The prevalence of non-fatal overdose among people who inject drugs: a multi-stage systematic review and meta-analysis

Samantha Colledge, Amy Peacock, Janni Leung, Sarah Larney, Jason Grebely, Matthew Hickman, Evan B Cunningham, Adam Trickey, Jack Stone, Peter Vickerman, Louisa Degenhardt

Research output: Contribution to journalArticle (Academic Journal)peer-review

66 Citations (Scopus)
298 Downloads (Pure)


Background: People who inject drugs (PWID) are at an elevated risk of fatal overdose in the first year after experiencing a non-fatal event. Such non-fatal events may also result in overdose-related sequelae, ranging from physical injury to paralysis. Given variation in drug markets and treatment availability across countries and regions, we may see similar variations in non-fatal overdose prevalence. Monitoring non-fatal overdose prevalence among PWID is essential for informing treatment intervention efforts, and thus our review aims to estimate the global, regional, and national prevalence of non-fatal overdose, and determine characteristics associated with experiencing such an event.

Methods: We conducted a systematic review and meta-analyses to estimate country, regional, and global estimates of recent and lifetime non-fatal overdose prevalence among PWID. Using meta-regression analyses we also determined associations between sample characteristics and non-fatal overdose prevalence.

Results: An estimated 3.2 (1.8-5.2) million PWID have experienced at least one overdose in the previous year. Among PWID, 20.5% (15.0-26.1%) and 41.5% (34.6-48.4%) had experienced a non-fatal event in the previous 12 months and lifetime respectively. Frequent injecting was strongly associated with PWID reporting recent and lifetime non-fatal overdose. Estimates of recent non-fatal overdose were particularly high in Asia and North America.

Conclusion: Around one in five PWID are at an elevated risk of fatally overdosing every year, however there is substantial geographical variation. In countries with higher rates of non-fatal overdose there is need to introduce or mainstream overdose prevention strategies such as opioid agonist treatment and naloxone administration training programs.
Original languageEnglish
JournalInternational Journal of Drug Policy
Early online date24 Jul 2019
Publication statusE-pub ahead of print - 24 Jul 2019


  • drug-related mortality
  • injecting behavior
  • population size
  • opioid overdose
  • people who inject drugs
  • non-fatal overdose


Dive into the research topics of 'The prevalence of non-fatal overdose among people who inject drugs: a multi-stage systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this