Aims To investigate the role of recent life problems in non-fatal overdose among heroin users entering various drug treatment settings.
Design Cross-sectional data from a longitudinal study investigating drug treatment effectiveness.
Setting Five prison drug treatment services, three residential rehabilitation units, three residential detoxification units and 21 community drug treatment services located in rural, urban and inner-city areas of Scotland.
Participants Of a total of 793 primary heroin users commencing drug treatment during 2001–02, 337 (42.5%) were prison drug service clients; 91 (11.5%) were residential rehabilitation clients; 97 (12.2%) were residential detoxification clients; and 268 (33.8%) were community drug treatment clients.
Measurements Univariate and stepwise multivariate logistic regression analyses examined associations between overdosing in the 90 days prior to treatment entry and basic demographic characteristics, recent drug use and recent life problems.
Findings Ninety-one study participants (11.5%) reported at least one overdose and 19 (2.4%) reported more than one overdose in the 90 days prior to treatment entry. A χ2 test revealed no significant difference in rates of recent overdosing between the four treatment settings (P = 0.650). Recent drug use and recent life problems—but not demographic characteristics—were associated independently with recent overdosing. However, recent life problems were not associated independently with recent overdosing among clients entering prison, clients entering residential rehabilitation or with multiple recent overdosing.
Conclusions Associations between recent life problems and recent overdose were evident, but varied by treatment setting. Treatment providers should identify and address heroin users’ life problems as part of a broad strategy of overdose prevention.