Background/Aims: Non-fatal opioid overdose (NFOO) and major depression (MD) are highly prevalent in heroin users. Many risk factors are known for NFOO, but studies in non-clinical samples on its relationship with MD are lacking. We aimed to examine this relationship in a street-recruited sample, controlling for potential well-known confounders. Methods: A cross-sectional study in 452 heroin users street-recruited by chain referral methods in three Spanish cities. Eligibility criteria were: age ≤30 years, heroin use at least 12 days in the last year and at least once in the last 3 months. Depression was assessed using the Composite International Diagnostic Interview. A precise definition of NFOO was used. Adjusted odds ratios (AORs) for the NFOO predictors were obtained by logistic regression. Results: The prevalence of NFOO and MD in the last 12 months was 9.1 and 23.2%, respectively. After adjusting for potential confounders, NFOO and MD were significantly associated (AOR 2.2; 95% CI 1.01-4.74). Other associated factors were imprisonment (AOR 4.1; 95% CI 1.4-12.1), drug injection (AOR 6.7; 95% CI 2.4-18.4) and regular use of tranquillisers/sleeping pills (AOR 2.9; 95% CI 1.16-7). Conclusions: Drug and mental health treatment facilities should consider the relationship between MD and NFOO when contacting and treating heroin users. Imprisonment, drug injection and use of tranquillisers/sleeping pills are also risk factors for NFOO.

1.
EMCDDA: Annual report 2012: Annual report on the state of the drugs problem in Europe. Luxembourg, Office for Official Publications of the European Communities/European Monitoring Center for Drugs and Drug Addiction (EMCDDA), 2012.
2.
Darke S, Mattick RP, Degenhardt L: The ratio of non-fatal to fatal heroin overdose. Addiction 2003;98:1169-1171.
3.
Harris EC, Barraclough B: Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997;170:205-228.
4.
Darke S, Hall W: Heroin overdose: research and evidence-based intervention. J Urban Health 2003;80:189-200.
5.
Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR: Heroin overdose among young injection drug users in San Francisco. Drug Alcohol Depend 2005;80:297-302.
6.
Brooner RK, King VL, Kidorf M, Schmidt CW Jr, Bigelow GE: Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997;54:71-80.
7.
Havard A, Teesson M, Darke S, Ross J: Depression among heroin users: 12-month outcomes from the Australian Treatment Outcome Study (ATOS). J Subst Abuse Treat 2006;30:355-362.
8.
Brugal MT, Barrio G, De la Fuente L, Regidor E, Royuela L, Suelves JM: Factors associated with non-fatal heroin overdose: assessing the effect of frequency and route of heroin administration. Addiction 2002;97:319-327.
9.
Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J, Wood E: Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users. Drug Alcohol Depend 2007;87:39-45.
10.
Tobin KE, Latkin CA: The relationship between depressive symptoms and nonfatal overdose among a sample of drug users in Baltimore, Maryland. J Urban Health 2003;80:220-229.
11.
Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, Turner BJ, Eggan F, Beckman R, Vitiello B, Morton SC, Orlando M, Bozzette SA, Ortiz-Barron L, Shapiro M: Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry 2001;58:721-728.
12.
Stewart D, Gossop M, Marsden J: Reductions in non-fatal overdose after drug misuse treatment: results from the National Treatment Outcome Research Study (NTORS). J Subst Abuse Treat 2002;22:1-9.
13.
Darke S, Ross J, Hall W: Overdose among heroin users in Sydney, Australia. I. Prevalence and correlates of non-fatal overdose. Addiction 1996;91:405-411.
14.
Brugal MT, Domingo-Salvany A, Puig R, Barrio G, Garcia de Olalla P, De la Fuente L: Evaluating the impact of methadone maintenance programmes on mortality due to overdose and AIDS in a cohort of heroin users in Spain. Addiction 2005;100:981-989.
15.
Dean AJ, Bell J, Christie MJ, Mattick RP: Depressive symptoms during buprenorphine versus methadone maintenance: findings from a randomised, controlled trial in opioid dependence. Eur Psychiatry 2004;19:510-513.
16.
Wines JD Jr, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH: Overdose after detoxification: a prospective study. Drug Alcohol Depend 2007;89:161-169.
17.
Maloney E, Degenhardt L, Darke S, Nelson EC: Are non-fatal opioid overdoses misclassified suicide attempts? Comparing the associated correlates. Addict Behav 2009;34:723-729.
18.
Darke S, Mills K, Teesson M, Ross J, Williamson A, Havard A: Patterns of major depression and drug-related problems amongst heroin users across 36 months. Psychiatry Res 2009;166:7-14.
19.
Burns JM, Martyres RF, Clode D, Boldero JM: Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances. Med J Aust 2004;181:S25-S28.
