Which drugs cause overdose among opiate misusers? Study of personal and witnessed overdoses
Corresponding Author
John Strang
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
John Strang, MBBS, FRCPsych, MD, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United KingdomSearch for more papers by this authorPaul Griffiths
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Paul Griffiths, BA, MSc, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorBeverly Powis
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Beverly Powis, BSc(Hons), National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorJane Fountain
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Jane Fountain, BA(Hons), PhD, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorSara Williamson
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Sara Williamson, BSc(Hons), MSc, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorMichael Gossop
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Michael Gossop, BA, PhD, FBPsS, CPsychol, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorCorresponding Author
John Strang
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
John Strang, MBBS, FRCPsych, MD, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United KingdomSearch for more papers by this authorPaul Griffiths
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Paul Griffiths, BA, MSc, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorBeverly Powis
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Beverly Powis, BSc(Hons), National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorJane Fountain
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Jane Fountain, BA(Hons), PhD, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorSara Williamson
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Sara Williamson, BSc(Hons), MSc, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorMichael Gossop
National Addiction Centre, Institute of Psychiatry and the Maudsley Hospital, Denmark Hill, London, United Kingdom
Michael Gossop, BA, PhD, FBPsS, CPsychol, National Addiction Centre (Institute of Psychiatry/Maudsley), Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK.
Search for more papers by this authorAbstract
Concern has been expressed at the widespread prescribing of methadone in view of its inherent toxicity. Commentators have opined that methadone is more toxic than heroin and causes more overdose deaths. However, data deficiencies and flawed analyses leave continuing uncertainty about this crucial policy issue. The relative contributions of heroin, other opiates (e.g. methadone) and non-opiate drugs to overdose and overdose deaths among drug misusers were examined in a community-recruited sample of 312 injecting drug misusers in London. Data were collected on last personal overdose (n=117), last witnessed overdose (n=167) and last witnessed fatal overdose (n=55), and on the different drugs that had been involved with these overdoses. Heroin was involved in 83% of last personal overdoses, 90% of last witnessed overdoses and 80% of last witnessed fatal overdoses, while other opiates were involved in only 18%, 8% and 26%, respectively. Methadone accounted for about half of these “other opiate” overdoses. Overdoses involving a combination of heroin and a non-opiate were common − 29%, 21% and 39%, respectively. Heroin was the drug most frequently involved in overdose across all three areas of study. However, combinations of heroin and a non-opiate were surprisingly frequent, especially in witnessed fatal overdoses (as reported recently by other investigators using different methodologies). Considering the wide extent of methadone prescribing to this group, methadone was remarkably infrequently reported as responsible (solely or in combination) for either personal overdoses, witnessed overdoses or witnessed fatal overdoses.
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