Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: An unexplored dimension of the opioid overdose crisis

Kenny, Kathleen S.; Kolla, Gillian; Firestone, Michelle; Bannerman, Molly; Greig, Sarah; Flores, B.F.; Dodd, Zoë; Strike, Carol; Bayoumi, Ahmed M.

doi:10.1016/j.drugalcdep.2022.109539

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…Previous data suggest that PWID who witness an overdose are more likely to have an overdose event in the next six months [27]. Witnessing or experiencing an overdose may worsen feelings of both fearfulness and loneliness and has been associated with severe grief and loss responses [28][29][30]. Symptoms of fearfulness and loneliness are not specific to depressive disorders and may also be present in those with anxiety disorders, trauma history with post-traumatic stress disorder, and can be a symptom of worsening substance use disorder [31,32].…”

Section: Discussionmentioning

confidence: 99%

Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs

Falade-Nwulia,

Ward,

Wagner

et al. 2024

PLoS ONE

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Background People who inject drugs (PWID) experience high rates of drug overdose death with the risk of mortality increasing after each non-fatal event. Racial differences exist in drug overdose rates, with higher rates among Black people who use drugs. Psychological factors may predict drug overdose. Methods Cross-sectional data from a survey administered to PWID in Baltimore, MD enrolled in a social network-based intervention were analyzed. Linear regression methods with generalized estimating equations were used to analyze data from indexes and network members to assess for psychological factors significantly associated with self-reported number of lifetime drug overdoses. Factors associated with number of overdoses were assessed separately by race. Results Among 111 PWID enrolled between January 2018 and January 2019, 25.2% were female, 65.7% were Black, 98.2% reported use of substances in addition to opioids, and the mean age was 49.0 ± 8.3 years. Seventy-five individuals (67.6%) had a history of any overdose with a mean of 5.0 ± 9.7 lifetime overdoses reported. Reports of feeling fearful (β = 9.74, P = 0.001) or feeling lonely all of the time (β = 5.62, P = 0.033) were independently associated with number of drug overdoses. In analyses disaggregated by race, only the most severe degree of fearfulness or loneliness was associated with overdose among Black participants, whereas among White participants, any degree of fearfulness or loneliness was associated with overdose. Conclusions In this study of PWID loneliness and fearfulness were significantly related to the number of reported overdose events. These factors could be targeted in future interventions.

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Section: Discussionmentioning

confidence: 99%

Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs

Falade-Nwulia,

Ward,

Wagner

et al. 2024

PLoS ONE

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“…People with lived and living experience of substance use are the forefront of the unregulated drug poisoning emergency [ 30 , 31 ], and carry the burden of saving lives of friends, family, and other community members [ 32 ]. Responders often experience overwhelming loss, burnout, and frustration, and severe grief and loss responses are associated with experiencing or witnessing an overdose [ 32 , 33 ]. People who are exposed to overdose may exhibit symptoms of Post-Traumatic Stress Disorder and lack support and debriefing services [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Associations with experience of non-fatal opioid overdose in British Columbia, Canada: a repeated cross sectional survey study

Ferguson,

Choisil,

Lamb

et al. 2023

Harm Reduct J

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Introduction Lives lost in North America due to the unregulated drug poisoning emergency are preventable and those who survive an opioid overdose may suffer long-term disability. Rates of opioid overdose more than doubled following the onset of the COVID-19 pandemic in British Columbia, Canada. Materials and methods Our analytical sample was comprised of 1447 participants from the 2018, 2019, and 2021 Harm Reduction Client Survey who responded yes or no to having experienced an opioid overdose in the past 6 months. Participants were recruited from harm reduction sites from across British Columbia. We used logistic regression to explore associations of experiencing an opioid overdose. Results Overall, 21.8% of participants reported experiencing an opioid overdose in the last six months (18.2% in 2019 and 26.6% in 2021). The following factors were positively associated with increased adjusted odds of experiencing a non-fatal opioid overdose: cis men relative to cis women (AOR 1.49, 95% CI 1.10–2.02), unstably housed compared to people with stable housing (AOR 1.87, 95% CI 1.40–2.50), and participants from 2021 compared to those from 2019 (AOR 3.06, 95% CI 1.57–5.97). The effects of both previous experience of a stimulant overdose and having witnessed an opioid overdose depended on the year of study, with both effects decreasing over subsequent years. Conclusions Overdoses have increased over time; in 2021 more than one in four participants experienced an overdose. There is an urgent need for policy and program development to meaningfully address the unregulated drug poisoning emergency through acceptable life-saving interventions and services to prevent overdoses and support overdose survivors.

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“…Despite their long careers in the welfare services, most of the participants in this study, (Kenny et al, 2022). As such, it is reasonable to assume that most of the participants in this study who encountered clients with substance use problems also related to the DRD bereaved in their practice but without being aware of or attentive to the clients' experience of bereavement and loss.…”

Section: Bereavement Support Relies On Individualised Relationships A...mentioning

confidence: 97%

Bereavement support after a drug-related death: Professional perspectives

Reime,

Møgster,

Halvorsen

2024

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After a drug-related death, the bereaved are at risk of severe social and health consequences, but their need for professional support in their bereavement processes often falls under the radar. The bereaved themselves ask for continued support, and the research shows significant symptoms of prolonged grief for years after the loss. This article explores professionals’ perspectives on providing bereavement support to bereaved clients after a drug-related death. The article builds on focus group interviews with professionals from different health and welfare services in Norway who are likely to encounter the bereaved in their client work. A total of six focus group interviews were conducted, involving 29 professionals from services such as mental health and drug services, residential care, low threshold services, and medical services. The results show that bereavement support for the drug-death bereaved is perceived as demanding relational work that is not part of their primary work tasks. The work is highly individualised because formal organisational structures are lacking, which can impair bereaved peoples’ access to bereavement support. The lack of training, knowledge, and clear responsibility may lead to professionals lacking confidence and withdrawing from support initiatives in order to avoid stress and burnout.

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Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: An unexplored dimension of the opioid overdose crisis

Cited by 13 publications

References 30 publications

Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs

Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs

Associations with experience of non-fatal opioid overdose in British Columbia, Canada: a repeated cross sectional survey study

Bereavement support after a drug-related death: Professional perspectives

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