title: Morbidity associated with heroin overdose presentations to an emergency department: a 10-year record linkage study.
abstract: BACKGROUND
  To examine hospitalizations in a cohort of 224 patients who presented with non-fatal heroin overdose to an ED.
  
  
  METHODS
  A record linkage study, using the morbidity, mental health and mortality databases in the Data Linkage Unit of the Department of Health, Western Australia. The main outcome measures were hospital separations 5 years before and after entry into the cohort.
  
  
  RESULTS
  Before entry into the cohort, 199 (89%) patients had an admission to mental health services. These 199 had a combined total of 1367 separations, most commonly for a mental health condition, injury or poisoning. Women had more than twice the relative risk (RR) of men for all separations (RR 2.35, 95% confidence interval [CI] 1.96-2.82, P < 0.001) and for injury and poisoning separations (RR 2.04, 95% CI 1.56-2.66, P < 0.001). The highest concentrations of separations occurred within 1 year before and 1 year after entry into the cohort. There were 12 (5.4%, 95% CI 2.9-9.4%) deaths, most commonly from overdose.
  
  
  CONCLUSIONS
  Non-fatal heroin overdose ED presentations are associated with a cluster of hospitalizations around that episode, likely to be related to heroin availability. Presentation to hospital by heroin users represents an opportunity to counsel less risky behaviour.
authors.affiliation: Department of Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia. daniel.fatovich@health.wa.gov.au
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: Anne
authors.initials: A
authors.lastname: Bartu
authors.forename: Geoff
authors.initials: G
authors.lastname: Davis
authors.forename: Jag
authors.initials: J
authors.lastname: Atrie
authors.forename: Frank Fs
authors.initials: FF
authors.lastname: Daly
mesh_terms: D000328:Adult; D015331:Cohort Studies; D062787:Drug Overdose / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008498:Medical Record Linkage; D008605:Mental Health Services; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D012306:Risk; D017678:Sex Distribution; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult