Overdose after detoxification: A prospective study

• Published in: Drug and alcohol dependence Vol. 89; no. 2; pp. 161 - 169
• Main Authors: Wines, James D, Saitz, Richard, Horton, Nicholas J, Lloyd-Travaglini, Christine, Samet, Jeffrey H
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.07.2007; Elsevier Science
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Alcoholism - epidemiology; Alcoholism - rehabilitation; Biological and medical sciences; Boston; Cocaine - toxicity; Cocaine-Related Disorders - epidemiology; Cocaine-Related Disorders - rehabilitation; Comorbidity; Cross-Sectional Studies; Depression; Depression - epidemiology; Depressive symptoms; Drug addiction; Drug Overdose - epidemiology; Ethanol - toxicity; Female; Heroin - toxicity; Heroin Dependence - epidemiology; Heroin Dependence - rehabilitation; Humans; Intent; Intention; Male; Medical sciences; Mood disorders; Opioids; Overdose; Overdoses; Proportional Hazards Models; Prospective Studies; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Race; Risk Factors; Toxicology; Urban Population - statistics & numerical data; Boston; Depressive symptoms; Overdose; Intent; Opioids; Mood disorder; Human; Drug addiction; Poison withdrawal; Overdosing; Detoxification; Depression; Opiates; Symptomatology; Addiction; Follow up study; Psychiatry
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2006.12.019

Abstract Objective The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol. Methods We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use. Results Lifetime prevalence for any OD was 30.9% (145/470) in the total sample and 42.3% (85/201) in patients with opioid problems. During the 2-year follow-up, OD was estimated to occur in 16.9% of the total sample and 26.7% of the opioid problem subgroup, with new-onset (incidence) OD estimated at 5.7% and 11.0%, respectively. Factors associated with an increased hazard of OD in both samples included white race, more depressive symptoms, and prior OD regardless of intent. Prior suicidal ideation or attempt was not associated with future OD. Conclusions Findings underscore both the high prevalence of non-fatal OD among detoxification patients especially opioid users, and the potency of prior OD as a risk factor for future OD. Depressive symptoms, a modifiable risk factor, may represent a potential intervention target to prevent OD, including some “unintentional” ODs.