Heroin Overdose as Cause of Death: Truth or Myth

Abstract

Heroin-related deaths have many causes and occur in a heterogenous group of patients. The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and complexity of such deaths. In particular, the dominance of the widely held belief that heroin-related fatalities are a consequence of overdose is challenged. The presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy and study of pationts with acute opioid overdose who arrive in Emergency departments do not prove this coherency. Furthermore, deaths attributed to overdose are likely to have morphine levels no higher than those who survive, or heroin users who die from other causes. It is concluded that the term overdose may in many cases be a misleading term, since it implies the same mechanism of death in all cases. In order to determine the impact of co-intoxicants on mortality and morbidity after opioid overdose, future studies should measure serum levels of opioids and suspected co-intoxicants in both survivors and fatalities and conduct similar prospective follow-ups for defined adverse events including death.