Journal of Urban Health

, Volume 80, Issue 2, pp 189–200 | Cite as

Heroin overdose: Research and evidence-based intervention

Article

Abstract

Drug overdose is a major cause of premature death and morbidity among heroin users. This article examines recent research into heroin overdose to inform interventions that will reduce the rate of overdose death. The demographic characteristics of overdose cases are discussed, including factors associated with overdose: polydrug use, drug purity, drug tolerance, routes of administration, and suicide. Responses by heroin users at overdoses are also examined. Potential interventions to reduce the rate of overdose and overdose-related morbidity are examined in light of the emerging data in this field.

Keywords

Heroin Mortality Overdose 

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References

  1. 1.
    Fugelstad A, Annell A, Rajs J, Angren G. Mortality and causes and manner of death among drug addicts in Stockholm during the period 1981–1992. Acta Psychiatr Scand. 1997;96:169–175.PubMedGoogle Scholar
  2. 2.
    Goldstein A, Herrara J. Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up. Drug Alcohol Depend. 1995;40:139–150.CrossRefPubMedGoogle Scholar
  3. 3.
    Oppenheimer E, Tobutt C, Taylor C, Andrew T. Death and survival in a cohort of heroin addicts from London clinics: a 22 year follow-up. Addiction. 1994;89:1299–1308.CrossRefPubMedGoogle Scholar
  4. 4.
    Quaglio G, Talamini G, Lechi A, Venturini L, Lugoboni F, Mezzelani P. Study of 2708 heroin-related deaths in north-eastern Italy 1985–98 to establish main causes of death. Addiction. 2001;96:1127–1137.CrossRefPubMedGoogle Scholar
  5. 5.
    Sanchez-Carbonell X, Seus L. Ten year survival analysis of a cohort of heroin addicts in Catalonia: the EMETYST project. Addiction. 2000;95:941–948.CrossRefPubMedGoogle Scholar
  6. 6.
    Darke S, Zador D. Fatal heroin overdose: a review. Addiction. 1996;91:1765–1772.CrossRefPubMedGoogle Scholar
  7. 7.
    Sporer K. Acute heroin overdose. Ann Int Med. 1999;130:584–590.PubMedGoogle Scholar
  8. 8.
    Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences. Addiction. 2001;96:1113–1125.CrossRefPubMedGoogle Scholar
  9. 9.
    Centers for Disease Control. Heroin overdose deaths—Multnomah County, Oregon, 1993–1999. MMWR Morb Mortal Wkly Rep. 2000;49:633–636.Google Scholar
  10. 10.
    Centers for Disease Control. Unintentional opiate overdose deaths—Kings County, Washington, 1990–1999. MMWR Morb Mortal Wkly Rep. 2000;49:636–640.Google Scholar
  11. 11.
    Ochoa KC, Hahn JA, Seal KH, Moss AR. Overdosing among young injection drug users in San Francisco. Addict Behav. 2001;26:453–460.CrossRefPubMedGoogle Scholar
  12. 12.
    O’Driscoll PT, McGough J, Hagan H, Thiede H, Critchlow C, Russell AE. Predictors of accidental fatal drug overdose among a cohort of injection drug users. Am J Public Health. 2001;26:984–987.Google Scholar
  13. 13.
    Hall W, Degenhardt L, Lynskey M. Trends in opioid overdose and suicide mortality in young adults in Australia 1964–1997. Med J Aust. 1999;171:34–37.PubMedGoogle Scholar
  14. 14.
    Bennett G, Higgins D. Accidental overdose among injecting drug users in Dorset, UK. Addiction. 1999;94:1179–1190.CrossRefPubMedGoogle Scholar
  15. 15.
    Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia. I. Prevalence and correlates of non-fatal overdose. Addiction. 1996;91:405–411.CrossRefPubMedGoogle Scholar
  16. 16.
    Darke S, Ross J. Overdose risk perceptions and behaviours among heroin users in Sydney, Australia. Eur Addict Res. 1997;3:87–92.Google Scholar
  17. 17.
    Gossop M, Griffiths P, Powis B, Williamson S, Strang J. Frequency of non-fatal heroin overdose: survey of heroin users recruited in non-clinical settings. BMJ. 1996;313:402.PubMedGoogle Scholar
  18. 18.
    McGregor C, Darke S, Christie P, Ali R. Experience of non-fatal overdose among heroin users in Adelaide: circumstances and risk perception. Addiction. 1998;93:701–711.CrossRefPubMedGoogle Scholar
  19. 19.
