title: Association between non-fatal opioid overdose and encounters with healthcare and criminal justice systems: Identifying opportunities for intervention.
abstract: BACKGROUND
  Accidental overdose, driven largely by opioids, is a leading cause of death among people who inject drugs (PWIDs). We conducted secondary analysis of data from a cohort of PWIDs to identify venues where high-risk PWID could be targeted by overdose education/naloxone distribution (OEND) programs.
  
  
  METHODS
  573 PWIDs completed a quantitative survey between June, 2012 and January, 2014, which was analyzed using multivariable logistic regression. The dependent variable was a dichotomous indicator of experiencing a heroin/opioid-related overdose in the past six months. Independent variables included: demographics, drug use behavior, and encounters with two venues - the health care and criminal justice systems - that could serve as potential venues for OEND programs.
  
  
  RESULTS
  Almost half (41.5%) reported ever experiencing a heroin/opioid overdose, and 45 (7.9%) reported experiencing at least one heroin/opioid overdose in the past six months. In the final multivariable model, receiving care in a hospital in the past six months (Adjusted Odds Ratio [AdjOR] 4.08, 95% Confidence Interval [C.I.] 2.07, 8.04, p<0.001) and being arrested for drug possession in the past six months (AdjOR 5.17, 95% C.I. 2.37, 11.24, p<0.001) were associated with experiencing an opioid overdose in the past six months.
  
  
  CONCLUSIONS
  Identifying venues outside of those that traditionally target services to PWIDs (i.e., syringe exchange programs) will be critical to implementing OEND interventions at a scale sufficient to address the growing epidemic of heroin/opioid related deaths. Clinical settings, such as hospitals, and drug-related encounters with law enforcement officers are promising venues for the expansion of OEND programs.
authors.affiliation: School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, NV 89557, United States. Electronic address: karlawagner@unr.edu.
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wagner
authors.affiliation: Division of Biostatistics & Bioinformatics, Department of Family Medicine and Public Health, University of California School of Medicine, 9500 Gilman Drive MC 0717, La Jolla, CA 92093, United States.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0507, La Jolla, CA 92093, United States.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Davidson
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0507, La Jolla, CA 92093, United States.
authors.forename: Jazmine
authors.initials: J
authors.lastname: Cuevas-Mota
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0507, La Jolla, CA 92093, United States.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Armenta
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive MC 0507, La Jolla, CA 92093, United States.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D016739:Behavior, Addictive / Q000453:epidemiology / Q000523:psychology; D002140:California / Q000453:epidemiology; D003415:Crime / Q000523:psychology / Q000706:statistics & numerical data*; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: Naloxone; Opioids; Overdose; Overdose prevention; People who inject drugs