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Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths
Author(s) -
Strang John
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12904
Subject(s) - heroin , medicine , opiate , prison , psychological intervention , opioid overdose , (+) naloxone , drug overdose , poison control , psychiatry , drug , emergency medicine , opioid , psychology , criminology , receptor
Aims To describe work undertaken over a 20‐year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome. Methods Privileged‐access interviewers obtained data from non‐treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work‐force, including family as well as peers, and action research built into pilot implementation. Results Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug‐related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post‐discharge from detoxification and other in‐patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug‐using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take‐home schemes finds approximately 10% of dispensed naloxone is used in real‐life emergency situations. Conclusions Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High‐risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work‐force, but are rarely trained or given pre‐supply of naloxone. Large‐scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large‐scale randomized trials (e.g. N‐ALIVE prison‐release trial) are finally under way. Better naloxone products and better‐organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study.