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Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention

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Abstract

Heroin-related overdose is the single largest cause of accidental death in San Francisco. We examined demographic, location, nontoxicological, and toxicological characteristics of opiate overdose deaths in San Francisco, California. Medical examiner’s case files for every opioid-positive death from July 1, 1997, to June 30, 2000, were reviewed and classified as overdose deaths or other. Demographic variables were compared to two street-based studies of heroin users and to census data. From 1997 to 2000, of all heroin-related overdoses in San Francisco 47% occurred in low-income residential hotels; 36% occurred in one small central area of the city. In 68% of deaths, the victim was reportedly alone. When others were present between last ingestion of heroin and death, appropriate responses were rare. In three cases, police arrested the person who called emergency services or others present on the scene. We recommend the development of overdose response training targeted at heroin users and those close to them, including the staff of residential hotels.

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References

  1. Stephens B. Annual Report July 1, 1998–June 30, 1999. San Francisco, CA: Medical Examiner’s Office, City and County of San Francisco, California; 2000.

    Google Scholar 

  2. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network Annual Medical Examiner Data 1999. DAWN Series D-16. Rockville, MD: Dept Health and Human Services; 2000. DHHS Publication (SMA) 01-3491.

    Google Scholar 

  3. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94:961–972.

    Article  CAS  PubMed  Google Scholar 

  4. Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992—toxicological findings and circumstances. Med J Austr. 1996;164:204–207.

    CAS  Google Scholar 

  5. Hall W. Reducing the toll of opioid overdose deaths in Australia. Drug Alcohol Rev. 1999;18:213–220.

    Article  Google Scholar 

  6. Dietze P, Cantwell K, Burgess S. Bystander resuscitation attempts at heroin overdose: does it improve outcomes? Drug Alcohol Depend. 2002;67:213–218.

    Article  PubMed  Google Scholar 

  7. Strang J, Powis B, Best D, et al. Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability. Addiction. 1999;94: 199–204.

    Article  CAS  PubMed  Google Scholar 

  8. Lenton SR, Hargreaves KM. Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? Med J Aust. 2000;173: 260–263.

    CAS  PubMed  Google Scholar 

  9. Hall W. How can we reduce heroin “overdose” deaths? Med J Aust. 1996;164:197.

    CAS  PubMed  Google Scholar 

  10. Simini B. Bologna—naloxone supplied to Italian heroin addicts. Lancet. 1998;352:967–967.

    Article  Google Scholar 

  11. Title 7 Chapter 32 Part 7, Authorization to Administer Opioid Antagonists. New Mexico Register/R. Vol. 22. Commission of Public Records Administrative Law Division; 2001.

  12. Sporer KA, Firestone J, Isaacs SM. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med. 1996;3:660–667.

    Article  CAS  PubMed  Google Scholar 

  13. Darke S, Sunjic S, Zador D, Prolov T. A comparison of blood toxicology of heroin-related deaths and current heroin users in Sydney, Australia. Drug Alcohol Depend. 1997;47:45–53.

    Article  CAS  PubMed  Google Scholar 

  14. Gerostamoulos J, Staikos V, Drummer OH. Heroin-related deaths in Victoria: a review of cases for 1997 and 1998. Drug Alcohol Depend. 2001;61:123–127.

    Article  CAS  PubMed  Google Scholar 

  15. Tagliaro F, De Battisti Z, Smith FP, Marigo M. Death from heroin overdose: findings from hair analysis. Lancet. 1998;351:1923–1925.

    Article  CAS  PubMed  Google Scholar 

  16. Davidson P. Circumstances of Death: an Assessment of the Viability of Using Nontoxicological Coronial Data to Investigate Overdose Risk Factors. Perth, Australia: National Centre for Research into the Prevention of Drug Abuse; 1999.

    Google Scholar 

  17. Oxman G, Kowalski S, Drapela L et al. Heroin overdose deaths—Multnomah County, Oregon, 1993–1999. MMWR Morb Mortal Wkly Rep. 2000;49:633–636.

    Google Scholar 

  18. California Codes Government Code Sections 27490-27512.

  19. Goldberger BA, Cone EJ, Grant TM, Caplan YH, Levine BS, Smialek JE. Disposition of heroin and its metabolites in heroin-related deaths. J Anal Toxicol. 1994; 18:22–28.

    CAS  PubMed  Google Scholar 

  20. Hearn W, Walls H. Common methods in postmortem toxicology. In: Karch S, ed. Drug Abuse Handbook. Boca Raton, FL: CRC Press; 1998;890–926.

    Google Scholar 

  21. Hepler B, Isenschmid D. Specimen selection, collection, preservation, and security. In: Karch S, ed. Drug Abuse Handbook. Boca Raton, FL: CRC Press; 1998;873–889.

    Google Scholar 

  22. Hahn JA, Page-Shafer K, Lum P, Ochoa K, Moss AR. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco. Hepatology. 2001;34:180–187.

    Article  CAS  PubMed  Google Scholar 

  23. Watters JK. The significance of sampling and understanding hidden populations. Drugs Soc. 1993;7:13–21.

    Google Scholar 

  24. Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Social Probl. 1989;39:416–430.

