Titre : | Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths (2015) |
Auteurs : | J. STRANG |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.110, Suppl.2, July 2015) |
Article en page(s) : | 27-35 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus géographique ROYAUME-UNIThésaurus mots-clés SURDOSE ; HEROINE ; OPIACES ; MORTALITE ; NALOXONE ; PREVENTION ; URGENCE |
Résumé : |
Aims: To describe work undertaken over a 20-year period, investigating overdose characteristics among survivors, effects of acute heroin administration, clustering of risk of overdose fatality and potential interventions to reduce this fatal outcome.
Methods: Privileged-access interviewers obtained data from non-treatment as well as treatment samples; experimental study of drop in oxygen saturation following heroin/opiate injection; investigation of clusterings of death following prison release and treatment termination; and study of target populations as intervention work-force, including family as well as peers, and action research built into pilot implementation. Results: Overdose has been experienced by about half of heroin/opiate misusers, with even higher proportions having witnessed an overdose, and with high levels of willingness to intervene. Heroin/opiates are associated with the majority of drug-related deaths, despite relative scarcity of use. Heroin injection causes a rapid drop in oxygen saturation, recovering only slowly over the next half hour. Deaths from drug overdose are greatly more likely on prison release and post-discharge from detoxification and other in-patient or residential settings. High levels of declared willingness to intervene are matched by active interventions. Both drug-using peers and family members show ability to improve knowledge and gain confidence from training. Audit study of take-home schemes finds approximately 10% of dispensed naloxone is used in real-life emergency situations. Conclusions: Overdose is experienced by most users, with heroin/opiates contributing disproportionately to drug overdose deaths. High-risk times (e.g. after prison release) are now clearly identified. Peers and family are a willing potential intervention work-force, but are rarely trained or given pre-supply of naloxone. Large-scale naloxone provision (e.g. national across Scotland and Wales) is now being delivered, while large-scale randomized trials (e.g. N-ALIVE prison-release trial) are finally under way. Better naloxone products and better-organized provision are needed. The area does not need more debate; it now needs proper implementation alongside good scientific study. |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 41 |
Affiliation : | National Addiction Centre (Institute of Psychiatry/The Maudsley), London, UK |
Cote : | Abonnement |
Lien : | http://dx.doi.org/10.1111/add.12904 |
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