Opioid-involved overdose deaths are on the rise, both nationwide and in the state of Washington. In a survey of 443 participants at syringe exchanges in Seattle, Washington, 16% had overdosed in the last year. Several factors were significantly associated in bivariate analysis: lack of permanent housing; incarceration of five or more days in the past year; gender of sex partners; sharing of syringes and other injection paraphernalia; use of speedballs (cocaine and heroin together), goofballs (methamphetamine and heroin together), buprenorphine; injection use of crack cocaine and sedatives; and use of opioids with sedatives. Adjusting for other variables in multivariate logistic regression analyses, only recent incarceration and sharing of injection materials were still significantly associated with overdose. Correctional facilities, syringe exchange programs, and other agencies serving opioid injectors should include overdose prevention components in release planning and services.
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Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC). Issue Brief: Unintentional Drug Poisoning in the United States, 2010. Accessed online Jan 4 2010 at: http://www.cdc.gov/HomeandRecreationalSafetyl/pdf/poison-issue-brief.pdf
Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. Hyattsville, MD: National Center for Health Statistics; (NCHS) 2009. (NCHS) data brief 22.
Washington State Department of Health. Poisoning and drug overdose. In: The health of Washington State. A Statewide Assessment of Health Status, Health Risks, and Health Care Services. Olympia, WA: Washington State Dept of Health; 2007.
Paulozzi LJ [CDC, US Department of Health and Human Services]. Trends in unintentional drug poisoning deaths [testimony before Subcommitee on Oversight and Investigations, Energy and Commerce Committee, US House of Representatives, October 24, 2007]. http://www.hhs.gov/asl/testify/2007/10/t20071024a.html. Accessed Nov 28 2009.
Public Health—Seattle and King County. Drug-caused death data. Data analyzed. In: Caleb B-G, ed. Alcohol and Drug Abuse Institute. Seattle: University of Washington; 2009.
United States Department of Health and Human Services. National Institute of Health. National Institute on Drug Abuse (2010). Proceedings of the Community Epidemiology Work Group. Bethesda, MD: National Institute on Drug Abuse (in press). (Note: data are based upon weighted estimates for 12 DAWN ED areas for 2007).
Werb D, Kerr T, Lai C, Montaner J, Wood E. Nonfatal overdose among a cohort of street-involved youth. J Adolesc Health. 2008; 42(3): 303–306.
Kerr T, Fairbairn N, Tyndall M, et al. Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users. Drug Alcohol Depend. 2007; 87(1): 39–45.
Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR. Heroin overdose among young injection drug users in San Francisco. Drug Alcohol Depend. 2005; 80(3): 297–302.
Coffin PO, Tracy M, Bucciarelli A, Ompad D, Vlahov D, Galea S. Identifying injection drug users at risk of nonfatal overdose. Acad Emerg Med. 2007; 14(7): 616–623.
Seal KH, Kral AH, Gee L, et al. Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998–1999. Am J Public Health. 2001; 91(11): 1842–1846.
Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. Prevalence and correlates of non-fatal overdose. Addiction. 1996; 91(3): 405–411.
Ochoa KC, Hahn JA, Seal KH, Moss AR. Overdosing among young injection drug users in San Francisco. Addict Behav. 2001; 26(3): 453–460.
Darke S, Williamson A, Ross J, Mills KL, Havard A, Teesson M. Patterns of nonfatal heroin overdose over a 3-year period: findings from the Australian treatment outcome study. J Urban Health. 2007; 84(2): 283–291.
Darke S, Williamson A, Ross J, Teesson M. Non-fatal heroin overdose, treatment exposure and client characteristics: findings from the Australian treatment outcome study (ATOS). Drug Alcohol Rev. 2005; 24(5): 425–432.
Dettmer K, Saunders B, Strang J. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. BMJ. 2001; 322(7291): 895–896.
Galea S, Worthington N, Piper TM, Nandi VV, Curtis M, Rosenthal DM. Provision of naloxone to injection drug users as an overdose prevention strategy: early evidence from a pilot study in New York City. Addict Behav. 2006; 31(5): 907–912.
Baca CT, Grant KJ. Take-home naloxone to reduce heroin death. Addiction. 2005; 100(12): 1823–1831.
Seal KH, Thawley R, Gee L, et al. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. J Urban Health. 2005; 82(2): 303–311.
Maxwell S, Bigg D, Stanczykiewicz K, Carlberg-Racich S. Prescribing naloxone to actively injecting heroin users: a program to reduce heroin overdose deaths. J Addict Dis. 2006; 25(3): 89–96.
