Overdose – How protective are knowledge and medication?

10120260443_560161d92b_bJana Burson provides a synopsis of a recent study on the role of the user’s knowledge in OD. (Her blog provides her perspective as a doctor who prescribes buprenorphine. It is worth your time.)

The findings will not be a surprise to anyone who talks with injection users about their knowledge and experience.

The authors of the study concluded that these experienced drug users were aware of common risks for overdose, yet drug intoxication from sedatives such as alcohol or benzodiazepines may have clouded the user’s thinking when injecting opioids. They also found that unexpected availability of drugs contributed to overdoses.

This presents some serious challenges for harm reduction efforts.

Another interesting finding is this:

. . . more than half of the study subjects were in some form of treatment for substance use disorder. This finding is contrary to other studies, which have found being in treatment lowered the risk for overdose. Around 46% were in medication-assisted treatment with either methadone or buprenorphine. However, some of the overdoses happened on days that the person missed dosing for some reason, and substituted another opioid such as heroin or fentanyl. Thirty-two percent of study subjects dosed with either methadone or buprenorphine in the twenty-four hours prior to experiencing their overdose.

This will be a big surprise to anyone who follows the opioid crisis in the news and/or advocacy from the feds, pharma, and others. (Not such a big surprise if you follow the research and this blog.)

There’s no doubt that maintenance medications provide some protection from OD. However, studies like this suggest that this benefit is often overstated, even when patients actually take their medication. (Of course, there’s also the issue that people discontinue their medication at high rates.)