However, the greatest increase over the study period occurred in the South. In 5190 cases evaluated by the Italian Forensic Toxicology Group, 95.9% of deaths were attributed to heroin, but in about half of these, mixtures of three or more substances (heroin, benzodiazepines, cannabinoids, cocaine, methadone) were found in the deceased at doses that were likely to have contributed to death. Conclusions: The increase observed in the rates of death by overdose is likely to be a reflection of increased use of illicit drugs in the general population. Reporting practice by forensic pathologists might explain the extent of attribution of cause of death to heroin. Drop-out from addiction treatment is a commonly observed antecedent of fatal opioid overdose, therefore, caution is required when establishing treatment protocol for patients. Interventions that aim specifically at improving patient compliance with medical and psychiatric therapies should be favoured.

Socio-Demographic Profile and Hiv and Hepatitis C Prevalence Among Persons Who Died of a Drug Overdose

To describe the sociodemographic characteristics and HIV and Hepatitis C prevalence among persons who died of a drug overdose in the Vancouver metropolis health region in 1998. Methods: A retrospective review was conducted on all overdose death files in the Vancouver/Richmond health region reported to the Office of the Chief Coroner. The files included, autopsy, toxicology, virology, and coroner reports. External linkages were done to determine the proportion of individuals on antiretro-viral treatment. Contingency analyses were conducted to determine factors associated with Hepatitis C and HIV seropositivity. Results: Data on a total of 199 deaths were obtained from the coroner's office. Of these 37 (18.6%) were female and 162 (81.4%) were male. A total of 25 (12.6%) deaths were among persons of First Nations descent and 134 (73.6%) were among chronic drug users. The median age at death was 38 years (Interquartile range [IQR]: 32–45 years). The drug most commonly responsible for overdose was heroin [89 (47.3%) deaths]. A total of 91 (45.7%) deaths were tested for HIV and 95 (47.7%) deaths were tested for HCV. Of those deaths, 28 (29.8%) were HIV-positive and 78(78.0%) were HCV-positive. Conclusion: Our analysis suggests that those dying of illicit drug overdose in Vancouver during 1998, are largely comprised of older, male, chronic injection drug users. Rates of HIV and HCV positivity are very high in this group.

Author Index for Volume 31

Regional health bodies in British Columbia (BC) issue drug alerts to the public when health risks associated with drug quality are identified, such as increased illicit drug deaths, overdoses or other harms. There is a lack of evidence-based guidelines for producing timely, effective public health alerts to mitigate these harms. This study sought to understand (1) the practices used by people who use drugs (PWUD) to assess the quality of street drugs and reduce harms from adulterants and (2) how drug alerts could be better communicated to PWUD.Guided by interpretive and descriptive methodology, this study consisted of brief questionnaires and in-depth focus groups with 32 PWUD.Findings suggest the most effective and trusted information about drug quality was primarily from: (a) trusted, reputable dealers or (b) peer-based social networks. Most PWUD thought information received through health service providers was not timely and did not discuss drug quality with them. A number of concrete guidelines were suggested by participants to improve the effectiveness of drug alert modes and methods of communication in the community, including the use of language on drug alert postings that implies harm, indicates what drug effects to look for, and suggests appropriate responses to overdose, such as the use of naloxone. Participants also emphasized the need to date posters and remove them in a timely manner so as to not desensitize the community to such alerts.Since it is difficult to control adulteration practices in an unregulated drug market, this study suggests methods of effectively producing and communicating drug alerts among PWUD to mitigate harms associated with drug use.

Heroin-related deaths in Sydney, Australia. How common are they?

The objective of this article was to determine the number of recent deaths caused by accidental illicit drug overdoses seen at the NSW Institute of Forensic Medicine, Glebe (Sydney). All Forensic cases (3559) were reviewed during the period July 1995-February 1997. Any that were classified as accidental illicit drug overdose were followed up, and demographic and toxicological data were collected for analysis. Our results found that one hundred and forty three accidental illicit drug overdoses were identified from 3359 autopsies during the 20 month data collection period (4%). Male to female ratio was 5:1, but females predominated in the methadone toxicity group. Most of the cases were under 40 years of age. Toxicological results showed that 80% of the deaths were associated with morphine (heroin) levels in the toxic range, although 91% had morphine present at some level. Only 35% of cases had significant levels of bile morphine, suggesting "chronic" usage. In many cases, multiple illicit substances and/or alcohol were thought to be important contributing factors. Cocaine was found in 13% of cases, and all of these had morphine (heroin) in their blood. Methadone was found in 13% of cases, and 13/19 had toxic levels--9/19 also had morphine in their blood. Only two cases had amphetamines or methamphetamines in their blood. The authors conclude that Heroin overdose is by far the most common cause of accidental illicit drug overdose. Those at greatest risk are naive users and those who are not tolerant. There is an urgent need for increased awareness and further education concerning the dangers of heroin use, particularly of multiple drug use (including alcohol). Only about one-third of these cases appear to be "chronic" users.

Walking Overdoses: A Re-Appraisal of Non-Fatal Illicit Drug Overdose

The increase in the number of non-fatal opioid overdoses in Melbourne, Australia has occurred concomitantly with the emergence of street heroin dealing / using areas across different parts of Melbourne. The aim of this study was to examine the social and environmental factors that contribute to the risk of illicit drug overdose in a street heroin dealing / using setting. A detailed examination of overdose experiences, and consultations with drug users, police and shop traders, suggests that the harm related to drug overdose and the factors which contribute to the risk of overdose in a street-using / dealing environment may be significantly underestimated. The clinical definition of drug overdose may underestimate the harm associated with illicit drug use. Through not fully understanding drug user's experiences of drug overdose, and thus incorrectly defining drug overdose, significant opportunities to intervene in what is a significant medical and social problem may be lost.

Methadone, methadone treatment and non-fatal overdose

This paper provides a mainly qualitative investigation of the role of methadone and methadone treatment in non-fatal illicit drug overdose. During 1997 and 1998, semi-structured interviews were conducted with 33 individuals in six hospital accident and emergency departments in two Scottish cities. The research identified four overdose situations related to methadone/methadone treatment. These were: (1) topping up a legitimate methadone prescription; (2) abusing another’s methadone prescription; (3) preferring illegal drugs to prescribed methadone; and (4) failing to obtain prescribed methadone. The implications of these findings for methadone treatment policy and practice are discussed.

Experiences of Illicit Drug Overdose: An Ethnographic Study of Emergency Hospital Attendances

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 &amp; 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.