Gossop, M., Marsden, J., Stewart, D., et al (1998) Substance use, health and social
problems of service users at 54 drug treatment agencies Intake data from the National
Treatment Outcome Research Study. British Journal of Psychiatry, 173, 166-171.
Conclusions The range and severity of problems adversely affect individual users,
their families, and present a challenge to addiction treatment services. These problems
create costs for the health care, social service and criminal justice system responses.
1 National Drug and Alcohol Research Centre, University of New South Wales, Australia
2 Drug and Akohot Services, Central Sydney Area Health Service, New South Wales,
Correspondence: Dr Shane Darke, National Drug and Alcohol Research Centre, University
of New South Wales, NSW, 2052, Australia.
The current paper examines critically the literature on deaths attributed to heroin
overdose, and examines the characteristics and circumstances of such deaths. In particular,
the dominance of the widely held belief that heroin-related fatalities are a consequence
of overdose is challenged. Deaths attributed to overdose represented in the literature
are typically older, heroin-dependent males not in drug treatment at the time of
death. Fatalities involving only heroin appear to form a minority of overdose occasions,
the presence of other drugs (primarily central nervous system depressants such as
alcohol andbenzodiazepines) being commonly detected at autopsy. Furthermore, deaths
attributed to overdose are likely to have morphine levels no higher than those who
survive, or heroin users who die from other causes. It is concluded that the term
overdose is, in many cases, a misleading term, since it implies the same mechanism
of death in all cases, an implication that is neither clinically useful nor consistent
with published data. Implications for the prevention of heroin-related deaths are
Seal KH, Kral AH, Gee L, Moore LD, Bluthenthal RL, Lorvick J, Edlin BR: Predictors
and prevention of nonfatal overdose among street-recruited injection heroin users
in the San Francisco Bay Area, 1998–1999.