The Need to Rethink Harm Reduction for People Using Drugs Alone to Reduce Overdose Fatalities

Abstract

Background: During the ongoing opioid epidemic, Cuyahoga County (second largest in Ohio) reported overdose mortality rates (54/per 100,000) higher than the national average. Prior research demonstrates that people who use drugs often use alone but there is minimal research on people who died of overdose while using alone. The objective of this study is to examine sociodemographic, toxicologic, and injury characteristics, and emergency medical response to overdose decedents who died using drugs alone. Method: Data from the Cuyahoga County Medical Examiner’s Office (2016–2020, N = 2944) on unintentional overdose deaths in adults was tabulated including socio-demographic, toxicologic, and injury-related information. Decedents using drugs alone were identified and compared to those not using alone via Chi-square and Fisher’s exact tests. We further fit a multivariate logistic regression model to evaluate socio-demographic, toxicologic, and injury-related factors associated with increased odds of using alone. All results are reported with 95% confidence intervals. Result: Among decedents, 75% (n = 2205) were using drugs alone. Decedents using alone were more likely to be using drugs at home (p = 0.001) or be found dead at the scene (p < 0.001) and less likely to receive naloxone (p < 0.001) have other person/bystander, not using, present (p = 0.002). Using drugs at home (aOR = 1.61[1.19–2.20]) was associated with higher odds of using alone; and being married (aOR = 0.57[0.38–0.86]), having history of illicit drug use (aOR = 0.25[0.08–0.81]) and other person present, who was not using (aOR = 0.58[0.42–0.79]) were associated with lower odds of using alone. Conclusion: New harm reduction approaches targeting people using drugs alone are needed to reduce overdose deaths.

Keywords:

• Unintentional overdose death
• illicitly manufactured fentanyl
• analogs
• using alone
• harm reduction

Acknowledgments

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Justice and the Centers for Disease Control and Prevention.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Ethical approval

This analysis was part of an ongoing project evaluation being conducted by the authors as part of a CDC-funded project to examine the effectiveness and outcomes of the use of data in linking individuals to SUD treatment. The protocol was reviewed by Case Western Reserve University’s (CWRU) IRB (STUDY20191491) and found to be non-human research. The overdose death case review coding methodology was developed as part of an NIJ-funded project, and the protocol for that was approved by CWRU’s IRB (IRB-2018-2205).

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Funding

This work was supported by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice [Grant No. 2017-DN-BX-0168]; the Centers for Disease Control and Prevention [Grant No. 5-NU17CE925005-02-00]; and Clinical and Translational Science Award [Award Number UL1TR002548].