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We assessed sociodemographic variables, risky determinants, and type of drug use associated with fatal overdose among people who use drugs (PWUD). Studies in English published from January 1, 1985 to May 1, 2021, were searched on PubMed, Scopus, Cochrane, and Web of Science to identify studies on variables associated with fatal overdoses among PWUDs. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: PWUD; (ii) intervention: fatal overdose in the past year; (iii) comparator: PWUD who had not fatal overdose; (iv) outcome: fatal overdose in the last year and (v) study type: cross-sectional, cohort, and case–control studies. Out of 13,821 articles, 25 studies met eligibility criteria. Our findings showed socio-demographic determinants (younger age, marital status, being homeless, being male,) risky determinants (poor mental health, experience non-fatal overdose and needle sharing), and type of drug use (cocaine disorder, benzodiazepines disorder, alcohol disorder, psychostimulant disorder, polysubstance disorders, and heroin dependence), were significantly associated with fatal overdose among PWUD. The present study data indicated that numerous characteristics were correlated with overdose-induced mortality. Such characteristics are certainly interrelated; however, each factor could potentially be targeted for intervention. The most particular reason for death was practicing illicit drug use, including opioids (e.g., heroin). PWUD: People who use drug; CI: Confidence intervals; NOS: Newcastle-Ottawa Scale; OR: Odds ratio; PICO: Population, Intervention, Comparator, Outcomes; PRISMA: Protocols of Systematic Reviews and Meta-Analyses; PWIDs: People who inject drugs; WHO: World Health Organization [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the prevalence of non-fatal overdose among people who use illicit opioids (PWUIOs) and determine the demographic and behavioral characteristics associated with non-fatal overdose among this population. Studies in English published before February 1, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIOs. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PICOs criteria. After a detailed assessment of over 13,845 papers, a total of 67 studies met the eligibility criteria. The findings showed a past-year pooled prevalence rate of non-fatal overdose among PWUIOs of 26% (95% CI, 23% −29%). Greater odds of non-fatal overdose among PWUIOs was associated with (i) being younger, (ii) being female, (iii) being homeless, (iv) individuals who received money, goods, or drugs in exchange for sex, (v) individuals who had witnessed somebody else have an overdose, (vi) individuals who had used public spaces as primary injection locations, (vii) individuals who reported polydrug use, (vii) use of non-injection methamphetamine, and (viii) high injecting frequency (more than two daily drug injections). Harm-reduction programs should consider the provision of education concerning overdose-related risk factors to the vulnerable and hard-to-reach PWUIOs. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the association between drug type, risk behaviors and non-fatal overdose among people who use drugs (PWUD). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. After a detailed assessment of over 13,845 articles, a total of 49 studies met the eligibility criteria. We found that non-injection opioid use, heroin injection, cocaine use, concurrent use of buprenorphine and benzodiazepines, benzodiazepine use, incarceration, injecting drugs, and duration of injecting were associated with greater odds of non-fatal overdose among PWUD. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management, and further focusing on the need to balance the current emphasis on enforcement-based responses to illegal drug use with health-related interventions. [ABSTRACT FROM AUTHOR]