Drug type and risk behaviors associated with non-fatal overdose among people who use drugs: a systematic review and meta-analysis

J Addict Dis. 2022 Jan-Mar;40(1):114-125. doi: 10.1080/10550887.2021.1950262. Epub 2021 Jul 21.


The present study aimed to determine the association between drug type, risk behaviors and non-fatal overdose among people who use drugs (PWUD). We searched for studies in English published before February 1, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. After a detailed assessment of over 13,845 articles, a total of 49 studies met the eligibility criteria. We found that non-injection opioid use, heroin injection, cocaine use, concurrent use of buprenorphine and benzodiazepines, benzodiazepine use, incarceration, injecting drugs, and duration of injecting were associated with greater odds of non-fatal overdose among PWUD. The findings of the current meta-analysis support the requirement to improve suitable harm reduction strategies for drug users, such as peer-based overdose management, and further focusing on the need to balance the current emphasis on enforcement-based responses to illegal drug use with health-related interventions.

Keywords: Non-fatal overdose; cocaine use; crystal methamphetamine use; heroin injection.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Drug Overdose* / epidemiology
  • Drug Users*
  • Humans
  • Opioid-Related Disorders*
  • Risk-Taking
  • Substance Abuse, Intravenous* / epidemiology