Intended for healthcare professionals

Education And Debate

Strategies for preventing heroin overdose

BMJ 2003; 326 doi: (Published 22 February 2003) Cite this as: BMJ 2003;326:442
  1. Karl A Sporer, associate clinical professor (
  1. Department of Medicine, University of California, San Francisco, CA 94143, USA
  1. Correspondence to: K Sporer, Emergency Services, San Francisco General Hospital, San Francisco, CA 94110
  • Accepted 21 October 2002

Making naloxone available in addicts' homes is one of several official or unofficial ways that are being tried out to reduce the rising toll of fatalities from heroin overdose.

Dead addicts don't recover.


The recent “heroin epidemic” has led to a dramatic increase in the incidence of fatal and non-fatal heroin overdose in many countries.13 Deaths from opioid overdose increased 55-fold in Australia between 1964 and 1997,4 and heroin overdose was the leading cause of death among men aged 25–54 in Portland, Oregon, in 1999.1

In 1999, the Drug Abuse Warning Network recorded 4820 heroin related deaths in the United States, as well as 16 646 non-fatal cases of heroin overdose in patients presenting to emergency departments. Every year about 2% of people who inject heroin die, which is six to 20 times the rate expected in peer controls who do not use drugs.5 This epidemic of deaths among injecting heroin users has led many organisations to develop strategies other than simple abstinence to prevent this tragedy. 6 7 Several underground and government programmes to this end have recently been implemented in several countries, but their effectiveness and community acceptance needs evaluation.

Summary points

Heroin overdose is a leading cause of morbidity and mortality among active injectors of heroin

Education, family support groups, motivational post-overdose interviews, and safe injecting rooms have been proposed as complementary strategies to reduce the incidence of heroin overdose

Methadone maintenance is the most effective proved method of reducing mortality from overdose

Home treatment with naloxone by an acquaintance is a controversial programme being tried out in a variety of locations, but research is needed to measure its effectiveness and safety

Epidemiology of heroin overdose

The epidemiology, clinical presentation, and pharmacology of fatal and non-fatal heroin overdoses have recently been reviewed. 8 9 Most deaths …

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