title: Circumstances and witness characteristics associated with overdose fatality.
abstract: OBJECTIVE
  Emergency physicians have an opportunity to provide overdose fatality prevention interventions to individuals at risk for experiencing or witnessing an overdose to reduce fatality. The present study uses data about the most recent overdose observed by a sample of inner-city drug users to determine the circumstances of overdose that are associated with overdose fatality.
  
  
  METHODS
  Participants (n=690) aged 18 years or older were recruited with targeted street outreach. All participants had used heroin or cocaine in the previous 2 months and had witnessed at least 1 overdose. Survey data included the circumstances of the last overdose witnessed, including actions taken, drug use behavior, the location of the event, and whether or not the overdose was fatal (the outcome measure).
  
  
  RESULTS
  One hundred fifty-two (21.7%) of the witnessed overdoses were fatal. Witness powdered cocaine use (adjusted odds ratio=1.6; 95% confidence interval [CI] 1.0 to 2.6) and injection drug history (adjusted odds ratio=0.5; 95% CI 0.3 to 0.9) were associated with the last witnessed overdose being fatal. Witnessed overdoses that occurred in public or abandoned buildings compared with homes were more likely to be fatal (adjusted odds ratio=1.9; 95% CI 1.0 to 3.5), as were overdoses in which witnesses sought outside medical help (adjusted odds ratio=1.5; 95% CI 1.0 to 2.1).
  
  
  CONCLUSIONS
  Future prevention interventions may fruitfully target users of powdered cocaine, drug users without a history of injecting, and individuals who use drugs in public or abandoned buildings for brief interventions on responding when witnessing an overdose to reduce mortality.
authors.affiliation: VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI 48105, USA. amybohne@med.umich.edu
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.forename: Melissa
authors.initials: M
authors.lastname: Tracy
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000293:Adolescent; D000328:Adult; D019970:Cocaine-Related Disorders / Q000401:mortality*; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D033062:Friends; D007722:Health Knowledge, Attitudes, Practice; D006556:Heroin Dependence / Q000401:mortality*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D014505:Urban Population; D055815:Young Adult