a Department of Forensic Medicine , Monash University , Melbourne , Australia.
b Department of Community Emergency Health and Paramedic Practice , Monash University , Melbourne , Australia.
Clin Toxicol (Phila). 2019 May;57(5):325-330. doi: 10.1080/15563650.2018.1529319. Epub 2018 Nov 17.
Take-home naloxone (THN) programs have been implemented in order to reduce the number of heroin-overdose deaths. Because of recent legislative changes in Australia, there is a provision for a greater distribution of naloxone in the community, however, the potential impact of these changes for reduced heroin mortality remains unclear. The aim of this study was to examine the characteristics of the entire cohort of fatal heroin overdose cases and assess whether there was an opportunity for bystander intervention had naloxone been available at the location and time of each of the fatal overdose events to potentially avert the fatal outcome in these cases.
The circumstances related to the fatal overdose event for the cohort of heroin-overdose deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated. Coronial data were investigated for all cases and data linkage was performed to additionally investigate the Emergency Medical Services information about the circumstances of the fatal heroin overdose event for each of the decedents.
There were 235 fatal heroin overdose cases identified over the study period. Data revealed that the majority of fatal heroin overdose cases occurred at a private residence (n = 186, 79%) and where the decedent was also alone at the time of the fatal overdose event (n = 192, 83%). There were only 38 cases (17%) where the decedent was with someone else or there was a witness to the overdose event, and in half of these cases the witness was significantly impaired, incapacitated or asleep at the time of the fatal heroin overdose. There were 19 fatal heroin overdose cases (8%) identified where there was the potential for appropriate and timely intervention by a bystander or witness.
This study demonstrated that THN introduction alone could have led to a very modest reduction in the number of fatal heroin overdose cases over the study period. A lack of supervision or a witness to provide meaningful and timely intervention was evident in most of the fatal heroin overdose cases.
为了减少海洛因过量死亡人数，实施了外出用纳洛酮（THN）计划。由于澳大利亚最近的立法变化，社区中纳洛酮的分发量有所增加，但是这些变化对降低海洛因死亡率的潜在影响尚不清楚。本研究的目的是检查整个致命海洛因过量用药病例队列的特征，并评估在每个致命过量用药事件的地点和时间是否有机会进行旁观者干预，如果当时有纳洛酮，是否有可能避免这些病例的致命后果。
调查了澳大利亚维多利亚州 2012 年 1 月 1 日至 2013 年 12 月 31 日期间致命海洛因过量用药病例队列的致命过量用药事件的情况。对所有病例进行了验尸数据调查，并进行了数据链接，以进一步调查每位死者的致命海洛因过量用药事件的紧急医疗服务信息。
在研究期间确定了 235 例致命海洛因过量用药病例。数据显示，大多数致命海洛因过量用药病例发生在私人住宅（n=186，79%），并且在致命过量用药事件发生时，死者也独自一人（n=192，83%）。只有 38 例（17%）病例死者与他人在一起或有人目睹了过量用药事件，而在这些情况下，有一半的目击者在致命海洛因过量用药时受到严重损害、丧失能力或入睡。有 19 例致命海洛因过量用药病例（8%）确定有潜在的适当和及时的旁观者或证人干预。
本研究表明，仅引入 THN 在研究期间可能导致致命海洛因过量用药病例数的适度减少。在大多数致命海洛因过量用药病例中，缺乏监督或目击者提供有意义和及时的干预。
