Accidental and deliberate overdose among opiate addicts in methadone maintenance treatment: are deliberate overdoses systematically different?

Abstract

The frequency of accidental or deliberate overdose was investigated among 200 opiate addicts in methadone substitution treatment in clinics in Edinburgh and south London. One hundred and three of the participants reported a mean of 3.4 overdoses, with 71 (69%) reporting that their most recent overdose was accidental, 27 (26%) deliberate—the remainder were uncertain. Those whose last overdose was deliberate were more likely to have been prescribed diazepam at that time and were more depressed at the time of interview. Differentiation by self‐reported reason for overdose suggests that treatment providers should distinguish between accidental and deliberate overdose in developing overdose prevention strategies.

Intentional Overdose Among Heroin Overdose Survivors

“…Many of the studies conducted to date have not explored the meaning of deliberate or intentional to the individual, [5][6][7]10 and most (including this study) categorize overdoses as intentional or otherwise on the basis of a dichotomous question. Suicidal thought and behavior are complex, and it is possible that more sensitive questioning could reveal some level of suicidal intent, while dichotomous questioning may reveal none.…”

“…Best et al 7 found that 65% who reported a deliberate overdose had been in treatment at the time, compared to only 35% who said their overdose was accidental. Furthermore, those who reported a deliberate overdose were more likely to be depressed, but no more anxious than other participants.…”

“…Another limitation of many of these studies is that, while they may inquire about the lifetime history of overdosing, they only focus on the deliberateness of the most recent overdose. 7,9,10 Therefore, these studies may underreport the true rate of lifetime intentional overdose.…”

“…Many of the studies reviewed here have used one or the other term without investigating how participants interpret their meaning. [5][6][7]10 It is known that suicidal thinking is often characterized by ambivalence, 12 and it is possible that some people who deny "intending" to overdose were experiencing strong suicidal feelings at the time. Others who acknowledge the deliberateness of the event may in fact have had a relatively low wish actually to die from the overdose.…”

“…5 A number of previous studies have examined the prevalence of intentional overdose among heroin users and the associated risk factors. [5][6][7][8][9][10] The studies yielded differing estimates, from 1% (see Darke et al 11 ) to 49% (see Neale 9 ), of the extent to which heroin overdoses are intentional. This variation is probably a consequence of the different samples included (e.g., methadone maintenance clients vs. nontreatment samples), definitions used of nonaccidental overdose, and recall bias.…”