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

• NCJ Number: 308281
• Journal: Substance Use & Misuse Volume: Online Dated: 2023
• Author(s): Vaishali S. Deo; Manreet K. Bhullar; Thomas P. Gilson; Daniel J. Flannery; Sarah E. Fulton
• Date Published: 2023
• Grant Number(s): 2017-DN-BX-0168
• Agencies: NIJ-Sponsored
• Publication Type: Research (Applied/Empirical)
• Award: Cuyahoga County, Ohio, Heroin and Crime Initiative: Informing the investigation and prosecution of heroin-related overdose

Annotation

This study assesses responses to overdose decedents who died using drugs alone and concludes that harm reduction approaches targeting people using drugs alone could overdose deaths.

Abstract

This study examines sociodemographic, toxicologic, and injury characteristics, and emergency medical response to overdose decedents who died using drugs alone and concludes that new harm reduction approaches targeting people using drugs alone are needed to reduce overdose deaths. 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. The authors 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. 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. During the ongoing opioid epidemic, Cuyahoga County 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. (Published Abstract Provided)