Determinants of overdose incidents among illicit opioid users in 5 Canadian cities

Fischer, Benedikt; Brissette, Suzanne; Brochu, Serge; Bruneau, Julie; El-Guebaly, Nady; Noël, Lina; Rehm, Jürgen; Tyndall, Mark; Wild, Cameron; Mun, Phil; Haydon, Emma; Baliunas, Dolly
August 2004
CMAJ: Canadian Medical Association Journal;8/3/2004, Vol. 171 Issue 3, p235
Academic Journal
Background: Drug overdose is a major cause of death and illness among illicit drug users. Previous research has indicated that most illicit drug users experience nonfatal overdoses and has suggested a variety of factors that are associated with risk of overdose. In this study, we examined the occurrence of and the factors associated with nonfatal overdoses within a Cana-dian sample of illicit opioid users not enrolled in treatment at the time of study recruitment. Methods: Interviewers used a standard questionnaire to collect data on sociodemographic characteristics, drug use, health and health care, experience in the criminal justice system and treatment for drug problems; they also performed standard as-sessments for mental health and infectious disease. The associ-ation between overdose and sociodemographic and drug-use factors was examined with X2 and t test analyses; marginally significant variables were examined with logistic regression to determine independent effects. Results: A total of 679 subjects were interviewed; 651 provided answers sufficient for this analysis. One hundred and twelve (17.2%) of the 651 respondents reported an overdose episode in the previous 6 months. In the logistic regression analysis (af-ter adjustment for sociodemographic factors), homelessness, noninjection use of hydromorphone in the past 30 days and involvement in drug treatment in the past 12 months were pre-dictors of overdose ( p< 0.05). Interpretation: Overdose poses a considerable health risk for illicit opioid users. We found that a diverse set of factors was associ-ated with overdose episodes. Prevention efforts will likely be more effective if they can be directed to specific causal factors.


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