title: Characteristics of drug users who witness many overdoses: implications for overdose prevention.
abstract: BACKGROUND
  Programs to improve response of drug users when witnessing an overdose can reduce overdose mortality. Characteristics of drug users may be associated with the number of overdoses ever witnessed. This information could inform overdose prevention programs.
  
  
  METHODS
  Participants in New York City, who were age 18 and older with heroin and/or cocaine use in the past two months, were administered structured interviews (n=1184). Survey topics included overdose response, drug use behavior, treatment history, and demographic information.
  
  
  RESULTS
  In a multivariable negative binomial regression model, those persons who were male (IRR [Incidence Rate Ratio]=1.7, CI [95% Confidence Interval]=1.4,2.2), had experienced homelessness (IRR=1.9, CI=1.4,2.6), had used heroin (IRR=2.0, CI=1.3,3.2), had overdosed themselves (IRR=1.9, CI=1.6,2.4), or had attended Narcotics Anonymous (IRR=1.3, CI=1.1,1.6) witnessed a greater count of overdoses in their lifetime. Those persons who have witnessed more overdoses were less likely to have sought medical assistance (OR [Odds Ratio]=0.7) and more likely to report counter-productive or ineffective actions (ORs between 1.9 and 2.4) at the last overdose they witnessed compared to persons who had only ever witnessed one or two overdoses.
  
  
  CONCLUSIONS
  Persons at high risk for overdose are likely to witness more overdoses. Persons who had witnessed more overdoses were more likely to report taking ineffective action at the last overdose witnessed. Individuals who have witnessed many overdoses are likely key targets of overdose response training.
authors.affiliation: VA National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, United States. 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: D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology