Systematic review and meta-analysis to estimate the burden of fatal and non-fatal overdose among people who inject drugs

Abstract

Background: People who inject drugs (PWID) have high overdose risk. To assess the burden of drug overdose among PWID in light of opioid epidemic-associated increases in injection drug use (IDU), we estimated rates of non-fatal and fatal overdose among PWID living in Organization for Economic Cooperation and Development (OECD) countries using data from 2010 or later. Methods: PubMed, Psych Info, and Embase databases were systematically searched to identify peer-reviewed studies reporting prevalence or rates of recent (past 12 months) fatal or non-fatal overdose events among PWID in OECD countries. Data were extracted and meta-analyzed using random effects models to produce pooled non-fatal and fatal overdose rates. Results: 57 of 13,307 identified reports were included in the review, with 33/57 studies contributing unique data and included in the meta-analysis. Other (24/57) studies presented overlapping data to those included in meta-analysis. The rates of non-fatal and fatal overdose among PWID in OECD countries were 24.74 per 100 person years (PY) (95% CI: 19.86 - 30.83; n=28; I2=98.5%) and 0.61 per 100 PY (95% CI: 0.32 - 1.16; n=8; I2=93.4%), respectively. The rate of non-fatal overdose was 27.79 in North American countries, 25.71 in Canada, 28.59 in the U.S., and 21.44 in Australia. Conclusion: These findings suggest there is a fatal overdose for every 40 non-fatal overdose events among PWID in OECD countries. The magnitude of overdose burden estimated here underscores the need for expansion of overdose prevention and treatment programs and serves as a baseline estimate for monitoring success of such programs.

Kentucky Outreach Service Kiosk (KyOSK) Study protocol: a community-level, controlled quasi-experimental, type 1 hybrid effectiveness study to assess implementation, effectiveness and cost-effectiveness of a community-tailored harm reduction kiosk on HIV, HCV and overdose risk in rural Appalachia

“…Policies and risk environments surrounding drug use place people who use drugs (PWUD) at increased vulnerability to numerous harms,1–4 including the transmission of bloodborne viruses,5–9 overdose9–11 and injection-related bacterial infections 12–20. Harm reduction programmes reduce PWUD’s risk of these adverse health outcomes,21–30 but access to these services in the USA and globally remains insufficient 31.…”

Non-fatal drug overdose among persons who inject drugs during first two years of the COVID-19 pandemic in New York City: Prevalence, risk factors

“…Over 75% of these overdoses involved opioids, with fentanyl being the most important drug. It has been estimated that among people who inject drugs (PWID), there are 40 non-fatal overdose events for every fatal overdose that occurs in high income countries ( Shealey et al., 2022 ). In response to the increased overdose rates, a great expansion occurred in the distribution of naloxone to reverse overdoses ( Khoury et al., 2021 ).…”