Piper TM, Rudenstine S, Stancliff S, et al. Overdose prevention for injection drug users: lessons learned from naloxone training and distribution programs in New York City. Harm Reduct J. 2007; 4: 3.
Buajordet I, Naess AC, Jacobsen D, Brørs O. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med. 2004; 11(1): 19–23.
Yealy DM, Paris PM, Kaplan RM, Heller MB, Marini SE. The safety of prehospital naloxone administration by paramedics. Ann Emerg Med. 1990; 19(8): 902–905.
Washington State Legislature. Engrossed Senate Bill 5516 (2010). Drug Overdose Prevention. Accessed online April 1 2010 at: http://apps.leg.wa.gov/billinfo/summary.aspx?bill=5516&year=2009.
Binswanger IA, Stern MF, Deyo RA, et al. Release from prison—a high risk of death for former inmates. N Engl J Med. 2007; 356(2): 157–165.
Lloyd-Smith E, Kerr T, Zhang R, Montaner JS, Wood E. High prevalence of syringe sharing among street involved youth. Addict Res Theory. 2008; 16(4): 353–358.
Wood E, Tyndall MW, Spittal PM, et al. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS. 2002; 16(6): 941–943.
Valente TW, Vlahov D. Selective risk taking among needle exchange participants: implications for supplemental interventions. Am J Public Health. 2001; 91(3): 406–411.
Bluthenthal RN, Malik MR, Grau LE, Singer M, Marshall P, Heimer R. Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities. Addiction. 2004; 99(9): 1136–1146.
Donoghoe MC, Dolan KA, Stimson GV. Life-style factors and social circumstances of syringe sharing in injecting drug users. Br J Addict. 1992; 87(7): 993–1003.
Wood E, Tyndall MW, Stoltz J, et al. Factors associated with syringe sharing among users of a medically supervised safer injecting facility. Am J Infect Dis. 2005; 1(1): 50–54.
Frischer M, Goldberg D, Rahman M, Berney L. Mortality and survival among a cohort of drug injectors in Glasgow, 1982–1994. Addiction. 1997; 92(4): 419–427.
Kral AH, Lorvick J, Edlin BR. Sex- and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. J Acquir Immune Defic Syndr. 2000; 24(2): 162–167.
Fennema JS, Van Ameijden EJ, Van Den Hoek A, Coutinho RA. Young and recent-onset injecting drug users are at higher risk for HIV. Addiction. 1997; 92(11): 1457–1465.
Garfein RS, Doherty MC, Monterroso ER, Thomas DL, Nelson KE, Vlahov D. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 18(Suppl 1): S11–S19.
Banta-Green CJ, Jackson TR, Freng S, Hanrahan M, Albert DH, Haruff R, Kingston S, Forbes A, Miller S, Burt R, Thiede H. Recent drug abuse trends in the Seattle-King County area, June 2007 Seatle: Alcohol & Drug Abuse Institute, University of Washington, June 2007, 17 pp. Accessed online Nov 27 2009 at: http://adai.washington.edu/pubs/cewg/ban07_02.pdf.
US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. National survey on drug use and health, 2007. Washington, DC: US Dept of Health and Human Services; 2007 .
Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998; 51(3): 253–263. discussion 267–268.
Dowling-Guyer S, Johnson ME, Fisher DG, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994; 1: 383–392.
Latkin CA, Vlahov D, Anthony JC. Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users. Addiction. 1993; 88(4): 517–526.
Watters JK, Needle R, Brown BS, Weatherby N, Booth R, Williams M. The self-reporting of cocaine use. JAMA. 1992; 268(17): 2374–2375; author reply 2375–2376.
The authors thank the following individuals: David S. Harrison for his review of this article; Barbara Leigh for her comments on data analysis; Chantelle Lucas, Kevin Kogin, Joshua O’Neal, and Laura Samples for their assistance with data collection; staff at the Public Health—Seattle and King County Needle Exchange staff for facilitation during data collection, including Joe Tinsley, Adrienne Anderson, Ronnie Holt, Jason Kilgore, Paul Mollard, Kaye Ramaekers, Carrie Shriver, Phil Turner, and James Walker; and the Needle Exchange clients, for their willingness to participate in this survey. No external funding was used to support the data collection or analyses. Data collection was conducted by Public Health—Seattle and King County for the purposes of program planning.
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Jenkins, L.M., Banta-Green, C.J., Maynard, C. et al. Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges. J Urban Health 88, 118–128 (2011) doi:10.1007/s11524-010-9525-6
- Injection drug use
- Prescription opioids
- Needle exchange
- Syringe exchange