Theme: Epidemiology & Public Health Research Year: 2022
Global estimates of drug-related deaths are increasing annually, with most involving opioids.
Demographic risk factors have been identified in the literature, however evidence is lacking on
psychosocial factors associated with overdose which could inform targeted harm reduction
interventions. The aim of this systematic review was to identify psychosocial factors associated with
Observational studies were eligible if they included people who used drugs, focused on psychosocial
factors associated with fatal or non-fatal drug overdose. Systematic reviews and papers not in
English were excluded. Systematic searches were conducted in Medline, Embase, PsycINFO and
Cinahl. Google Scholar was searched for grey literature. Reference lists of selected papers were
searched manually. Data were extracted by two reviewers. The data were thematically analysed and
results presented as a narrative synthesis.
Twenty-two studies were included in the systematic review, with a total of 185,442 participants.
Most studies were conducted in North America (n=17). In most studies poly-drug use was reported
(4 did not report). Factors (n=92) were extracted from the studies, and thematically analysed,
resulting in 13 themes grouped under 7 overarching themes. The themes explored a variety of
psychosocial factors associated with increased risks of overdose: demographic factors influencing
behaviour, incarceration, traumatic experiences, overdose experience and risk perception,
healthcare engagement, drug use behaviour, and social network characteristics.
The themes identified in this review reveal a complex picture where past experiences meet present
conditions and overdose risk is influenced by internal factors and external pressures. Individuals’
capability to use substances safely is influenced by physical and social opportunities which, despite
high levels of knowledge of drugs and perception of risk, perpetuate risk-taking by disinhibiting use
of substances. Interventions to reduce risk of overdose should investigate mechanisms of individual
behaviour change to respond to environmental factors.
Disclosure of Interest Statement:
All authors report no conflict of interest. This study was funded by the Scottish Drug Death Taskforce
(Scottish Government). The funder had no involvement in collection, analysis and interpretation of
data, in the writing of the report, or in the decision to submit the manuscript for publication.