    Google Scholar 

  25. Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–1401.

    Article  CAS  PubMed  Google Scholar 

  26. US Census Bureau. Census 2000 Summary File 1 (SF 1) 100% Data, Matrices PCT12H, I, J, K, L, M, N, O. Washington, DC: Bureau of the Census; 2001.

    Google Scholar 

  27. California Department of Health Services. Consensus meeting on HIV/AIDS incidence and prevalence in California. Sacramento, CA: California Department of Health Services; 2001.

    Google Scholar 

  28. Duflou J. Classification of opioid deaths—a forensic pathologist’s perspective. Paper presented at: International Opioid Overdose Symposium; August 14–15, 1997; Sydney, Australia.

  29. Hardman J, Limbird L, Molinoff P, Ruddon R, Gilman A eds. Goodman and Gilman’s the Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill; 1996.

    Google Scholar 

  30. San Francisco Administrative Code, Chapter 41D, Residential Hotel Visitor Policies.

  31. Davidson P, Ochoa K, Hahn J, Evans J, Moss A. Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco. Addiction. 2002;97:1511–1516.

    Article  PubMed  Google Scholar 

  32. Sherman SG, Latkin CA, Gielen AC. Social factors related to syringe sharing among injecting partners: a focus on gender. Subst Use Misuse. 2001;36:2113–2136.

    Article  CAS  PubMed  Google Scholar 

  33. Fry C, Fox S, Rumbold G. Establishing safe injecting rooms in Australia: attitudes of injecting drug users. Aust N Z J Public Health. 1999;23:501–504.

    CAS  PubMed  Google Scholar 

  34. Gerlach R, Schneider W. Injecting room at INDRO, Münster, Germany: some key information and experiences—revised and updated internet version. March 7, 2002. Available at: www.indro-online.de/sir.htm. Accessed August 27, 2002.

  35. Dolan K, Kimber J, Fry C, Fitzgerald J, McDonald D, Trautmann F. Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug Alcohol Rev. 2000;19:337–346.

    Google Scholar 

  36. Broadhead R, Kerr T, Grund J, Altice F. Safer injecting facilities in North America: their place in public policy and health initiatives. J Drug Issues. 2002;32:329–356.

    Google Scholar 

  37. Dettmer K, Saunders B, Strang J. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. BMJ. 2001;322:895–896.

    Article  CAS  PubMed  Google Scholar 

  38. Bigg D. Data on take home naloxone are unclear but not condemnatory. BMJ. 2002; 324:678.

    Article  PubMed  Google Scholar 

  39. Baca C. Take home naloxone to prevent deaths from opiate overdose [rapid response]. BMJ. May 21, 2001. Available at: http://bmj.com/cgi/eletters/322/7291/895#14648. Accessed February 10, 2003.

  40. Campana M. Overdose mortality and naloxone distribution in Italy. Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.

  41. Seal KH, Kral AH, Gee L, Moore L, Lorvick J, Edlin BR. Nonfatal overdose among street-recruited injection drug users in the San Francisco Bay Area: prevalence and risk factors, 1998–1999. Presented at: Bridging the Gap in San Francisco: Harm Reduction Research, Policy and Practice; January 11–12, 2001; San Francisco, CA.

  42. Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: II. responses to overdose. Addiction. 1996;91:413–417.

    Article  CAS  PubMed  Google Scholar 

  43. Seal KH, Hammond JP, Kingsley S, et al. Providing “take-home” naloxone to injection drug users to prevent heroin overdose deaths—a feasible option? Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.

  44. Select Committee Into the Misuse of Drugs Act 1981. Finding the Right Balance: Working Together as a Community to Prevent Harm From Illicit Drugs and to Help Individuals and Families in Need. Final Report August 1998. Perth, Australia: Legislative Assembly of Western Australia; 1998.

    Google Scholar 

  45. Swarner R. Making it safe to call 911. Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; January 13–14, 2000; Seattle, WA.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California, San Francisco, Box 1306, 94143-1306, San Francisco, CA

    Peter J. Davidson,  Rachel L. McLean &  Andrew R. Moss

  2. Department of Family and Community Medicine, University of California, San Francisco, Box 1306, 94143-1306, San Francisco, CA

    Alex H. Kral

  3. City and County of San Francisco Community Substance Abuse Services, Box 1306, 94143-1306, San Francisco, CA

    Alice A. Gleghorn

  4. Prevention Sciences Group, the University of California, San Francisco, Box 1306, 94143-1306, San Francisco, CA

    Brian R. Edlin

Authors
  1. Peter J. Davidson
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  2. Rachel L. McLean
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  3. Alex H. Kral
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  4. Alice A. Gleghorn
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  5. Brian R. Edlin
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  6. Andrew R. Moss
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Correspondence to Peter J. Davidson.

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Davidson, P.J., McLean, R.L., Kral, A.H. et al. Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention. J Urban Health 80, 261–273 (2003). https://doi.org/10.1093/jurban/jtg029

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