Non-Fatal Opioid Overdose and Major Depression among Street-Recruited Young Heroin Users

Abstract

Background/Aims: Non-fatal opioid overdose (NFOO) and major depression (MD) are highly prevalent in heroin users. Many risk factors are known for NFOO, but studies in non-clinical samples on its relationship with MD are lacking. We aimed to examine this relationship in a street-recruited sample, controlling for potential well-known confounders. Methods: A cross-sectional study in 452 heroin users street-recruited by chain referral methods in three Spanish cities. Eligibility criteria were: age ≤30 years, heroin use at least 12 days in the last year and at least once in the last 3 months. Depression was assessed using the Composite International Diagnostic Interview. A precise definition of NFOO was used. Adjusted odds ratios (AORs) for the NFOO predictors were obtained by logistic regression. Results: The prevalence of NFOO and MD in the last 12 months was 9.1 and 23.2%, respectively. After adjusting for potential confounders, NFOO and MD were significantly associated (AOR 2.2; 95% CI 1.01-4.74). Other associated factors were imprisonment (AOR 4.1; 95% CI 1.4-12.1), drug injection (AOR 6.7; 95% CI 2.4-18.4) and regular use of tranquillisers/sleeping pills (AOR 2.9; 95% CI 1.16-7). Conclusions: Drug and mental health treatment facilities should consider the relationship between MD and NFOO when contacting and treating heroin users. Imprisonment, drug injection and use of tranquillisers/sleeping pills are also risk factors for NFOO.

Predictors of In-hospital Postoperative Opioid Overdose After Major Elective Operations

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Attention-Deficit Hyperactivity Disorder Symptom Status in a Mixed Gender Population of Opioid-Maintained Prison Inmates

“…But, considering the high rate of suicidal ideation (more than one third) and persisting depressive symptoms, sufficient antidepressant treatment is yet to be provided and would probably need to go beyond the scope of psychopharmacological treatment, encompassing psychotherapy and psycho-social support measures. Imprisonment in itself represents a risk factor for depression [70]. In the general population, ADHD and substance abuse have both been identified as independent risk factors for lifetime suicidal ideation [71].…”

Lethality of Opioid Overdose in a Community Cohort of Young Heroin Users

“…(5) We assumed that the annual FOR was constant during the study period, which is supported by the lack of statistical differences in the NOR between participants at baseline and those with updated information during follow-up. (6) Unfortunately, the inclusion of more independent variables in the models was not statistically possible due to the low number of deaths observed and consequent residual confounding due to uncontrolled factors such as depression [26] is possible; nevertheless, analyses were adjusted by the main sociodemographic factors and by the route of drug administration. (7) Some people classified at baseline as never having injected could have started injecting during follow-up without being detected [27].…”