|
|
|
|
|
Melissa Tracy, BA, Sandro Galea, MD, MPH, DrPH, Tinka Markham Piper, MPH, CSW, Danielle C. Ompad, PhD, Jennifer Ahern, MPH, Phillip O Coffin, MIA, and David Vlahov, PhD. Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-419-3583, mtracy@nyam.org
Accidental fatal and non-fatal drug overdoses are common among habitual drug users; other users are often present at such overdose events. We assessed the circumstances of witnessed overdose events in a predominantly minority urban population in order to develop interventions that can reduce overdose fatalities. Heroin, crack, and cocaine users were recruited and interviewed in Harlem and the South Bronx in New York City between 2001 and 2003. Of 1,056 participants, 692 (65.5%) had witnessed at least one overdose. Among these, median age was 38, 75.1% were male, 60.2% were Hispanic, 25.9% were Black, 13.9% were White or other race, and 62.1% were current injectors. 44.0% had ever overdosed themselves. During the most recently witnessed overdose, 230 (34.2%) respondents did not call for medical help; of the 443 that did get help, 87 (20.2%) delayed before calling. Fear of police involvement was the most commonly cited reason for not getting (45.2%) or delaying getting help (66.7%). A range of other actions was also undertaken by those present at overdoses; 55.2% employed home remedies (e.g., applied ice to the person, injected with water) and 17.2% performed first aid (e.g., placed person in coma position, conducted CPR). Respondents who had a prior non-fatal overdose were less likely to call for medical help (57.8% vs. 72.3% with no prior overdose; p<0.001); however, they were more likely to call for help if taken to the hospital during their most recent overdose (69.1% vs. 44.0% if not taken to the hospital; p<0.001). The most recently witnessed overdose ended in death in 137 cases (19.8%). Witnesses to fatal overdoses were more likely to call for medical help (85.3% vs. 60.3% for non-fatal; p<0.001) and to engage in first aid activities (24.1% vs. 16.3% for non-fatal; p=0.036). These data suggest that drug users who witness overdoses are hesitant to seek help, relying instead on home remedies, mostly out of fear of police response. The personal overdose experience of those present and the perceived seriousness of the event may also influence reactions to witnessed overdoses. Fatal overdoses received more urgent responses, although this may reflect efforts by participants to report socially desirable actions in cases known to have resulted in death. Education about first aid and early activation of EMS, as well as efforts to reduce police involvement, should accompany interventions aimed at minimizing overdose morbidity and mortality.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.