Fatal and Non-Fatal Heroin-Related Overdoses: Circumstances and Patterns

Abstract

Introduction

Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis.

Methods

Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases.

Results

The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome.

Conclusion

Future prevention and intervention measures should aim to consider the context, i.e. typical constellations of risk, and attempt to inhibit this through appropriate counter measures.

Keywords:

• Heroin
• overdose
• risk factors
• mortality
• cluster analysis

Acknowledgements

We discussed the empirical results in-depth with Herman Köhn (B.A. Soziale Arbeit; social education worker) and two nurses from the drug counselling centre Abrigado, the oldest drug consumption rooms having opened in 1994 (freiraum Hamburg e.V., Schwarzenbergstraße 74, 21073 Hamburg). These experts’ many years of experience with drug users was extremely valuable in interpreting the data.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article

Funding details

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This project was exclusively funded through the institute’s own funds.