    Swift W, Maher L, Sunjic S. Transitions between routes of heroin administration: a study of Caucasian and Indochinese heroin users in south-western Sydney, Australia. Addiction. 1999;94:71–82.CrossRefPubMedGoogle Scholar
  20. 20.
    Darke S, Sims J, McDonald S, Wickes W. Cognitive impairment among methadone maintenance patients. Addiction. 2000;95:687–695.CrossRefPubMedGoogle Scholar
  21. 21.
    Cherubin C, McCusker J, Baden M, Kavaler F, Amsel Z. The epidemiology of death in narcotic addicts. Am J Epidemiol. 1972;96:11–22.PubMedGoogle Scholar
  22. 22.
    Darke S, Ross J, Zador D, Sunjic S. Heroin-related deaths in New South Wales, Australia, 1992–1996. Drug Alcohol Depend. 2000;60:141–150.CrossRefPubMedGoogle Scholar
  23. 23.
    Frischer M, Bloor M, Goldberg D, Clark J, Green S, McKegany N. Mortality among injecting drug users: a critical reappraisal. J Epidemiol Community Health. 1993;47:59–63.PubMedCrossRefGoogle Scholar
  24. 24.
    Hall W, Darke S. Trends in opiate overdose deaths in Australia, 1979–1995. Drug Alcohol Depend. 1998;52:71–77.CrossRefPubMedGoogle Scholar
  25. 25.
    McGregor C, Ali R, Lokan R, Christie P, Darke S. Accidental fatalities among heroin users in South Australia, 1994–1997: toxicological findings and circumstances of death. Addict Res. 2002;26:335–346.CrossRefGoogle Scholar
  26. 26.
    Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances. Med J Aust. 1996;164:204–207.PubMedGoogle Scholar
  27. 27.
    Harlow KC. Patterns of rates of mortality from narcotics and cocaine overdose in Texas, 1976–1987. Public Health Rep. 1990;195:455–462.Google Scholar
  28. 28.
    Ruttenber AJ, Luke JL. Heroin-related deaths: new epidemiologic insights. Science. 1984;226:14–20.PubMedGoogle Scholar
  29. 29.
    Caplehorn JRM, Dalton SYN, Cluff MC, Petrenas AM, Retention in methadone maintenance and heroin addicts’ risk of death. Addiction. 1994;89:203–207.CrossRefPubMedGoogle Scholar
  30. 30.
    Davoli M, Perucci CA, Forastiere F,et al. Risk factors for overdose mortality: a case control study within a cohort of intravenous drug users. Int J Epidemiol.1993;22:273–277.PubMedGoogle Scholar
  31. 31.
    Fugelstad A, Rajs J, DeVerdier MG. Mortality among HIV-infected intravenous drug addicts in Stockholm in relation to methadone treatment. Addiction. 1995;90:711–716.CrossRefPubMedGoogle Scholar
  32. 32.
    Stewart D, Gossop M, Marsden J. Reductions in non-fatal overdose after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS). J Subst Abuse Treat. 2002;22:1–9.CrossRefPubMedGoogle Scholar
  33. 33.
    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.PubMedGoogle Scholar
  34. 34.
    Monforte JR. Some observations concerning blood morphine concentrations in narcotic addicts. J Forensic Sci. 1977;22:718–724.PubMedGoogle Scholar
  35. 35.
    Risser D, Honigschnabl S, Stichenwirth M, et al. Drug-related emergencies and drug-related deaths in Vienna, 1995–1997. Drug Alcohol Depend. 2001;61:307–313.CrossRefPubMedGoogle Scholar
  36. 36.
    Steentoft A, Worm K, Christenson H, Morphine concentrations in autopsy material from fatal cases after intake of morphine and/or heroin. J Forensic Sci Soc. 1988;28:87–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Gutierrez-Cebollada J, De La Torre R, Ortuno J, Garces J, Cami J. Psychotropic drug consumption and other factors associated with heroin overdose. Drug Alcohol Depend. 1994;35:169–174.CrossRefPubMedGoogle Scholar
  38. 38.
    Ruttenber AJ, Kalter HO, Santinga P. The role of ethanol abuse in the etiology of heroin-related death. J Forensic Sci. 1990;35:891–900.PubMedGoogle Scholar
  39. 39.
    Caplehorn J. Risk factors for non-HIV-related deaths among methadone maintenance patients. Eur Addict Res. 1996;2:49–52.Google Scholar
  40. 40.
    Richards RG, Reed D, Cravey RH. Death from intravenously administered narcotics: a study of 114 cases. J Forensic Sci. 1976;21:467–482.PubMedGoogle Scholar
  41. 41.
    Darke S, Ross J. The use of antidepressants among injecting drug users in Sydney, Australia. Addiction. 2000;95:407–417.CrossRefPubMedGoogle Scholar
