Response to Overdose Among Injection Drug Users

Background: Drug overdose is a leading cause of mortality among illicit drug users. This study characterizes responses to overdose among injection drug users (IDUs) in Baltimore, Maryland, and identifies factors associated with medically inappropriate response. Methods: A cross-sectional survey was administered to 924 IDUs in an ongoing cohort study between August 2003 and September 2004. Self-reported experiences of witnessing overdose were obtained by structured interview. Multiple logistic regression identified associations between overdose information sources and medically inappropriate responses. Results: Most IDUs (69.7%) reported ever witnessing an overdose. The most common responses were walking the victim around (70.8%), shaking them (64.9%), and inflicting pain (62.6%). One in four (25.8%) injected the victim with salt water. Two thirds (63.4%) called 911, but more than half delayed the call by 5 or more minutes. The most common reason cited for delaying or foregoing the 911 call was the belief that they could revive the victim themselves, followed by fear of police involvement. Most IDUs had received information on how to prevent or respond to an overdose, but most (73.2%) received this information from friends or other drug users. IDUs who got overdose information solely from lay sources were less likely to call 911 (adjusted odds ratio [AOR]=0.66, 95% confidence interval [CI]=0.46-0.94) and more likely to inject the victim with salt water (AOR=2.06, 95% CI=1.36-3.13) than IDUs who received no information at all. Injection drug users who received information from medical and social services providers only were less likely to delay the 911 call (AOR=0.35, 95% CI=0.22-0.72). Conclusions: Inappropriate overdose responses are widespread among IDUs in Baltimore. Interventions that provide overdose education and reduce police response to overdose events may improve witness response and reduce mortality associated with drug overdose.