Cause and motivation in cases of non-fatal drug overdoses in opiate addicts.
BACKGROUND
Drug overdose (OD) is a frequent incident among opiate addicts. Survivors of ODs are at risk for additional and eventually fatal ODs. ODs may be classified as accidental (aOD) or deliberate (dOD). Investigations into the connection between OD and suicide attempts have led to insconsistent results.


OBJECTIVE
(1) to determine how many non-fatal ODs were dODs and how many were aODs; (2) to determine how many cases of dODs were motivated by explicit or by ambivalent suicidal intentions; (3) to determine how many cases of aODs had causes that might respond to preventative measures; (4) to compare the addiction histories of dODs and aODs; (5) to compare the drugs causing the ODs; and (6) to compare the severity of the ODs in both groups.


METHODS
Prospective study utilizing a standardized questionnaire to evaluate opiate-addicted patients admitted to our treatment unit for OD. All cases underwent standardized drug testing to identify drug use patterns.


RESULTS
Seventy-four cases of OD underwent standardized interviews after awakening. Forty-three percent of the cases were dOD. Cases of dOD had significantly more OA in substitution programs, more previous ODs, and more often consumed methadone and cocaine. Among dODs, 22.5% had suicidal intention and 9.6% were ambivalent about committing suicide; background motivations were most often conflicts with spouses. Fifty-seven percent of the cases were aOD. Cases of aODs had significantly more potential lethal intoxications and had heroin detected more frequently. aODs happened with unexpected pure heroin (46%), in combination with alcohol (36%), as relapse after abstinence (40%) or after institutionalized treatment (19%). This group should be accessible for targeted education.
Pfab
R
R
Department of Toxicology, Klinikum rechts der Isar, Munich, Germany. rudi.pfab@t-online.de
Eyer
F
F
Jetzinger
E
E
Zilker
Thomas
T
D000328:Adult; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D009042:Motivation; D009294:Narcotics / Q000506:poisoning*; D009293:Opioid-Related Disorders / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D011446:Prospective Studies; D013406:Suicide, Attempted / Q000523:psychology; D011795:Surveys and Questionnaires
D009294:Narcotics; D008691:Methadone