20.
Watters JK, Biernacki P: Targeted sampling: options for the study of hidden populations. Soc Probl 1989;36:416-430.
21.
Heckathorn DD: Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl 1997;44:174-199.
22.
De la Fuente L, Brugal MT, Ballesta R, Bravo MJ, Barrio G, Domingo-Salvany A, Silva RT, Ambros M: Cohort study methodology of the ITINERE Project on heroin users in three Spanish cities and main characteristics of the participants (in Spanish). Rev Esp Salud Publica 2005;79:475-491.
23.
Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93-121.
24.
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolami G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC: Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 2006;15:167-180.
25.
Jones JD, Mogali S, Comer SD: Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend 2012;125:8-18.
26.
Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD: HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS 2012;26:403-417.
27.
Milloy MJ, Kerr T, Tyndall M, Montaner J, Wood E: Estimated drug overdose deaths averted by North America's first medically-supervised safer injection facility. PLoS One 2008;3:e3351.
28.
Neale J: Suicidal intent in non-fatal illicit drug overdose. Addiction 2000;95:85-93.
29.
Rossow I, Lauritzen G: Balancing on the edge of death: suicide attempts and life-threatening overdoses among drug addicts. Addiction 1999;94:209-219.
30.
Best D, Gossop M, Man L-H, Finch E, Greenwood J, Strang J: Accidental and deliberate overdose among opiate addicts in methadone maintenance treatment: are deliberate overdose systematically different? Drug Alchohol Rev 2000;19:213-216.
31.
Doe-Simkins M, Walley AY, Epstein A, Moyer P: Saved by the nose: bystander-administered intranasal naloxone hydrochloride for opioid overdose. Am J Public Health 2009;99:788-791.
32.
Merrall EL, Kariminia A, Binswanger IA, Hobbs MS, Farrell M, Marsden J, Hutchinson SJ, Bird SM: Meta-analysis of drug-related deaths soon after release from prison. Addiction 2010;105:1545-1554.
33.
World Health Organization: Prevention of acute drug-related mortality in prison populations during the immediate post-release period. Copenhagen, WHO Regional Office for Europe, 2010.
34.
McGregor C, Darke S, Ali R, Christie P: Experience of non-fatal overdose among heroin users in Adelaide, Australia: circumstances and risk perceptions. Addiction 1998;93:701-711.
35.
Pani PP, Maremmani I, Pacini M, Lamanna F, Maremmani AG, Dell'osso L: Effect of psychiatric severity on the outcome of methadone maintenance treatment. Eur Addict Res 2011;17:80-89.
36.
Colom FJ, Casas M, Perez de Los CJ, Del RM, Roncero C, Castells X, Valero S, Eiroa-Orosa FJ, Batlle F, Trujols J: Feasibility of double-blind clinical trials with oral diacetylmorphine: a randomized controlled phase II study in an inpatient setting. Eur Addict Res 2012;18:279-287.
37.
Gerber H, Borgwardt SJ, Schmid O, Gerhard U, Joechle W, Riecher-Rossler A, Wiesbeck GA, Walter M: The impact of diacetylmorphine on hypothalamic-pituitary-adrenal axis activity and heroin craving in heroin dependence. Eur Addict Res 2012;18:116-123.
38.
Frischknecht U, Beckmann B, Heinrich M, Kniest A, Nakovics H, Kiefer F, Mann K, Hermann D: The vicious circle of perceived stigmatization, depressiveness, anxiety, and low quality of life in substituted heroin addicts. Eur Addict Res 2011;17:241-249.
39.
Pedersen K, Waal H, Kringlen E: Patients with nonaffective psychosis are at increased risk for heroin use disorders. Eur Addict Res 2012;18:124-129.
40.
Torrens M, Rossi PC, Martinez-Riera R, Martinez-Sanvisens D, Bulbena A: Psychiatric co-morbidity and substance use disorders: treatment in parallel systems or in one integrated system? Subst Use Misuse 2012;47:1005-1014.
41.
Bravo MJ, Royuela L, Barrio G, Rodriguez-Arenas MA, De la Fuente L: Prevalence of indirect sharing of drug-injecting paraphernalia in Galicia, Madrid, Seville and Valencia (Spain) (in Spanish). Gac Sanit 2004;18:472-478.
42.
Folch C, Merono M, Casabona J: Factors associated with sharing syringes among street-recruited injecting drug users (in Spanish). Med Clin (Barc) 2006;127:526-532.
43.
Delegación del Gobierno para el Plan Nacional sobre Drogas: Informe del Observatorio Español sobre Drogas (OED). Informe número 6. Noviembre 2003. Madrid, Ministerio del Interior, 2004.
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