Circumstances of witnessed drug overdose in New York City: implications for intervention

Abstract

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.

Police officer attitudes towards intranasal naloxone training

“…Naloxone is an opioid antagonist that reverses the respiratory depression that occurs during an overdose. Many drug overdoses are witnessed by others and can be prevented if naloxone is used to intervene (Tracy et al, 2005;Sporer et al, 1996). For more than 40 years naloxone has been used by emergency medical personnel to reverse overdose (Clarke et al, 2005) though more recently there has been a growing trend in expanding those who can administer naloxone ranging from alternative public safety providers to community-based opioid overdose prevention programs providing naloxone (CDC, 2012;Beletsky, Rich, and Walley, 2012).…”

Attitudes of Australian Heroin Users to Peer Distribution of Naloxone for Heroin Overdose: Perspectives on Intranasal Administration

“…1,7,24 The most concerning of these included a potential increased reluctance to call an ambulance after naloxone treatment for peers, anticipated by 62% of our sample. To our knowledge such an effect has not been documented in relation to programs that have been implemented in other jurisdictions, but such an effect would need to be closely monitored in a 25 This is particularly important in situations where drugs other than heroin may be involved as there is evidence that more obtunded patients (e.g., alcohol affected) may require larger naloxone doses for successful resuscitation.…”

“…However, research has shown wide variation in both the nature and extent of peer responses at such events, in part because of reported fears of police involvement. 1,[5][6][7] Naloxone distribution for peer administration (hereafter referred to as peer naloxone distribution) has been suggested as a strategy to prevent fatal overdose 2,[7][8][9] and has been implemented in countries including Italy, Germany, England, and the United States. 10,11 It has been estimated that the introduction of such programs had saved more than 900 lives by February 2006.…”

Acetyl Fentanyl, a Novel Fentanyl Analog, Causes 14 Overdose Deaths in Rhode Island, March–May 2013

“…As of December 2014, 21 states and the District of Columbia have Overdose Good Samaritan Laws [40]. Rhode Island currently has an Overdose Good Samaritan Law, but citizens are not always aware of the protection and are often reluctant to alert the authorities when they witness a drug overdose because they fear prosecution [43,44].…”