Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges


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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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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Correspondence to Lindsay M. Jenkins.

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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

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  • Overdose
  • Injection drug use
  • Heroin
  • Prescription opioids
  • Opiates
  • Needle exchange
  • Syringe exchange