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Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids.
Drug Alcohol Depend. 2019 12 01; 205:107533.DA

Abstract

BACKGROUND

Although much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids.

METHODS

Analysis of opioid overdose deaths in Australia between 2000-2015, extracted from the National Coronial Information System (NCIS). The NCIS is an online database of deaths reportable to the coroner, and contains coroner's findings, autopsy and toxicology reports. Deaths were categorized into mutually exclusive groups: 1) Heroin deaths; and 2) PO deaths (excluding heroin). PO deaths were examined by individual opioid.

RESULTS

There were 10,795 opioid overdose deaths over the study period. Relative to deaths occurring in major cities, deaths in regional/remote areas had 15.2 (95 % CI: 11.5-20.2) times the risk of being attributed to pharmaceutical fentanyl than heroin. Relative to deaths among people without a recorded history of chronic pain, deaths among people with a recorded history of chronic pain had a 1.9-10.7-fold increased risk of the death being attributed to POs than heroin. Deaths among people with a recorded history of substance use problems where the opioid was injected prior to death had 7.2 and 1.7 times the risk of being attributed to methadone and pharmaceutical fentanyl (respectively) than heroin.

CONCLUSIONS

Findings suggest the need to: educate PO consumers about the risks of overdose at the time of prescribing; increase coverage and engagement in opioid dependence treatment (particularly in regional/remote areas); and increase uptake of take-home naloxone to reduce opioid overdose mortality.

Authors+Show Affiliations

National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia. Electronic address: a.roxburgh@unsw.edu.au.National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; University of Queensland Clinical Centre for Research, University of Queensland, Brisbane, QLD, 4072, Australia; University of Queensland Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, 4006, Australia; National Addiction Centre, Kings College London, WC2R 2LS, United Kingdom.National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia.National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW, 2052, Australia; School of Population and Global Health, University of Melbourne, VIC, 3010, Australia.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31704378

Citation

Roxburgh, Amanda, et al. "Characteristics and Circumstances of Heroin and Pharmaceutical Opioid Overdose Deaths: Comparison Across Opioids." Drug and Alcohol Dependence, vol. 205, 2019, p. 107533.
Roxburgh A, Hall WD, Gisev N, et al. Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids. Drug Alcohol Depend. 2019;205:107533.
Roxburgh, A., Hall, W. D., Gisev, N., & Degenhardt, L. (2019). Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids. Drug and Alcohol Dependence, 205, 107533. https://doi.org/10.1016/j.drugalcdep.2019.06.035
Roxburgh A, et al. Characteristics and Circumstances of Heroin and Pharmaceutical Opioid Overdose Deaths: Comparison Across Opioids. Drug Alcohol Depend. 2019 12 1;205:107533. PubMed PMID: 31704378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: Comparison across opioids. AU - Roxburgh,Amanda, AU - Hall,Wayne D, AU - Gisev,Natasa, AU - Degenhardt,Louisa, Y1 - 2019/10/22/ PY - 2018/12/10/received PY - 2019/06/27/revised PY - 2019/06/28/accepted PY - 2019/11/11/pubmed PY - 2020/7/1/medline PY - 2019/11/10/entrez KW - Fentanyl KW - Heroin KW - Morphine KW - Mortality KW - Opioid analgesics KW - Opioid overdose deaths KW - Oxycodone KW - Prescription opioids SP - 107533 EP - 107533 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 205 N2 - BACKGROUND: Although much is known about the correlates of heroin overdose, less is known about pharmaceutical opioid (PO) overdose. This study aimed to examine correlates of opioid overdose deaths by opioid and compare correlates between opioids. METHODS: Analysis of opioid overdose deaths in Australia between 2000-2015, extracted from the National Coronial Information System (NCIS). The NCIS is an online database of deaths reportable to the coroner, and contains coroner's findings, autopsy and toxicology reports. Deaths were categorized into mutually exclusive groups: 1) Heroin deaths; and 2) PO deaths (excluding heroin). PO deaths were examined by individual opioid. RESULTS: There were 10,795 opioid overdose deaths over the study period. Relative to deaths occurring in major cities, deaths in regional/remote areas had 15.2 (95 % CI: 11.5-20.2) times the risk of being attributed to pharmaceutical fentanyl than heroin. Relative to deaths among people without a recorded history of chronic pain, deaths among people with a recorded history of chronic pain had a 1.9-10.7-fold increased risk of the death being attributed to POs than heroin. Deaths among people with a recorded history of substance use problems where the opioid was injected prior to death had 7.2 and 1.7 times the risk of being attributed to methadone and pharmaceutical fentanyl (respectively) than heroin. CONCLUSIONS: Findings suggest the need to: educate PO consumers about the risks of overdose at the time of prescribing; increase coverage and engagement in opioid dependence treatment (particularly in regional/remote areas); and increase uptake of take-home naloxone to reduce opioid overdose mortality. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/31704378/Characteristics_and_circumstances_of_heroin_and_pharmaceutical_opioid_overdose_deaths:_Comparison_across_opioids_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(19)30292-3 DB - PRIME DP - Unbound Medicine ER -