In addition to naloxone distribution (see Sections 5 and 6), there are number of additional interventions and approaches which can prevent overdose deaths amongst people who use drugs. These are especially for non-opioid users (such as cocaine users), for whom naloxone offers no protection. This section includes papers on interventions in prisons, the impacts of high quality substitution treatments, and how the creation of a safer injection facility in Canada has helped to manage and reduce overdoses. There is also a comprehensive review of an overdose programme in Australia – which included peer education and informational materials.
Albizu-Garcia CE, Hernandez-Viver A, Feal J, Rodriguez-Orengo JF (2009) Characteristics of inmates witnessing overdose events in prison: implications for prevention in the correctional setting. Harm Reduction Journal 2009, 6:15
While community-based responses to drug overdose are becoming more common, information on drug overdose in prisons is scarce. This paper examines the frequency with which prisoners in Puerto Rican prisons witness drug overdose events in prison. In order to inform future overdose prevention programming in prisons, the study also examines socio-demographic variables and drug use history to assess whether those who have witnessed drug overdoses differ from those who have not.
Drug Policy Alliance (2009) Preventing Overdose, Saving Lives Strategies for Combating a National Crisis. USA: DPA.
This comprehensive report examines the extent of overdose related mortality in the United States and assesses the policy solutions available and how they have been successfully implemented across the country. It identifies areas in need of further study and investment
and offers a roadmap for responding to the national opioid overdose crisis with rational, compassionate and responsible public health policies.
Fatseas M & Auriacombe M (2007) Why buprenorphine is so successful in treating opiate addiction in France. Current Psychiatry Reports, 9:5, pages 358-364
The successful minimization of barriers to buprenorphine maintenance therapy access in France from 1995 onwards resulted in approximately 20% of all physicians in the country prescribing BMT to over half of the estimated 180,000 people who used heroin problematically. The paper describes how this rapid increase in availability led to a substantial decline in total opiate overdose deaths in France. Unfortunately, we are unable to provide free access to this article at this stage.
Kerr T, Small W, Moore D & Wood E (2007) A Micro-Environmental Intervention to Reduce the Harms Associated with Drug-Related Overdose: Evidence from the evaluation of Vancouver’s safer injection facility. International Journal of Drug Policy, 18, pages 37 – 45.
Conventional drug overdose prevention strategies have been criticised for failing to address the macro- and micro-environmental factors that shape drug injecting practices and compromise individual ability to reduce risks. This paper – from Harm Reduction International’s official journal – reports on the perspectives of injecting drug users and suggests that safer injection facilities can address many of the micro-environmental factors that drive overdose risks. These interventions may play a key role in managing and preventing overdoses – particularly in large street-based drug scenes.
Kerr T, Tyndall MW, Lai C, Montaner JSG & Wood E (2006) Drug-Related Overdoses within a Medically Supervised Safer Injection Facility. International Journal of Drug Policy, 17, pages 436 – 441.
This is one of two papers in this section from Harm Reduction International’s official journal which focus on the role of safer injection facilities in terms of preventing overdoses. This research paper examines the incidence and features of overdoses witnessed at the supervised injection facility in Canada. In the study period, there were 336 ‘overdose events’ in the facility, most of which were treated with oxygen. Despite this relatively large number, “it is noteworthy that none of these overdoses resulted in a fatality”. Unfortunately, we are unable to provide free access to this article.
McGregor C, Hall K, Ali R, Christie P, Braithwaite R & Darke S (1999) It’s Rarely Just the “H”: Addressing Overdose Among South Australian Heroin Users Through a Process of Intersectoral Collaboration. South Australia: Drug and Alcohol Services Council.
This document reviews the South Australian heroin overdose intervention, which started in 1994. The three strands of the project were the development of partnerships among key stakeholders and the achievement of structural change, the development and implementation of a peer education process, and the development and dissemination of information materials. This report aimed to identify the experience and circumstances of overdoses in South Australia, develop appropriate interventions to reduce these, evaluate the effectiveness of targeted interventions, and review institutional sources of data. The findings demonstrate that the majority of overdoses involve the use of heroin and other depressant drugs together, and that such interventions are feasible and effective.
Milloy M-J, Kerr T, Tyndall M, Montaner J & Wood E (2008) Estimated Drug Overdose Deaths Averted by North America's First Medically-Supervised Safer Injection Facility. PLoS ONE, 3(10), e3351.
This research study investigates the number of deaths potentially averted by the implementation of a medically supervised safer injection facility (SIF) in Vancouver, Canada. One of the objectives of the SIF, known as InSite, is to prevent overdose incidents through the provision of education and the medical supervision of drug injecting. The authors conclude that the potentially fatal overdoses at InSite during the study period could have resulted in between 8 and 51 deaths had they occurred outside the facility. This equates to between 6% and 37% of the total overdose mortality burden in the neighbourhood during this time, illustrating a clear overdose prevention benefit from the facility.