Risk Factors for Opioid Overdose

Purpose of Review: Opioid overdoses have risen starkly over the last two decades in the USA and are now among the leading causes of overall mortality. This review summarizes the current literature on risk factors for overdose as well as public health solutions. Recent Findings: Although opioid overdose mortality is highest among men and non-Hispanic whites, the rate of death is rising more rapidly now among women and non-Hispanic blacks. Incarceration remains a significant risk factor for overdose death, especially in the first weeks upon reentry reflecting the absence of treatment in prisons and jails despite strong evidence for the benefits of pharmacotherapy integration into these settings. Pharmacotherapy with either methadone or buprenorphine greatly reduces the risk of overdose; however, treatment discontinuation leads to an increase risk of death. Summary: Naloxone distribution both through co-prescribing and community-based opioid overdose prevention programs remains the fundament of the public health response. Both are effective and cost-effective in reducing overdose; however, uptake is hampered due to variance in state naloxone access and Good Samaritan laws. Supervised injection facilities are a promising innovation to address overdose, especially in communities with high overdose rates. © 2018, Springer Nature Switzerland AG.