'Facing the risk of overdose' A grounded theory study exploring heroin users' experiences of overdose.

Overdose is a significant cause of death among heroin users and up to two-thirds
of heroin users will experience at least one non-fatal overdose in their lifetime.
Despite a recent increase in the literature on overdose psychological
understandings of the processes involved are limited, particularly from the
perspective of heroin users. This study explored heroin users' experiences of
overdose particularly the two areas of intent and risk.
Semi-structured interviews were conducted with thirteen individuals who had a
history of heroin use and were attending a treatment service in south London. A
social constructionist grounded theory approach was followed and the theory
'facing the risk of overdose' was developed. The findings suggested that risk of
overdose was affected by complex inter-relationships between individual, social
and substance related factors. Participants located overdose in a context with
other risks some of which were linked to a drug-using lifestyle. Therefore,
overdose was often not the only risk faced by participants and this had
implications for how they considered and managed risks. Overall, 'facing the risk
of overdose' was best characterised as a social process influenced by
acquaintances, friends, family and professionals. Intent appeared complex and
dynamic, and although many overdoses were described as accidents some were
intentional or accompanied by ambivalence about survival; attributions were also
made to luck or chance.
The findings are discussed in relation to existing literature. Clinical implications for
services include dissemination of context-specific harm reduction information and
the importance of addressing mental health needs as well as substance misuse.
Recommendations for clinical psychologists include an increase in
psychologically informed interventions. In recognition that overdose was a social
behaviour clinical implications are also discussed at the community level. Finally,
recommendations for future research are highlighted.

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