title: Heroin overdose among young injection drug users in San Francisco.
abstract: OBJECTIVE
  We sought to identify prevalence and predictors of heroin-related overdose among young injection drug users (IDU).
  
  
  METHODS
  A total of 795 IDU under age of 30 years were interviewed in four neighbourhoods in San Francisco, California, USA. Participants were recruited as part of a broader study of HIV, hepatitis B and C among injecting drug users in San Francisco using street outreach and snowball techniques. Independent predictors of recent heroin overdose requiring intervention were determined using regression analysis.
  
  
  RESULTS
  Of 795 injecting drug users under age of 30 years, 22% (174/795) of participants reported a heroin overdose in the last year. In stepwise multiple logistic regression, independent predictors of recent heroin overdose were lifetime incarceration exceeding 20 months (odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.52-5.88); heroin injection in the last 3 months (OR = 4.89, 95% CI = 2.03-11.74); cocaine injection in the last 3 months (OR = 1.67, 95% CI = 1.14-2.45); injection of heroin mixed with methamphetamine in the last 3 months (OR = 1.74, 95% CI = 1.15-2.65); ever tested for hepatitis B or C (OR = 1.66 per year, CI = 1.09-2.54) and ever having witnessed another person overdose (OR = 2.89, 95% CI = 1.76-4.73).
  
  
  CONCLUSIONS
  Individuals with high levels of incarceration are at great risk of overdose, and prison or jail should be considered a primary intervention site. Further research on the role of cocaine and amphetamine in heroin-related overdose is indicated.
authors.affiliation: University of California, San Francisco General Hospital, 995 Potrero Avenue, Building 90, Ward 95, Room 513, San Francisco, CA 94110, USA.
authors.forename: Kristen C
authors.initials: KC
authors.lastname: Ochoa
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Davidson
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Evans
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
authors.forename: Kimberly
authors.initials: K
authors.lastname: Page-Shafer
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Moss
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002391:Catchment Area, Health; D062787:Drug Overdose; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects*; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008694:Methamphetamine; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires
chemical_list: D008694:Methamphetamine; D003932:Heroin