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CATHERINE McGREGOR,' SHANE DARKE,2 ROBERT ALI.1' & PAUL CHRISTIE1
Abstract
Aims. To ascertain the prevalence and risk factors for non-fatal overdose among heroin users to assist in the development of an effective intervention. Design. Cross-sectional design. Setting. Community setting, principally metropolitan Adelaide. Participants. Current heroin users (used heroin in the previous six months). Measurements. A structured questionnaire including the Severity of Dependence Scale. Finding. Of 218 current South Australian heroin users interviewed in 1996, 48% had experienced at least one non-fatal overdose their life-time (median: two overdoses), and 11% had overdosed in the previous 6 months. At some time, 70% had been present at someone else's overdose (median: three overdoses). At the time of their own most recent overdose, 52% had been using central nervous system depressants in addition to heroin, principally benzodiazepines (33%) and/or alcohol (22%). The majority of overdoses occurred in a private home (81%) and in the presence of other people (88%). Unrealistic optimism regarding the risk of overdose was evident across the sample. Despite almost half the sample reporting having had an overdose, and the belief expressed by respondents that on average about SO% of regular heroin users would overdose during their life-time 73% had, during the previous 6 months, "rarely" or "never" worried about possibly overdosing. Optimism regarding the possibility of future overdose was reduced in those with recent experience of overdose in comparison to the rest of the sample. A targeted intervention aimed at the reduction of overdose among heroin users is outlined.
Introduction
A number of recent cohort studies conducted overseas have reported excess mortality ratios among heroin users compared to their nonheroin-using peers of between 10 and 22 to one (e.g. 10:1 in Rome,1 18:3 in Stockholm2 and 22 in Glasgow3). Several European studies have shown that HIV and fatal overdose are the two major contributors to this excess mortality among heroin users.l,4,5 In Australia, where HIV prevalence rates are relatively low,6 fatal opioid overdose is the principal contributor to this excess mortality. The latest available data show that deaths due to opiate use among people aged 15-44 years increased from 79 in 1979 to 550 in 1995. The average age at death increased steadily from 24 to 30 years during the same period....