Nathan C Stam, Monika Shrestha, Basak Tas, John Furler, Yvonne Bonomo, John Strang
{"title":"Analysis of rapid onset heroin overdose cases from a supervised injecting facility in Melbourne, Australia.","authors":"Nathan C Stam, Monika Shrestha, Basak Tas, John Furler, Yvonne Bonomo, John Strang","doi":"10.1111/add.70199","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>To characterise the clinical condition of rapid onset heroin overdose cases, and to determine the incidence and characteristics of such cases.</p><p><strong>Design: </strong>A retrospective cohort study of witnessed heroin overdose cases over a 12-month period (1 July 2023 to 30 June 2024).</p><p><strong>Setting: </strong>The Medically Supervised Injecting Room in Melbourne, Australia.</p><p><strong>Cases: </strong>Individuals who experienced a rapid onset overdose. A control group of standard onset cases amongst those same individuals was used for comparison.</p><p><strong>Measurements: </strong>The severity of acute opioid toxicity for rapid versus standard onset heroin overdose cases, using a clinical severity scale regularly used at the Medically Supervised Injecting Room.</p><p><strong>Findings: </strong>From a total of 1727 heroin overdoses, 202 were identified as rapid onset cases that occurred amongst a cohort of 98 individuals. There were 997 standard overdoses from 75 individuals from this same cohort used as a control. Rapid onset overdoses presented with greater severity of respiratory depression. Forty-one percent (n = 82) of cases required positive pressure ventilation, including 19% (n = 38) classified as Grade 2 severity and 22% (n = 44) classified as Grade 3a severity. The standardised rate of rapid overdoses was approximately doubled on High overdose risk days (0.151/overdose) compared with that on Low overdose risk days (0.077/overdose).</p><p><strong>Conclusion: </strong>Rapid onset heroin overdoses typically present as medical emergencies involving severe respiratory depression shortly after heroin administration. Some people appear more likely to experience a rapid onset overdose than others, but factors for this are unclear. Rapid onset heroin overdoses also more commonly occur on some days compared with others, which may indicate an interrelationship between personal risk and the unregulated drug market. Rapid onset overdose cases may play a substantial role in hypoxic-related morbidity and mortality associated with heroin overdoses.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Addiction","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/add.70199","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: To characterise the clinical condition of rapid onset heroin overdose cases, and to determine the incidence and characteristics of such cases.
Design: A retrospective cohort study of witnessed heroin overdose cases over a 12-month period (1 July 2023 to 30 June 2024).
Setting: The Medically Supervised Injecting Room in Melbourne, Australia.
Cases: Individuals who experienced a rapid onset overdose. A control group of standard onset cases amongst those same individuals was used for comparison.
Measurements: The severity of acute opioid toxicity for rapid versus standard onset heroin overdose cases, using a clinical severity scale regularly used at the Medically Supervised Injecting Room.
Findings: From a total of 1727 heroin overdoses, 202 were identified as rapid onset cases that occurred amongst a cohort of 98 individuals. There were 997 standard overdoses from 75 individuals from this same cohort used as a control. Rapid onset overdoses presented with greater severity of respiratory depression. Forty-one percent (n = 82) of cases required positive pressure ventilation, including 19% (n = 38) classified as Grade 2 severity and 22% (n = 44) classified as Grade 3a severity. The standardised rate of rapid overdoses was approximately doubled on High overdose risk days (0.151/overdose) compared with that on Low overdose risk days (0.077/overdose).
Conclusion: Rapid onset heroin overdoses typically present as medical emergencies involving severe respiratory depression shortly after heroin administration. Some people appear more likely to experience a rapid onset overdose than others, but factors for this are unclear. Rapid onset heroin overdoses also more commonly occur on some days compared with others, which may indicate an interrelationship between personal risk and the unregulated drug market. Rapid onset overdose cases may play a substantial role in hypoxic-related morbidity and mortality associated with heroin overdoses.
期刊介绍：
Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines.
Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries.
Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.
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