Heroin overdoses and overdose fatalities have been increasing in North America and around the world. Many basic questions about overdose, however, remain clouded by myth and misunderstanding. Through scholarly articles, news reports and a variety of links, this focal point examines the definition of overdose, risk factors and the complex issues of prevention and response.
Studies from Europe, Australia and North America have consistently found that most heroin overdose fatalities occur among longtime users with heavy dependence. Most fatalities involve use of alcohol or other depressants along with heroin and many occur after a recent period of abstinence (self-imposed abstinence, abstinence-based treatment, prison or jail). Many fatal overdoses also occur in the presence of witnesses, yet help is rarely received until more than three hours after the overdose occurs. The number one reason given for not calling help earlier is fear of police.
This information has inspired a variety of initiatives to address overdoses and overdose fatalities. Programs in different localities have designed population-specific messages, coordinated with ambulance and police services, distributed naloxone (a short-acting opiate antagonist) directly to drug users, trained drug users in CPR and rescue breathing, addressed treatment and relapse concerns, expanded maintenance protocols and availability, developed safer injection rooms and employed research techniques based on the conditions of drug users' lives. These initiatives all share the common goal of reducing the negative consequences of drug use and drug prohibitionist policies to drug users and the communities in which they live.