Heroin overdose among a treatment sample of injecting drug misusers: accident or suicidal behaviour?

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Abstract
Overdose is a common cause of premature death in opiate misusers. Substance misuse is known to increase the risk of completed suicide. The relationship between ‘non-intentional overdoses’ and ‘intentional overdoses’ or suicides is unclear. In order to investigate this relationship a semi-structured interview investigating the history of heroin overdose and suicidal thoughts and behaviour was undertaken with 48 injecting drug misusers attending a South London community-based treatment centre. Fifty-four percent had previously overdosed on heroin, and 35% had made a suicide attempt. A history of suicide attempts and history of heroin overdose were significantly associated. However, heroin overdose as a means of attempting suicide was uncommon, with the majority reporting overdose by use of other drugs. It is concluded that heroin overdose and history of suicide attempts were both common. Although heroin overdose was seldom chosen as a suicide method, the findings suggest that the risks of non-intentional heroin overdose and of suicide overlap. Non-intentional overdoses and suicide attempts should be regarded as risk markers for each other.