Drug overdose is an important, yet an inadequately understood,
public health problem. Global attention to unintentional drug overdose has been
limited by comparison with the scope of the problem. There has been a
substantial increase in drug overdose incidence and prevalence in several
countries worldwide over the past decade, contributing to both increased costs
and mortality.
The aim of this study was to systematically synthesize the
peer-reviewed literature to document the global epidemiological profile of
unintentional drug overdoses and the prevalence, time trends, mortality rates,
and correlates of drug overdoses. We searched different combinations of Medical
Subject Headings (MeSH) terms in PubMed for articles published from 1980 until
July 2013, and we organized these results in tabular spreadsheets and compared
them. We restricted the search to English-language articles that deal with
unintentional overdose, focusing on 1 or more of the following key constructs:
prevalence, time trends, mortality rates, and correlates. The term
"overdose" as a MeSH major topic yielded 1076 publications. In
addition, we searched the following combinations of nonmajor MeSH terms:
"street drugs" and "overdose" yielded 180,
"death" and "overdose" yielded 114, and "poisoning"
and "drug users" yielded 17. There was some overlap among the
searches. Based on the search and inclusion and exclusion criteria, we selected
a total of 169 relevant articles for this article based on a close review of
abstracts.
We found wide variability in lifetime prevalence of experiencing
a nonfatal overdose or witnessing an overdose, and in mortality rates
attributable to overdose. Lifetime prevalence of witnessed overdose among drug
users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median
of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users
personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6%
to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of
14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged
from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable
to the diversity in regions, time periods, and samples. Most studies on
longitudinal trends of overdose death rates or overdose-related hospitalization
rates showed increases in overdose death rates and in overdose-related
hospitalization rates across time, which have led to peaks in these rates at
the present time. An overall trend of increasing deaths from prescription
opioid use and decreasing deaths from illicit drug use in the past several
years has been noted across most of the literature. With the increase in
prescription opioid overdose deaths, drug overdose is not just an urban
problem: rural areas have seen an important increase in overdose deaths.
Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly
associated with unintentional drug overdoses worldwide and the demographic and
psychiatric correlates associated with unintentional drug overdoses are similar
globally.
There is a need to invest in research to understand the
distinct determinants of prescription drug overdose worldwide. Several other
countries need to collect in a systematic and continuous fashion such data on
sales of prescription opioids and other prescription drugs, nonmedical use of
prescription drugs, and hospitalization secondary to overdoses on prescription
drugs. The sparse evidence on the environmental determinants of overdose
suggests a need for research that will inform the types of environmental
interventions we can use to prevent drug overdose. Methodological issues for
future studies include enhancing data collection methods on unintentional fatal
and nonfatal overdoses, and collecting more detailed information on drug use
history, source of drug use (for prescription drugs), and demographic and
psychiatric history characteristics of the individual who overdosed.
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