Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999

Objectives. This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. Methods. From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. Results. Of the 1427 participants, 684 (48%) had had an overdose, 466 (33%) had experienced 2 or more overdose events, and 182 (13%) had had a recent overdose. In multiple logistic regression, being younger (adjusted odds ratio [OR] for each year of increasing age=0.95; 95% confidence interval [Cl]=0.94, 0.97), having been arrested 3 or more times in the past year (adjusted OR=2.50; 95% Cl=1.61, 3.87), drinking 4 or more alcoholic drinks per day (adjusted OR=2.05; 95% Cl=1.37, 3.05), and having participated in methadone detoxification during the past year (adjusted OR=1.47; 95% Cl=1.03, 2.09) were independently associated with recent overdose. Being homeless; identifying as gay, lesbian, bisexual, or transgender; having spent 5 or more years in prison or jail; and having engaged in sex work also were associated with recent overdose. Conclusions. Targeted interventions that decrease risk for overdose are urgently needed.