Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdose among psychologically distressed people who inject drugs?

Abstract Background With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. Methods Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering “Yes” to the question: “In the last six months, have you ever overdosed by accident? (at least once)”. We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. Results Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2–0.9). Conclusion Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.

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No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada

Addictive Behaviors ◽

10.1016/j.addbeh.2016.03.029 ◽

2016 ◽

Vol 60 ◽

pp. 8-12 ◽

Cited By ~ 4

Author(s):

Daniel J. Escudero ◽

Brandon D.L. Marshall ◽

Thomas Kerr ◽

Kanna Hayashi ◽

Cindy Feng ◽

...

Keyword(s):

People Who Inject Drugs ◽

Hiv Status ◽

Fatal Overdose

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Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast

International Journal of Drug Policy ◽

10.1016/j.drugpo.2020.102934 ◽

2020 ◽

Vol 85 ◽

pp. 102934 ◽

Cited By ~ 1

Author(s):

Pablo K. Valente ◽

Angela R. Bazzi ◽

Ellen Childs ◽

Peter Salhaney ◽

Joel Earlywine ◽

...

Keyword(s):

People Who Inject Drugs ◽

Urban Settings ◽

Polysubstance Use ◽

The U.S

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High Rate of Fatal Overdose After Release from Prison In BC, Canada: A Data Linkage Study

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1606 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Stuart A Kinner ◽

Wenqi Gan ◽

Amanda Slaunwhite

Keyword(s):

Risk Factors ◽

Target Population ◽

Linkage Study ◽

High Rate ◽

Physical And Mental Health ◽

Overdose Death ◽

Fatal Overdose ◽

Increased Risk ◽

The Impact ◽

Release From Prison

IntroductionThe province of BC, Canada is in the grips of a sustained overdose epidemic. People released from prison are at increased risk of fatal drug overdose, but the impact of the overdose epidemic on mortality after release from prison in BC is poorly understood. Few studies have been able to examine risk factors for overdose death in this population. Objectives and ApproachWe aimed to (a) measure risk of overdose-related and all-cause death in different time periods after release from prison; and (b) identify risk factors for overdose-related and all-cause death. In a random 20% sample of the population of BC, Canada, we identified those released from prison 2015-2017 and examined linked health and correctional records for this cohort. ResultsOf 6106 persons released from prison 2015-2017, 77 (1.3%) died from any cause and 48 (0.8%) died from overdose 2015-2017. The incidence of all-cause death was 16.1 (95%CI 13.7-18.8) per 1000 person years, and the incidence of overdose death was 11.2 (95%CI 9.2-13.5) per 1000 person years. Risk factors for overdose death included a history of 3 or more incarcerations (HR=3.00, 95%CI 1.67-5.39), co-occurring substance use disorder and mental illness (HR=4.73, 95%CI 2.94-7.62), chronic physical morbidity (HR=3.10, 95%CI 1.97-4.88), and being dispensed benzodiazepines (HR=3.31, 95%CI 2.27-4.84) or opioids for pain (HR=6.77, 95%CI 3.86-11.89). The incidence of fatal overdose was significantly higher in the first two weeks post-release than at any other time during follow-up. ConclusionPeople released from prison in BC are at markedly increased risk of preventable death, mainly due to overdose. As such, people transitioning from prison to the community should be a key target population for overdose prevention efforts. To be maximally effective, these efforts must go beyond provision of methadone and naloxone on release, to consider physical and mental health comorbidities, and psychosocial disadvantage.

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Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

PLoS ONE ◽

10.1371/journal.pone.0230127 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0230127

Author(s):

Megan Buresh ◽

Rachel E. Gicquelais ◽

Jacquie Astemborski ◽

Gregory D. Kirk ◽

Shruti H. Mehta ◽

...

Keyword(s):

People Who Inject Drugs ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Overdose Prevention ◽

Fatal Overdose

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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis

International Journal of Drug Policy ◽

10.1016/j.drugpo.2019.07.030 ◽

2019 ◽

Vol 73 ◽

pp. 172-184 ◽

Cited By ~ 8

Author(s):

Samantha Colledge ◽

Amy Peacock ◽

Janni Leung ◽

Sarah Larney ◽

Jason Grebely ◽

...

Keyword(s):

Systematic Review ◽

People Who Inject Drugs ◽

Meta Analysis ◽

Fatal Overdose ◽

Multi Stage

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Durable HIV Suppression Among People Who Inject Drugs From a Community-Based Cohort Study in Baltimore, Maryland, 1997–2017

American Journal of Epidemiology ◽

10.1093/aje/kwz258 ◽

2019 ◽

Vol 188 (12) ◽

pp. 2086-2096 ◽

Cited By ~ 1

Author(s):

Becky L Genberg ◽

Gregory D Kirk ◽

Jacquie Astemborski ◽

Hana Lee ◽

Noya Galai ◽

...

Keyword(s):

Cohort Study ◽

Viral Suppression ◽

People Who Inject Drugs ◽

Transition Probabilities ◽

Multinomial Logistic Regression ◽

Hiv Treatment ◽

Community Based ◽

Risk Of Death ◽

Increased Risk ◽

Durable Viral Suppression

Abstract People who inject drugs (PWID) face disparities in human immunodeficiency virus (HIV) treatment outcomes and may be less likely to achieve durable viral suppression. We characterized transitions into and out of viral suppression from 1997 to 2017 in a long-standing community-based cohort study of PWID, the AIDS Link to Intravenous Experience (ALIVE) Study, analyzing HIV-positive participants who had made a study visit in or after 1997. We defined the probabilities of transitioning between 4 states: 1) suppressed, 2) detectable, 3) lost to follow-up, and 4) deceased. We used multinomial logistic regression analysis to examine factors associated with transition probabilities, with a focus on transitions from suppression to other states. Among 1,061 participants, the median age was 44 years, 32% were female, 93% were African-American, 59% had recently injected drugs, and 28% were virologically suppressed at baseline. Significant improvements in durable viral suppression were observed over time; however, death rates remained relatively stable. In adjusted analysis, injection drug use and homelessness were associated with increased virological rebound in earlier time periods, while only age and race were associated with virological rebound in 2012–2017. Opioid use was associated with an increased risk of death following suppression in 2012–2017. Despite significant improvements in durable viral suppression, subgroups of PWID may need additional efforts to maintain viral suppression and prevent premature mortality.

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