Drug overdose: Risks, responses and treatment seeking among injection drug users in Baltimore, Maryland

Introduction. Drug overdose is a leading cause of death among injection drug users (IDUs). Baltimore City, Maryland, has one of the highest overdose mortality rates in the United States. Prospective studies of overdose risk are lacking, as is information on responses to overdose among IDUs in Baltimore. The feasibility of linking survivors with drug treatment to prevent repeat overdoses also has not been explored.; Methods.We conducted a longitudinal analysis of non-fatal overdose predictors in the AIDS Link to Intravenous Experiences (ALIVE) study, a community-based cohort study of IDUs in Baltimore. A cross-sectional survey was administered to characterize witness responses to overdose and drug treatment seeking after overdose recovery.; Results. The strongest predictor of non-fatal overdose was a prior overdose. Other predictors included drug withdrawal, incarceration, shooting gallery attendance, speedball injection, marijuana use, daily alcohol consumption and self-reported symptoms of hepatitis or jaundice. Inappropriate witness responses to overdose included an unusually high rate of salt water injection (26%) and previously undocumented interventions (e.g., 52% placed ice on the groin). Believing the victim could be revived without medical treatment was the most common reason for delaying or forgoing a 911 call. IDUs who received overdose prevention/response information from a medical or social services provider (17%) reported more appropriate responses. Only 26% of IDUs reported seeking drug treatment after their last overdose. Not being ready for treatment was the most common barrier, but missed opportunities for medical personnel to engage IDUs in treatment were also common.; Conclusions. IDUs with a history of drug overdose are a priority group for preventive interventions. Overdose response education programs should dispel myths about the effectiveness of inappropriate interventions, and initiatives to promote drug treatment entry among overdose survivors in the medical setting are needed.