Opioid overdose and the power of old myths: What we thought we knew, what we do know and why it matters
Year: 2014
Type: article
Abstract: Opioid overdose and the power of old myths: What we thought we knew, what we do know and why it mattersThe past few decades have seen an explosion of research on opioid overdose, work that has dramatically recast our understanding of this phenomenon.Indeed, it is not stretching truth too far to opine that almost everything that we firmly believed to be the case regarding overdose was subsequently shown to be incorrect.As with many cherished beliefs, it was only in the harsh light of research that this was shown to be the case.Why should so much effort have been put into this field?Firstly, there is the sheer extent of mortality associated with the opioids.Of all commonly used drugs, opioids have by far the highest mortality risk [1][2][3][4][5][6].Indeed, by the age of 50, approximately half of any cohort of opioid users will have died, overdose being the most common cause [3][4][5]7,8].The harms associated with overdose, however, extend far beyond mortality: for every fatal overdose, we estimate that there are 25-50 'near misses' [9][10][11][12][13][14][15].Apart from the immediate harm deriving from near misses (e.g.anoxic brain damage, injury through fall), a history of non-fatal overdose is a significant predictor of subsequent overdose and, more particularly, of a subsequent fatal overdose [4,12].Despite the extensive body of work that has accrued, old myths have proven remarkably powerful, particularly in the media.In this piece, I will examine what was believed to be the case, what turned out to be true and how this has informed our ideas on overdose prevention.The literature on opioid overdose is now extensive and covers the circumstances, toxicology and organ pathology of fatal case series, laboratory studies of the physical effects of drug interactions, longitudinal cohort studies and cross-sectional structured interviews with opioid users on non-fatal overdose histories.In reviewing this literature, I will address four of what I regard as the most prominent myths that have bedevilled the field.Broadly speaking, these relate to misapprehensions as to who is dying and why they are dying: Myth 1.It is the young, inexperienced user who overdoses; Myth 2. It is variation in the purity of illicit opioids that is the major cause of overdose; Myth 3. It is the opioid that is crucial in overdose, not other drugs; and Myth 4. Impurities in illicit opioids are the major cause of overdose.
Source: Drug and Alcohol Review
DOI: 10.1111/dar.12108
Author: Shane Darke
Institutions: UNSW Sydney, National Drug and Alcohol Research Centre
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2031916570