A study which aimed ‘to explore drug users’ experiences and perspectives of overdose’ was carried out in Dublin in 2006.1 The main objectives were to investigate drug users’ personal perspectives and experiences of overdose, their experiences of witnessed overdoses, and their views on possible strategies to prevent or reduce the incidence of overdoses. 

The inclusion criteria were as follows: all participants in the study must be receiving methadone maintenance therapy in the Drug Treatment Centre Board for treatment of opiate addiction, all participants must have overdosed in the preceding year, all participants must have voluntarily agreed to participate in the study and signed a consent form, and all participants must be fluent in English. A convenience sampling method was used and the first 10 participants who volunteered and met the inclusion criteria were selected to take part in in-depth semi-structured interviews, which lasted between 30 and 60 minutes. Participants ranged in age from 22 to 46 years; seven were male and three were female. All 10 had hepatitis C and four had HIV. 

The researcher asked participants questions about their own overdose experiences, including: what drugs they had used; their method of drug taking; their actual experience of overdose; whether the overdose was accidental or intentional; their perceived reasons and/or precipitating factors for accidental overdose; trigger factors for intentional overdose; their knowledge of medical treatment for overdose; and possible strategies to prevent or reduce future overdoses. 

The numbers of personal overdoses among the participants ranged from two to 30. The most recent overdose was accidental in six cases and intentional in four cases. All 10 had engaged in polydrug use in their most recent overdose. Five of the six participants who had accidentally overdosed had used heroin, and one of the four who had intentionally overdosed had used heroin. The most common drug used was methadone and all 10 participants had consumed methadone in their most recent overdose. Three of the participants reported intentionally overdosing on a combination of prescribed methadone and other prescription medication. Trigger factors for intentional overdoses included sexual abuse, physical abuse, depression and recent bereavement. Perceived reasons for accidental overdoses included reduced tolerance to drugs following a period of abstinence, variation in the quantity and quality of heroin used, and polydrug use, especially of benzodiazepines or alcohol in conjunction with heroin. Four participants were hospitalised as a result of their most recent overdose (two from intentional overdoses, two from accidental overdoses). Participants showed a lack of knowledge about medical treatment of overdose. Those hospitalised did not know how they had been treated, and only one of the 10 participants was able to name the heroin antidote given to overdose victims.   

All 10 participants had witnessed another person overdosing. They were questioned about their knowledge of overdose intervention, how they had intervened and, if they had not done so, why they had not. Interventions such as slapping the victim, walking them around, dousing them with water, using mouth-to-mouth resuscitation and placing them in the recovery position were implemented before an ambulance was called. In general, an ambulance was called only in cases where there was serious danger, and only then after a delay of at least 10 minutes. In cases where the participants witnessed an overdose and did not intervene, the most common reason given was fear of police involvement. 

Participants were asked whether they thought training in overdose prevention should be available to drug users. All 10 agreed that such training should be available to all drug users and two stated that it should be made compulsory.    

The study makes a number of recommendations for reducing drug overdoses and deaths:

• a training programme on drug overdose prevention
• tighter legislation and caution when prescribing medication to drug users
• improvements in initial and ongoing psychiatric assessment of drug users
• frequent drug analysis screening of street heroin
• decreased police presence at overdose situations
• pilot studies on naloxone distribution among peers
• supervised drug injecting facilities.

1. Bolger A (2007) Drug users’ experiences and perspectives of overdose: an exploratory study.  MSc thesis submitted to Dublin City University.