  42. 42.
    Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999;54:155–161.CrossRefPubMedGoogle Scholar
  43. 43.
    Desmond DP, Maddux JF, Trevino A. Street heroin potency and deaths from overdose in San Antonio. Am J Drug Alcohol Abuse. 1978;5:39–49.PubMedGoogle Scholar
  44. 44.
    Risser D, Uhl A, Stichenwirth M, et al. Quality of heroin and heroin-related deaths from 1987 to 1995 in Vienna, Austria. Addiction. 2000;95:375–382.CrossRefPubMedGoogle Scholar
  45. 45.
    Coomber R. How often does the adulteration/dilution of heroin actually occur? An analysis of 228 “street” heroin samples across the UK (1995–96) and discussion of monitoring policy. Int J Durg Policy. 1997;8:178–186.Google Scholar
  46. 46.
    Coomber R. The cutting of heroin in the United States in the 1990s. J Drug Issues. 1999;29:17–36.Google Scholar
  47. 47.
    Maher L, Swift W, Dawson M. Heroin purity and composition in Sydney, Australia. Drug Alcohol Rev. 2001;20:439–448.CrossRefGoogle Scholar
  48. 48.
    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.CrossRefPubMedGoogle Scholar
  49. 49.
    Kintz P, Mangin P, Lugnier AA, Chaumont AJ. Toxicological data after heroin overdose. Hum Toxicol. 1989;8:487–489.PubMedCrossRefGoogle Scholar
  50. 50.
    Darke S, Hall W, Kaye S, Ross J, Duflou J. Hair morphine concentrations of fatal heroin overdose cases and living heroin users. Addiction. 2002;97:977–984.CrossRefPubMedGoogle Scholar
  51. 51.
    Tagliaro F, Debattisti Z, Smith FP, Marigo M. Death from heroin overdose: findings from hair analysis. Lancet. 1998;351:1923–1925.CrossRefPubMedGoogle Scholar
  52. 52.
    Kronstrand R, Grundin R, Jonsson J. Incidence of opiates, amphetamines, and cocaine in hair and blood in fatal cases of heroin overdose. Forensic Sci Int. 1998;92:29–38.CrossRefPubMedGoogle Scholar
  53. 53.
    Darke S, Kaye S, Finlay-Jones R. Drug use and injection risk-taking among prison methadone maintenance patients. Addiction. 1998;93:1169–1175.CrossRefPubMedGoogle Scholar
  54. 54.
    Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ. 1998;316:426–428.PubMedGoogle Scholar
  55. 55.
    Seymour A, Oliver JS, Black M. Drug-related deaths among recently released prisoners in the Strathelyde region of Scotland J Forensic Sci. 2000;45:649–654.PubMedGoogle Scholar
  56. 56.
    Strang J, Griffiths P, Powis B, Gossop M. Heroin chasers and heroin injectors: differences observed in a community sample in London, UK. Am J Addict. 1999;8:148–160.CrossRefPubMedGoogle Scholar
  57. 57.
    Neaigus A, Miller M, Friedman S, et al. Potential risk factors for the transition to injecting among non-injecting heroin users: a comparison of former injectors and never injectors. Addiction. 2001;96:847–860.CrossRefPubMedGoogle Scholar
  58. 58.
    Perez-Jimenez JP, Robert MS. Transitions in the route of heroin use. Eur Addict Res. 1997;3:93–98.CrossRefGoogle Scholar
  59. 59.
    Darke S, Ross J. Fatal heroin overdoses resulting from non-injecting routes of administration, NSW, Australia, 1992–1996. Addiction. 2000;95:596–599.Google Scholar
  60. 60.
    Dinwiddie SH, Reich T, Cloninger CR. Psychiatric comorbidity and suicidality among intravenous drug users. J Clin Psychiatry. 1992;53:364–369.PubMedGoogle Scholar
  61. 61.
    Darke S, Ross J. Poly drug dependence and psychiatric comorbidity among heroin injectors. Drug Alcohol Depend. 1997;48:135–141.CrossRefPubMedGoogle Scholar
  62. 62.
    Kosten TR, Rounsaville BJ. Suicidality among opioid addicts: a 2.5 year follow-up. Am J Drug Alcohol Abuse. 1998;14:357–369.Google Scholar
  63. 63.
    Hulse GK, English DR, Milne E, Holman CDJ. The quantification of mortality resulting from the regular use of illicit opiates. Addiction. 1999;94:221–229.CrossRefPubMedGoogle Scholar
  64. 64.
    Neale J. Suicidal intent in non-fatal illicit drug overdose. Addiction. 2000;95:85–93.CrossRefPubMedGoogle Scholar
  65. 65.
    Rossow I, Lauritzen G. Balancing on the edge of death: suicide attempts and life-threatening overdoses among drug addicts. Addiction. 1999;94:209–219.CrossRefPubMedGoogle Scholar
