A taxonomy of preventability of overdose death: a multi-method study

Document type
Hickman, Matthew; Carrivick, Sandra; Cusick, Linda
NHS National Treatment Agency for Substance Misuse
Date of publication
2 April 2007
Research briefing; 23
Substance Misuse
Social welfare
Material type

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The aims of this study were to provide a description and initial taxonomy of overdose deaths in London. Firstly, coronial files from seven of the eight coroners’ courts in London were examined to identify drug-related poisonings that took place or went to inquest in 2003 and reported a positive toxicology, or circumstances of death that implicated heroin, cocaine, methadone, MDMA, amphetamine or dihydrocodeine. 151 deaths were determined or suspected as drug-related poisonings, which represents approximately 75 per cent of all drug-related deaths involving illicit drugs or opiates in London in 2003. Both qualitative data, from witness statements and reports, and quantitative data were extracted from the files. In addition, 61 narratives of overdose death were collected to discover naturally occurring witness accounts of overdose death to compensate for the incomplete information available from coroners’ records. Finally, a panel of expert drug user analysts checked the plausibility of the data in a sample of the witness statements and narratives, and also provided insight on the ways drug users might interpret the accounts. The study found that the majority of deaths were in subjects with a history of opiate use and drug dependence, and drug-related deaths are on average older and more likely to be male than problem drug users in treatment or in the population. In approximately one-third of cases there was evidence of recent release from prison or current substitute prescription. The study concluded that opportunities do exist to prevent overdose deaths and many of these depend on improved communication between drug users, and between service providers and drug users, with specific reference to assessing the risk of altered tolerance, norms of sharing and scoring, assisted injecting, checking vital signs during drug use, knowing how to prioritise actions once signs of trouble arise, prevention literature including information on stimulant overdose signs of trouble, specific information on assessing drug quality and polydrug use risks, especially for mixing respiratory depressant drugs and stimulants, and detailed written information on all drugs literature being available in all languages. Consideration should be given to campaigns that raise awareness of signs of overdose, but also seek to encourage a shared responsibility or duty of care for other drug users.

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