Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs

Caudarella, Alexander; Dong, Huiru; Milloy, M.‐J.; Kerr, Thomas; Wood, Evan; Hayashi, Kanna

doi:10.1016/j.drugalcdep.2016.02.024

Cited by 190 publications

(141 citation statements)

References 29 publications

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“…[4] Seven of thirteen Canadian provinces and territories have initiatives to expand take-home naloxone (THN) access and coverage. [2,5] Since ED visits and non-fatal ODs are markers for subsequent OD mortality, [3,6,7] EDs become an opportune setting to reach those at highest risk. In North America, EDs increasingly dispense THN [8][9][10][11][12][13] and 70% of ED patients accept THN.…”

Section: Introductionmentioning

confidence: 99%

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone

Kestler

Giesler

Buxton

et al. 2018

CJEM

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CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdose accept emergency department (ED)-based take-home naloxone (THN). What did this study ask? Why do at-risk ED patients refuse or accept THN? What did this study find? Those refusing THN felt: 1) not at risk of overdose; or 2) their ED visit was not the right time or place for THN. Those accepting THN wanted to save the lives of others. Why does this study matter to clinicians? Those refusing ED THN may accept THN elsewhere if referred to appropriate community services for overdose risk education and THN distribution.

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Section: Introductionmentioning

confidence: 99%

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone

Kestler

Giesler

Buxton

et al. 2018

CJEM

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“…Approximately 44,000 cases of death due to overdose occur annually in the United States, making it the leading cause of injury-related deaths 1 . Non-fatal overdose is independently associated with subsequent overdose-related deaths 2, 3. Moreover, overdose was the major cause of emergency hospital admissions and the leading cause for admission to tertiary care centers in Japan 4 .…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database

Okumura

Sakata

Takahashi

et al. 2017

Journal of Epidemiology

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BackgroundLittle is known about the nationwide epidemiology of the annual rate, causative substance, and clinical course of overdose-related admission. We aimed to describe the epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge to home.MethodsWe assessed all cases of admission due to overdose (21,663 episodes) in Japan from October 2012 through September 2013 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.ResultsThe annual rate of overdose admission was 17.0 per 100,000 population. Women exhibited two peaks in admission rates at 19–34 years (40.9 per 100,000) and ≥75 years (27.8 per 100,000). Men exhibited one peak in the admission rate at ≥75 years (23.7 per 100,000). Within 90 days prior to overdose, ≥60% and ≥9% of patients aged 19–49 years received a prescription for benzodiazepines and barbiturates, respectively. In addition, 59% of patients aged ≥75 years received a prescription for benzodiazepines prior to overdose, 47% had a history of congestive heart failure, and 24% had a diagnosis of poisoning by cardiovascular drugs. The proportion of patients with recent psychiatric treatments decreased with age (65.1% in those aged 35–49 years and 13.9% in those aged ≥75 years).ConclusionsThe findings emphasize the need for overdose prevention programs that focus on psychiatric patients aged 19–49 years who are prescribed benzodiazepines or barbiturates and on non-psychiatric patients aged ≥75 years who are prescribed benzodiazepines or digitalis.

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“…However, sequelae of non-fatal overdose (e.g., aspiration pneumonia, cognitive impairments, renal failure) can be devastating. Also, given that non-fatal overdose is a risk factor for fatal overdose (Caudarella et al, 2016), interventions to decrease risk of non-fatal overdose could reasonably be expected to reduce fatal overdoses.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence

Kim

Walley

Heeren

et al. 2017

Journal of Substance Abuse Treatment

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Introduction People living with HIV (PLWH) are at risk of both polypharmacy and unintentional overdose yet there are few data on whether polypharmacy increases risk of overdose. The study objective was to determine if the number and type of medication (e.g., sedating) were associated with non-fatal overdose (OD) among PLWH with past-year substance dependence or a lifetime history of injection drug use. Materials and Methods This was a longitudinal study of adults recruited from two urban, safety-net HIV clinics. Outcomes were i) lifetime and ii) past-year non-fatal OD assessed at baseline and a 12-month follow-up. We used logistic regression to examine the association between each outcome and the number of medications (identified from the electronic medical record) in the following categories: i) overall medications, ii) non-antiretroviral (non-ARV), iii) sedating, iv) non-sedating, as well as any vs. no opioid medication and any vs. no non-opioid sedating medication. Covariates included demographics, medical comorbidities, depressive and anxiety symptoms, and substance use. Results Among 250 participants, 80% were prescribed a sedating medication, 50% were prescribed an opioid; 51% exceeded risky drinking limits. In the past month, 23% reported illiict opioid use and 9% illicit opioid sedative use; 37% reported lifetime non-fatal OD and 7% past-year non-fatal OD. The median number (interquartile range) of total medications was 10 (7, 14) and 2 (1, 3) sedating. The odds of lifetime non-fatal OD were significantly higher with each additional sedating medication (OR 1.26, 95% CI 1.08, 1.46) and any opioid medication (OR 2.31; 95% CI 1.37, 3.90), but not with each overall, non-ARV, or non-sedating medication. The odds of past year non-fatal OD were greater with each additional sedating medication (OR 1.18; 95% CI 1.00, 1.39, p=0.049), each additional non-ARV medication (OR 1.07; 95% CI 1.00, 1.15, p=0.048), and non-significantly for any opioid medication (OR 2.23; 95% CI 0.93, 5.35). Conclusions In this sample of PLWH with substance dependence and/or injection drug use, number of sedating medications and any opioid were associated with non-fatal overdose; sedating medications were prescribed to the majority of patients. Polypharmacy among PLWH and substance dependence warrants further research to determine whether reducing sedating medications, including opioids, lowers overdose risk.

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Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs

Cited by 190 publications

References 29 publications

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone

Yes, not now, or never: an analysis of reasons for refusing or accepting emergency department-based take-home naloxone

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database

Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence

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