  66. 66.
    Darke S, Ross J. The relationship between suicide and overdose among methadone maintenance patients in Sydney, Australia. Addiction. 2001;96:1443–1453.CrossRefPubMedGoogle Scholar
  67. 67.
    Kjelsberg E, Winther M, Dahl AA. Overdose deaths in young substance abusers: accidents or hidden suicides. Acta Psychiatr Scand 1995;91:236–242.PubMedGoogle Scholar
  68. 68.
    Darke S, Ross J. Suicide among heroin users: rates, risk factors and methods. Addiction. 2002;97:1383–1394.CrossRefPubMedGoogle Scholar
  69. 69.
    Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia. II. Responses to overdose. Addiction. 1996;91:413–417.CrossRefPubMedGoogle Scholar
  70. 70.
    Strang J, Best D, Man L, Noble A, Gossop M. Peer-initiated overdose resuscitation: fellow drug users could be mobilised to implement resuscitation. Int J Drug Policy. 2000;11:437–445.CrossRefPubMedGoogle Scholar
  71. 71.
    Manning FJ, Ingraham LH, Derouin EM, Vaughn MS, Kukura FC, St Michel GR. Drug “overdoses” among US soldiers in Europe, 1978–1979. II. Psychological autopsies following deaths and near-deaths. Int J Addict. 1983;18:153–156.PubMedGoogle Scholar
  72. 72.
    Garriot JC, Sturner WQ. Morphine concentrations and survival periods in acute heroin fatalities. N Engl J Med. 1973;289:1276–1278.CrossRefGoogle Scholar
  73. 73.
    Nakamura GR. Toxicological assessments in acute heroin fatalities. Clin Toxicol. 1978; 13:75–87.PubMedCrossRefGoogle Scholar
  74. 74.
    Bammer G, Sengoz A. Non-fatal heroin overdoses. Med J Aust. 1994;161:572–573.PubMedGoogle Scholar
  75. 75.
    McGregor C, Ali R, Christie P, Darke S. Overdose among heroin users: evaluation of an intervention in South Australia. Addict Res. 2001;9:481–501.Google Scholar
  76. 76.
    Darke S, Hall W. The distribution of naloxone to heroin users. Addiction. 1997;92:1195–1199.CrossRefPubMedGoogle Scholar
  77. 77.
    Lenton S, Hargreaves K. 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.PubMedGoogle Scholar
  78. 78.
    Strang J, Darke S, Hall W, Farrell M, Ali R. Heroin overdose: is there a case for takehome naloxone? BMJ. 1996;312:1435.PubMedGoogle Scholar
  79. 79.
    Hunt N, Griffiths P, Southwell M, Stillwell G, Strang J. Proventing and curtailing injecting drug use: a review of opportunities for developing and delivering “route transition interventions” Drug Alcohol Rev. 1999;18:441–445.CrossRefGoogle Scholar
  80. 80.
    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;337–346.Google Scholar
  81. 81.
    Kemmesies UE. The Open Drug Scene and the Safe Injection Rooms Offers in Frankfurt am Main 1995. Frankfurt, Germany: Stadt Frankfurt/Dezernat Frauen und Gesundheit; 1999.Google Scholar
  82. 82.
    Poschadel S, Hoger R, Schnitzler J, Schreckenberg D. Evaluation der Arbeit der Drogenkonsumraume in der Bundesrepublik Deutschland. Bochum, Germany: ZEUS GmbH; 2002.Google Scholar
  83. 83.
    Ronco C, Spuhler G, Coda P, Schopfer R. Evaluation for alley-rooms I, II and II in Basel. Soc Prev Med. 1996;S58–S68.Google Scholar
  84. 84.
    Rehm J, Gschwend P, Steffen T, Gutzwiller F, Dobler-Mikola A, Uchtenhagen A. Feasibility, safety, and efficacy of injectable heroin prescription. Lancet. 2001;358:1417–1420.CrossRefPubMedGoogle Scholar
  85. 85.
    Hall W. Assessing the Population-Level Impact of the Swiss Model of Heroin Prescribing. Sydney, Australia: University of New South Wales, Sydney; 1999. National Drug and Alcohol Research Centre Technical Report 76.Google Scholar
  86. 86.
    Warner-Smith M, Darke S, Day C. Morbidity associated with non-fatal heroin overdose. Addiction. 2002;97:963–967.CrossRefPubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2003

Authors and Affiliations

  1. 1.National Drug and Alcohol Research CentreUniversity of New South WalesAustralia
  2. 2.Office of Public Policy and Ethics, Institute for Molecular BioscienceUniversity of QueenslandAustralia

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