Witnessing heroin-related overdoses: The experiences of young injectors in San Francisco. Addiction, 97(12), 1511-1516

Department of Epidemiology and Biostatistics, University of California, San Francisco, 94143, USA.
Addiction (Impact Factor: 4.74). 01/2003; 97(12):1511-6. DOI: 10.1046/j.1360-0443.2002.00210.x
Source: PubMed


Assessment of young injectors' exposure and response to others' heroin-related overdose.
Cross-sectional survey.
San Francisco, CA, United States.
Nine hundred and seventy-three street-recruited current injectors under 30 years old.
Self-reported experiences of witnessing heroin-related overdoses from structured interviews.
Seven hundred and nine of 973 (73%) had ever witnessed at least one heroin-related overdose, and 491 of 973 (50%) had witnessed an overdose in the last 12 months. Fourteen per cent of those who had witnessed an overdose in the past year reported that the outcome of the overdose was death. Emergency services were called to 52% of most recent witnessed overdoses. Cardiopulmonary resuscitation (CPR) or expired air resuscitation (EAR or 'rescue breathing') was performed in 61% of cases. Inappropriate strategies such as injection with stimulants or application of ice were rare. In 67% of cases in which emergency services were not called the witness said this was because the victim regained consciousness. In the remaining 33%, 56% stated emergency services were not called due to fear of the police.
Respondents were willing to act at overdoses at which they were present, but frequently did not do so in the most efficacious manner. Fear of police was identified as the most significant barrier to the ideal first response of calling emergency services.

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Available from: Jennifer L Evans, Sep 09, 2014
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    • "These data suggest that drug users may frequently be witnesses at the overdoses of other drug users. Witnesses at an overdose are able to intervene and reduce the risk of fatality through actions such as calling for medical help and providing first aid, and research indicates that overdose witnesses frequently do attempt to intervene (Best et al., 2002; Davidson et al., 2002; Pollini et al., 2006a; Tracy et al., 2005). "
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    ABSTRACT: Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs. Participants in New York City, who were age 18 and older with heroin and/or cocaine use in the past two months, were administered structured interviews (n=1184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information. In a multivariable negative binomial regression model, those persons who were male (IRR [Incidence Rate Ratio]=1.7, CI [95% Confidence Interval]=1.4,2.2), had experienced homelessness (IRR=1.9, CI=1.4,2.6), had used heroin (IRR=2.0, CI=1.3,3.2), had overdosed themselves (IRR=1.9, CI=1.6,2.4), or had attended Narcotics Anonymous (IRR=1.3, CI=1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio]=0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses. Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed. Individuals who have witnessed many overdoses are likely key targets of overdose response training.
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    • "Young injection drugs users (IDUs) – persons aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) -are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et al., 2004; Rondinelli et al., 2009). Young IDUs – whose lifetime prevalence of heroin has approached 100% in some studies (Ochoa et al., 2005; Havens et al., 2006) -are at increased risk for initiation and misuse of prescription opioids (SAMSHA, 2009b). "
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    • "Given that witnessing an overdose was common in this setting and fatal overdoses typically take hours to develop [29,30], the need to improve peer responses is clear. Inappropriate or suboptimal responses by IDU to overdose are not uncommon and have been reported from a number of settings [26,29,31]. However, overdose management education has been shown to be effective at training IDU to respond appropriately to overdose [26,32]. "
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