Over the past decade fatal opioid overdose has emerged as a major public health issue internationally. This paper examines the risk factors for overdose from a biomedical perspective. While significant risk factors for opioid overdose fatality are well recognized, the mechanism of fatal overdose remains unclear. Losses of tolerance and concomitant use of alcohol and other CNS depressants clearly play a major role in fatality; however, such risk factors do not account for the strong age and gender patterns observed consistently among victims of overdose. There is evidence that systemic disease may be more prevalent in users at greatest risk of overdose. We hypothesize that pulmonary and hepatic dysfunction resulting from such disease may increase susceptibility to both fatal and non-fatal overdose. Sequelae of non-fatal overdose are recognized in the clinical literature but few epidemiological data exist describing the burden of morbidity arising from such sequelae. The potential for overdose to cause persisting morbidity is reviewed.

There appears to be extensive morbidity associated with non-fatal overdose. This is clearly an area that requires more research to document the prevalence and nature of these harms, and factors associated with them.

Background: Injecting drug use (IDU) and associated mortality appear to be increasing in many parts of the world. IDU is an important factor in HIV transmission. In estimating AIDS mortality attributable to IDU, it is important to take account of premature mortality rates from other causes to ensure that AIDS related mortality among injecting drug users (IDUs) is not overestimated. The current review provides estimates of the excess non-AIDS mortality among IDUs. Method: Searches were conducted with Medline, PsycINFO, and the Web of Science. The authors also searched reference lists of identified papers and an earlier literature review by English et al (1995). Crude mortality rates (CMRs) were derived from data on the number of deaths, period of follow up, and number of participants. In estimating the all-cause mortality, two rates were calculated: one that included all cohort studies identified in the search, and one that only included studies that reported on AIDS deaths in their cohort. This provided lower and upper mortality rates, respectively. Results: The current paper derived weighted mortality rates based upon cohort studies that included 179 885 participants, 1 219 422 person-years of observation, and 16 593 deaths. The weighted crude AIDS mortality rate from studies that reported AIDS deaths was approximately 0.78% per annum. The median estimated non-AIDS mortality rate was 1.08% per annum. Conclusions: Illicit drug users have a greatly increased risk of premature death and mortality due to AIDS forms a significant part of that increased risk; it is, however, only part of that risk. Future work needs to examine mortality rates among IDUs in developing countries, and collect data on the relation between HIV and increased mortality due to all causes among this group.T he injection of illicit drugs and the mortality and morbidity caused by their use appear to be increasing in many parts of the world.1 2 Estimating mortality related to illicit drug use is difficult 3 but such estimates are needed because injecting drug use (IDU) clearly has a substantial adverse effect on the health and wellbeing of those who engage in it. 4 5 One of the most widely discussed causes of death among injecting drug users (IDUs) is AIDS. In 2005, it was estimated that 40.3 million people were living with HIV, and that AIDS had caused 3.1 million deaths in 2005, and 25 million since 1981.6 Injecting drug use is thought to be the primary factor responsible for the spread of HIV in Eastern Europe and Central Asia.6 It can account for at least 10% of AIDS cases in many high income countries. 6Given the importance of IDU in the transmission of HIV in many areas of the world it is important to have valid estimates of AIDS mortality in this population. [7][8][9][10] In deriving these estimates it is also important to take account of the increased premature mortality rate among IDUs, which previous work has suggested is approximately 13 times that of their non-injecting peers.5 11 It is accordingly important to take account of thi...

Since 2001 the UNAIDS Secretariat has retained the responsibility for monitoring progress towards global commitments on HIV/AIDS. Key critical characteristics of the reporting system were assessed for the reporting period from 2004 to 2014 and analyses were undertaken of response rates and core indicator performance. Country submission rates ranged from 102 (53%) Member States in 2004 to 186 (96%) in 2012. There was great variance in response rates for specific indicators, with the highest response rates for treatment-related indicators. The Global AIDS reporting system has improved substantially over time and has provided key trend data on responses to the HIV epidemic, serving as the global accountability mechanism and providing reference data on the global AIDS response. It will be critical that reporting systems continue to evolve to support the monitoring of the Sustainable Development Goals, in view of ending the AIDS epidemic as a public health threat by 2030.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-016-1662-9) contains supplementary material, which is available to authorized users.

More data are needed to reliably inform trends in HIV incidence and AIDS mortality in many countries to allow an assessment of progress against national and global targets. In addition, impact evaluation studies are needed to assess the relationship between changes in incidence and mortality and the HIV response and to determine the extent to which these changes can be attributed to specific programmatic interventions.