Correlates of experiencing and witnessing non-fatal opioid overdoses among individuals accessing harm reduction services in Philadelphia, Pennsylvania

Abstract

Background: With the dramatic increase in overdose deaths in the United States, layperson overdose education and naloxone distribution (OEND) programs serve a critical role in preventing opioid overdose fatality. This study examines associations for witnessing an opioid overdose or experiencing a non-fatal opioid overdose to identify new opportunities for expansion of OEND programs. Methods: Cross sectional surveys were administered at the sole needle and syringe exchange program in Philadelphia, PA. Bivariate and multivariable logistic regression analyses were conducted to examine associations for witnessing an opioid overdose or experiencing a non-fatal opioid overdose in the previous 12 months. Results: In total, 370 individuals were identified as using opioids in the previous three months and included in the study. Factors associated with experiencing a non-fatal opioid overdose were unstable housing (aOR: 2.16; 95% CI: 1.12–3.99), recent incarceration (aOR: 2.34; 95% CI: 1.41–3.89), co-use of opioids and benzodiazepines (aOR: 2.04; 95% CI: 1.22–3.41), co-use of heroin and cocaine (aOR: 1.69; 95% CI: 1.04–2.75), drug injection (aOR: 4.25; 95% CI: 1.90–9.54), inpatient detoxification history (aOR: 2.33; 95% CI:1.27–4.43), and witnessing an overdose in the previous 12 months (aOR: 2.51; 95% CI: 1.02–6.13). Factors associated with witnessing an overdose were unstable housing (aOR: 5.14; 95% CI: 2.57–10.28), recent incarceration (aOR: 2.88; 95% CI: 1.24–6.74), and a history of being trained to use naloxone (aOR: 3.39; 95% CI: 1.63–7.04). Discussion: Findings presented here show characteristics of those most likely to witness an overdose or experience a non-fatal overdose who could be served by expansion of OEND programs.

Keywords:

• Overdose
• naloxone
• opioids
• injection drug use
• overdose prevention
• heroin
• fentanyl

Additional information

Funding

This study was supported in part by the appointment of L.N. Pizzicato to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded through the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT000143-04 by the Substance Abuse and Mental Health Services Administration. The project was directly supported by the Council of State and Territorial Epidemiologists (CSTE), with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) through the Centers for Disease Control (CDC) cooperative agreement number 5U38OT00143-05. The funders had no role in the study design, analysis, interpretation of the data, and preparation and review of the manuscript and do not necessarily represent the official views of CSTE, SAMHSA, CDC, or the Department of Health and Human Services.