Recent contact with health and social services by drug misusers in Glasgow who died of a fatal overdose in 1999

FRANÇAIS :
Une enquête a été menée, rétrospectivement, sur l'utilisation des services sanitaires et sociaux par 87 usagers de drogues avant leur mort par overdose. La plupart étaient des hommes, injecteurs de longue date, leur décès mettant majoritairement en cause l'héroïne (seule ou en association avec d'autres produits). 32 % d'entre eux sont morts dans les 2 semaines suivant une sortie de prison. Parmi les 77 personnes sur lesquelles des données médicales étaient disponibles : un tiers d'entre elles avaient consulté un médecin généraliste dans le mois précédent l'accident ; la moitié avaient eu récemment recours à des services d'urgence et 22 % avaient fait l'objet d'un diagnostic psychiatrique dans l'année. Les tendances suicidaires et dépressives apparaissent comme des facteurs de risque pour l'overdose, ainsi qu'une récente sortie de prison.
ENGLISH :
Aim. To explore the recent contact with health and social services by drug misusers who died of a fatal overdose and identify opportunities for preventive intervention. Design. Retrospective case analysis. Subjects. Eighty-seven residents of the Greater Glasgow area who died of a drug misuse-related overdose in 1999. Methods. Analysis of matched data from several sources: Strathclyde Police; University of Glasgow Department of Forensic Medicine and Science; the Scottish Prison Service; general practitioners' medical notes, including records of accident and emergency attendances and psychiatric assessments; and five specialist agencies for drug misusers or the homeless. Findings. Most of those who died of an overdose were males, long-standing heroin injectors and resident in a deprived area. Heroin caused most deaths, either alone or with other drugs. Twenty-three per cent died within 2 weeks of release from prison. For the 77 whose medical records were available, 90% had seen their general practitioner (32% in the month before death), 48% had attended accident and emergency services and 22% had received a psychiatric assessment in the year before death. Over 40% of the 87 used a drug agency in the year before death and 20% had used more than one agency. Conclusions. Previous suicidal ideation, attempted suicide and depression were common among those who died of an overdose, as was recent release from prison. Almost all had been in contact with and several were receiving specific treatment from health or specialist addiction services in their last weeks or months. The findings highlight both the numerous opportunities for intervention and the challenge of using them to prevent death. (Author' s abstract)