Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. We assessed the circumstances of witnessed heroin-related overdoses in New York City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police response was the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality.

Naloxone administration by injection drug users is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale.

Using new data collected in high emigration communities within Mexico, we explore the impact of partial family migration on children left behind in Mexico. Multivariate results suggest that households where respondents have a spouse who was a caregiver and who migrated to the USA are more likely to have at least one child with academic, behavioral, and emotional problems than non-migrant households. This finding supports efforts to decrease the need for families to cross borders either by decreasing the economic necessities for migration or by designing immigration policies aimed at decreasing the separation of families across borders and increasing family support after a caregiver's departure to the USA. The end goal of these efforts and policies is to improve children's health and well-being in communities with high levels of migration. À partir de nouvelles données collectées au Mexique auprès de communautés résidant dans des zones où la migration est très forte, nous explorons l'impact de l'émigration partielle d'une famille aux Etats-Unis sur le bien-être des enfants demeurés au Mexique. Les résultats de modèles multivariés suggèrent que les foyers ayant des répondants avec un époux qui avait plusieurs tâches parentales avant sa migration aux Etats-Unis ont plus de chance d'avoir au moins un enfant avec des problèmes au niveau académique, comportemental et émotionnel que les foyers qui ne sont pas touchés pas la migration. Ces résultats appuient les mesures visant à diminuer les besoins des familles à traverser les frontières telles la diminution des mauvaises conditions économiques qui poussent à émigrer ainsi que l'augmentation du support apporté aux familles suite au départ pour les Etats-Unis d'un parent ou de toute autre personne qui assumait beaucoup de responsabilités parentales. L'objectif ultime pour tous ces efforts et ces politiques est l'amélioration de la santé et du bien-être des enfants vivant dans des communautés à forts courants migratoires.

Naloxone, an opiate antagonist that can avert opiate overdose mortality, has only recently been prescribed to drug users in a few jurisdictions (Chicago, Baltimore, New Mexico, New York City, and San Francisco) in the United States. This report summarizes the first systematic evaluation of large-scale naloxone distribution among injection drug users (IDUs) in the United States. In 2005, we conducted an evaluation of a comprehensive overdose prevention and naloxone administration training program in New York City. One hundred twenty-two IDUs at syringe exchange programs (SEPs) were trained in Skills and Knowledge on Overdose Prevention (SKOOP), and all were given a prescription for naloxone by a physician. Participants in SKOOP were over the age of 18, current participants of SEPs, and current or former drug users. Participants completed a questionnaire that assessed overdose experience and naloxone use. Naloxone was administered 82 times; 68 (83.0%) persons who had naloxone administered to them lived, and the outcome of 14 (17.1%) overdoses was unknown. Ninety-seven of 118 participants (82.2%) said they felt comfortable to very comfortable using naloxone if indicated; 94 of 109 (86.2%) said they would want naloxone administered if overdosing. Naloxone administration by IDUs is feasible as part of a comprehensive overdose prevention strategy and may be a practicable way to reduce overdose deaths on a larger scale.

This research reassesses the role of policing and drugs in the sharp homicide decline in New York City in the 1990s. Drawing on theoretical arguments about “broken windows” policing and lethal violence associated with the diffusion of crack cocaine, we estimate the effects of measures of misdemeanor arrests and cocaine prevalence on homicide rates with pooled, cross‐sectional time‐series data for 74 New York City precincts over the 1990–1999 period. The results of mixed regression models reveal a significant negative effect of changes in misdemeanor arrests and a significant positive effect of changes in cocaine prevalence on changes in total homicide rates. Additional analyses of homicide disaggregated by weapon indicate that the effects of misdemeanor arrests and cocaine prevalence emerge for gun‐related but not for non‐gun‐related homicides. Overall, the research generally supports influential interpretations of the homicide decline in New York City but also raises questions about underlying mechanisms that warrant more inquiry in future research.

Accidental drug overdose continues to be a substantial cause of mortality for drug users. Characteristics of the neighborhood built environment may be important determinants of the likelihood of drug overdose mortality independent of individual-level factors. Using data from the New York City Office of the Chief Medical Examiner, we conducted a multilevel case control study using data on accidental overdose deaths as cases and non-overdose accidental deaths as controls. We used archival data from the New York City Housing and Vacancy Survey and the Mayor's Office of Operations to assess characteristics of neighborhood external (e.g. dilapidation of buildings) and internal (e.g. quality of utilities in houses) built environment. Multilevel analyses were used to assess the relations between the neighborhood built environment and the likelihood of overdose death. Six out of the eight characteristics of the external environment studied and three out of the six characteristics of the internal environment studied were significantly associated with the likelihood of fatal drug overdose in multilevel models after adjusting for individual-level (age, race, sex) and neighborhood-level (income, drug use) variables. Deterioration of the built environment, particularly the external environment, is associated with an increased likelihood of fatal accidental drug overdose. Disinvestment in social resources, psychosocial stressors, neighborhood differences in response to a witnessed overdose, and differences in vulnerability to the adverse consequences of drug use in different neighborhoods may explain the observed associations.

BackgroundDrug-induced and drug-related deaths have been increasing for the past decade throughout the US. In NYC, drug overdose accounts for nearly 900 deaths per year, a figure that exceeds the number of deaths each year from homicide. Naloxone, a highly effective opiate antagonist, has for decades been used by doctors and paramedics during emergency resuscitation after an opiate overdose. Following the lead of programs in Europe and the US who have successfully distributed take-home naloxone, the Overdose Prevention and Reversal Program at the Lower East Side Harm Reduction Center (LESHRC) has started providing a similar resource for opiate users in NYC. Participants in the program receive a prescription for two doses of naloxone, with refills as needed, and comprehensive training to reduce overdose risk, administer naloxone, perform rescue breathing, and call 911. As of September 2005, 204 participants have received naloxone and been trained, and 40 have revived an overdosing friend or family member. While naloxone accessibility stands as a proven life-saving measure, some opiates users at LESHRC have expressed only minimal interest in naloxone use, due to past experiences and common misconceptions.MethodsIn order to improve the naloxone distribution program two focus groups were conducted in December 2004 with 13 opiate users at LESHRC to examine knowledge about overdose and overdose prevention. The focus groups assessed participants' (i) experiences with overdose response, specifically naloxone (ii) understanding and perceptions of naloxone, (iii) comfort level with naloxone administration and (iv) feedback about increasing the visibility and desirability of the naloxone distribution program.ResultsAnalyses suggest that there is both support for and resistance to take-home naloxone, marked by enthusiasm for its potential role in reviving an overdosing individual, numerous misconceptions and negative views of its impact and use.ConclusionFocus group results will be used to increase participation in the program and reshape perceptions about naloxone among opiate users, also targeting those already prescribed naloxone to increase their comfort using it. Since NYC is advancing toward a citywide naloxone distribution program, the LESHRC program will play an important role in establishing protocol for effective and wide-reaching naloxone availability.

There was no appreciable increase in methadone-induced overdose mortality in New York City during the 1990s. Both heroin-induced overdose mortality and prescriptions of methadone increased during the same interval.