title: Overdose after detoxification: a prospective study.
abstract: OBJECTIVE
  The aim of this study was to determine predictors of non-fatal overdose (OD) among a cohort of 470 adults after detoxification from heroin, cocaine or alcohol.
  
  
  METHODS
  We examined factors associated with time to OD during 2 years after discharge from an urban detoxification unit in Boston, MA, USA using multivariable regression analyses. Separate analyses were performed for both the total sample and a subgroup with problem opioid use.
  
  
  RESULTS
  Lifetime prevalence for any OD was 30.9% (145/470) in the total sample and 42.3% (85/201) in patients with opioid problems. During the 2-year follow-up, OD was estimated to occur in 16.9% of the total sample and 26.7% of the opioid problem subgroup, with new-onset (incidence) OD estimated at 5.7% and 11.0%, respectively. Factors associated with an increased hazard of OD in both samples included white race, more depressive symptoms, and prior OD regardless of intent. Prior suicidal ideation or attempt was not associated with future OD.
  
  
  CONCLUSIONS
  Findings underscore both the high prevalence of non-fatal OD among detoxification patients especially opioid users, and the potency of prior OD as a risk factor for future OD. Depressive symptoms, a modifiable risk factor, may represent a potential intervention target to prevent OD, including some "unintentional" ODs.
authors.affiliation: Alcohol and Drug Abuse Research Center (ADARC), McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA. jwines@hms.harvard.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Wines
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D001900:Boston; D003042:Cocaine / Q000633:toxicity*; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D062787:Drug Overdose / Q000453:epidemiology; D000431:Ethanol / Q000633:toxicity*; D005260:Female; D003932:Heroin / Q000633:toxicity*; D006556:Heroin Dependence / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D000431:Ethanol; D003932:Heroin; D003042:Cocaine