The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis

Colledge, Samantha; Peacock, Amy; Leung, Janni; Larney, Sarah; Grebely, Jason; Hickman, Matthew; Cunningham, Evan B; Trickey, Adam; Stone, Jack; Vickerman, Peter; Degenhardt, Louisa

doi:10.1016/j.drugpo.2019.07.030

Cited by 83 publications

(64 citation statements)

References 95 publications

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“…The age that individuals start using opioids is also important to know about and understand because evidence suggests those who begin using at an earlier age are more susceptible to drug dependence and other associated social and/or health problems [ 21 – 26 ]. Consistent with previous studies [ 27 , 28 ] our analysis suggests that the participants who started injecting less than 2 years before interview (new injectors), were more likely to report a non-fatal overdose. One possible explanation for this is that those with less injecting experience and lower tolerance are more susceptible.…”

Section: Discussionsupporting

confidence: 90%

Non -fatal overdose among people who inject drugs in Tehran, Iran

Noroozi

Higgs

Bayani

et al. 2020

Subst Abuse Treat Prev Policy

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Background With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. Methods Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering “Yes” to the question: “In the last six months, have you ever overdosed by accident? (at least once)”. We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. Results Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2–0.9). Conclusion Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.

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Section: Discussionsupporting

confidence: 90%

Non -fatal overdose among people who inject drugs in Tehran, Iran

Noroozi

Higgs

Bayani

et al. 2020

Subst Abuse Treat Prev Policy

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“…However, there are very few, if any, objective definitions of NFOD. Most studies have ascertained overdose through self-report (Colledge et al, 2019;Martins et al, 2015). Self-reported drug use, illegal behaviour, and risk-taking behaviour have been found to be reasonably reliable in people who use drugs (Darke, 1998).…”

Section: Introductionmentioning

confidence: 99%

“…However, self-report is, by definition, subjective, and can be influenced by recall and social desirability bias (Kerr et al, 2007). Further, the definition and ascertainment of NFOD by studies using self-report have varied considerably (Colledge et al, 2019). Some studies have limited their definition of overdose to those involving opioids (Brugal et al, 2002;Stoové et al, 2009;Yin et al, 2007), while others have left NFOD undefined and open to participant interpretation (Best et al, 2000;Kerr et al, 2007;Lake et al, 2015;Milloy et al, 2008;Neale and Robertson, 2005;Powis et al, 1999;Winter et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Comparing the predictive capability of self-report and medically-verified non-fatal overdose in adults released from prison: A prospective data linkage study

Keen

Kinner

Borschmann

et al. 2020

Drug and Alcohol Dependence

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Background: Self-reported non-fatal overdose (NFOD) is a predictor of future overdose and is often used to target overdose prevention for people released from prison. However, the level of agreement between self-reported and medically-verified NFOD history remains unknown. This study aimed to determine the agreement between, and predictive value of, self-reported and medically-verified history of NFOD in people recently released from prison. Methods: Pre-release baseline survey data from 1307 adults in prison surveyed from 2008 to 2010 in Queensland, Australia were linked to ambulance, emergency department, and hospital records. We compared the agreement of self-reported NFOD history in the baseline survey and medically-verified NFOD ascertained through linked medical data. Unadjusted and adjusted regression models were used to determine the association between self-reported and medically verified NFOD history and medically-verified NFOD after release from prison. Results: 224 (19 %) participants self-reported NFOD history only, 75 (5 %) had medically-verified NFOD history only, and 56 (4 %) both self-reported and had medically-verified NFOD history. Compared to those with no NFOD history, those who self-reported and had a medical history of NFOD (adjusted hazard ratio (AHR) 6.1, 95 %CI 3.1-11.9), those with a medical history only (AHR 3.4, 95 %CI 1.7-7.0), and those who self-reported only (AHR 1.8, 95 %CI 1.0-3.5) were at increased risk of medically-verified NFOD after release from prison. Conclusions: Relying on self-report of NFOD is likely to miss people at increased risk of future NFOD, many of whom could be identified through medical records. Wherever possible, data related to NFOD should be triangulated from multiple sources.

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“…Social and behavioural factors were selected based on prior associations with adverse outcomes such as HCV infection [30, 32–37], non‐fatal overdose [38–42] and mortality [43–46] in PWID. These include: frequent injection (< 30 versus ≥ 30/month); cocaine injection (no/yes); prescription opioid injection (no/yes); amphetamine injection (no/yes); housing status (stable versus unstable); recent incarceration (no/yes); and receiving opioid agonist therapy (OAT; no/yes).…”

Section: Methodsmentioning

confidence: 99%

Deconstructing the ‘cheque effect’: short‐term changes in injection drug use after receiving income assistance and associated factors

et al. 2020

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Background and Aims Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the ‘cheque effect’). However, relationships to injection drug use (IDU) remain understudied. We examined short‐term ‘cheque effects’ and associated factors among people who inject drugs (PWID). Design Cross‐sectional analysis nested within a cohort study. Setting Montreal, Quebec, Canada. Participants PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. Measurements and Methods At each cohort visit, an interviewer‐administered questionnaire captured retrospective reports of injection‐related behaviour during the 2‐day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe‐sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency (‘cheque effect’) were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate‐adjusted two‐part model. Findings Prevalence of IDU and syringe‐sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P < 0.001). Among people with past‐month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a ‘cheque effect’ was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR) = 2.639, 95% confidence interval (CI) = 2.04–3.41], unstable housing (OR = 1.272, 95% CI = 1.03–1.57) and receiving opioid agonist therapy (OR =1.597, 95% CI = 1.27–2.00) during the same month. Magnitude of the ‘cheque effect’ was positively associated with cocaine injection [rate ratio (RR) = 1.795, 95% CI = 1.43–2.16], unstable housing (RR = 1.198, 95% CI = 1.02–1.38) and frequent injection (RR = 2.938, 95% CI = 2.43–3.44), but inversely associated with opioid agonist therapy (RR = 0.817, 95% CI = 0.68–0.95) and prescription opioid injection (RR = 0.794, 95% CI = 0.66–0.93). Conclusion Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe‐sharing appear to be more prevalent in the 2 days after versus before receiving income assistance. The odds and rate of individual‐level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing.

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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis

Cited by 83 publications

References 95 publications

Non -fatal overdose among people who inject drugs in Tehran, Iran

Non -fatal overdose among people who inject drugs in Tehran, Iran

Comparing the predictive capability of self-report and medically-verified non-fatal overdose in adults released from prison: A prospective data linkage study

Deconstructing the ‘cheque effect’: short‐term changes in injection drug use after receiving income assistance and associated factors

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