Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances (original) (raw)
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Journal of Urban Health, 2007
To determine annual patterns and correlates of nonfatal heroin overdose across 3 years, data were analyzed on 387 heroin users recruited for the Australian Treatment Outcome Study (ATOS), interviewed at 12, 24, and 36 months. A heroin overdose across follow-up was reported by 18.6%, and naloxone had been administered to 11.9%. Annual rates of overdose declined between baseline and 12 months and then remained stable. Previous overdose experience was strongly related to subsequent overdose. Those with a history of overdose before ATOS were significantly more likely to overdose during the study period. In particular, there was a strong association between overdose experience in any 1 year and increased overdose risk in the subsequent year. This is the first study to examine long-term annual trends in nonfatal heroin overdose. While overdose rates declined after extensive treatment, substantial proportions continued to overdose in each year, and this was strongly associated with overdose history.
Heroin overdose: Prevalence, correlates, consequences and interventions
2001
Over the past decade fatal opioid overdose has emerged as a major public health issue in Australia. This report has been prepared in order to provide a comprehensive overview both of the epidemiology and circumstances of heroin overdose, and of interventions that may potentially reduce mortality from overdose.
Drug and Alcohol Review, 2005
The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injectionrelated health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories. [Ross J, Teesson M, Darke S, Lynskey M, Ali R, Ritter A, Cooke R. The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2005;24:411 -418]
Drug and Alcohol Dependence, 2005
To determine the rate of current major depressive disorder (MDD) among entrants to treatment for heroin dependence in three treatment modalities and a non-treatment comparison group; and to ascertain factors associated with depression. Design: Cross sectional structured interview. Setting: Sydney, Australia. Participants: 615 current heroin users: 201 entering methadone/buprenorphine maintenance (MT), 201 entering detoxification (DTX), 133 entering drug free residential rehabilitation (RR) and 80 not in treatment (NT). Findings: Current major depressive episode was reported by 25%. The rates of major depressive disorder ranged from 26% in the treatment groups (23% MT, 25% DTX, 31% RR) to 16% of those not in treatment. Females were more likely to have current major depressive episode (31% versus 21% OR 1.70, 95% CI 1.16-2.48). Factors associated with depression in the treatment groups were post traumatic stress disorder (PTSD), attempted suicide in the last 12 months and severe physical disability. Among the non-treatment group those with depression were also more likely to have PTSD. Women entering treatment were three times more likely to meet criteria for current major depression than women not in treatment. Among men however, the rates were not significantly different. Conclusion: Depression is a significant concern among entrants to treatment for heroin dependence. An essential component of treatment should be a consideration of depression, with the provision of appropriate treatment were required.
Heroin-related deaths in Victoria: a review of cases for 1997 and 1998
The number of deaths attributed to the intravenous use of heroin has increased dramatically in Victoria in the past five years. Since 1991, the prevalence of deaths attributed to heroin toxicity has risen from 49 to 268 in 1998. This represents a five-fold increase in seven years. The increase has been particularly dramatic over the last 12-months (an increase in over 60%). In 1998 deaths from intravenous use of heroin each year constituted 47% of all drug deaths reported to the coroner (Annual Report, 1997/98, Victorian Institute of Forensic Medicine). The heroin death is typified by a median age of 30 years (both male and female), although the age range extends from children as young as 15 to adults in their fifth decade of life. Over 85% of cases are using other central nervous system depressants, with benzodiazepines (45%) and alcohol (36%) being the most common. Approximately 60% of deaths occur indoors at a private residence, the remaining deaths occur in public places and other locations. A similar number (60%) die alone. Disturbingly, the heroin problem is not restricted to the known "hot-spots" in Melbourne; rather most suburban areas appear to be affected. The mean (± SD) blood concentration of total morphine was 0.52 ± 0.53 mg/l. Concentrations ranged from 0.01-3.4 mg/l. The median concentration was 0.4 mg/l. A summary of the toxicological findings from 434 heroin-related deaths will be presented.
Psychiatric comorbidity in young heroin users
Drug and Alcohol Dependence, 2006
In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.
The Medical journal of Australia, 2004
To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors...