The main cause of death among injecting drug users (IDUs) is opiate-related overdose. Some of the most common risk factors for overdose are age, gender, injecting drug use, drug purity, low tolerance, polydrug use, and recent imprisonment/release from prison. Problem drug users with a history of self-harm are also at increased risk of overdose.

A study in two Cork addiction services aimed to investigate injecting drug users’ experience of fatal, non-fatal, accidental and intentional overdose and to ascertain the requirement for any overdose prevention training and resuscitation skills.1

There were three phases to the study, which was part of an internal audit of service users.

• Phase one explored the experience of overdose among 52 service users attending the centres in 2012, measured their understanding of appropriate responses to overdose and assessed any need for resuscitation training. Questions were asked about the service users’ lifetime and recent (last six months) experience of non-fatal, accidental or intentional overdose, and the drugs involved.
• Phase two consisted of playing a DVD training programme on overdose prevention in the waiting room of the two centres for four weeks. After this, 26 services users out of the original 52 interviewed were re-interviewed about their overdose awareness and resuscitation skills.
• Phase three was a pilot training project of practical resuscitation skills and overdose prevention aimed at both service users and staff, which took place in 2013. In all, 14 service users, 10 family members and two staff took part in this phase.

Results of phase one were as follows:

• 60% had ever overdosed.
• 10% had overdosed in the previous six months.
• 80% of overdoses were accidental.
• Heroin was involved in 60% of all overdoses.
• Benzodiazepines were involved in 47% of all overdoses.
•        Benzodiazepines were more commonly reported in intentional overdoses (83%).
• 56% had witnessed a non-fatal overdose.
•        52% of non-fatal overdoses occurred in a private dwelling.
• 19% had witnessed a fatal overdose.
•        87% of fatal overdoses witnessed occurred in a private dwelling.
• Of those who had witnessed an overdose,
•        80% called an ambulance, and
•        55% reported putting the person into the recovery position.
• 54% reported never or rarely worrying about overdose.
• 92% knew what number to call an ambulance.
• 62% reported they knew what the recovery position was.
• 65% reported an interest in learning basis resuscitation skills.

Results of phase two showed that after the intervention, 100% of participants knew what number to call for an ambulance, and 73% knew what the recovery position was.  

For phase three, a brief evaluation and a focus group were conducted. The outputs highlighted a number of issues to be considered when considering how to prevent overdose risk behaviours – release from prison; polydrug use; the psychological effects of the experience of overdose for service users, for example the death of friends; the need for overdose prevention training for service users in order to equip them with the skills to prevent fatal overdoses; and the need for training and development for professionals working at the points of contact, for example in emergency departments.

While the sample size was small, and the study relied on self-reported answers, the participant responses were similar to those in other studies on overdose prevention. The authors felt that studies like theirs play an important part in understanding the dynamics of overdose in Ireland and highlight the need for overdose prevention training. They recommended the provision of intranasal naloxone to service users attending needle exchange and the consideration of supervised injecting rooms.2 The authors concluded that providing overdose prevention training and basic resuscitation skills can have a positive outcome not only for the individual but also for their peers and the wider community.

1 Horan J, Deasy C, Henry K, O'Brien D and Van Hout MC (2015) Overdose risk perceptions and experience of overdose among heroin users in Cork, Ireland. Preliminary results from a pilot overdose prevention study. Heroin Addiction and Related Clinical Problems (17): 19–26. https://www.drugsandalcohol.ie/24795/

2 On 15 December 2015 the Irish government approved additional heads for inclusion in the Misuse of  Drugs(Amendment)  Bill  2015  to allow for supervised injecting facilities in Ireland.

http://health.gov.ie/blog/press-release/o-riordain-welcomes-government-approval-for-medically-supervised-injection-facilities/