Prevalence and high-risk behaviors associated with non-fatal overdose among people who use illicit opioids: A systematic review and meta-analysis

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Background The aim of the present study was to determine the prevalence of non-fatal overdose among people who use illicit opioids (PWUIOs) and determine the demographic and behavioral characteristics associated with non-fatal overdose among this population.Methods Studies in English published before February 1, 2021, were searched for on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with non-fatal overdose among PWUIOs. After reviewing for study duplicates, the full-texts of selected papers were assessed for eligibility using PICOs criteria.Results After a detailed assessment of over 13,845 papers, a total of 67 studies met the eligibility criteria. The findings showed a past-year pooled prevalence rate of non-fatal overdose among PWUIOs of 26% (95% CI, 23% −29%). Greater odds of non-fatal overdose among PWUIOs was associated with (i) being younger, (ii) being female, (iii) being homeless, (iv) individuals who received money, goods, or drugs in exchange for sex, (v) individuals who had witnessed somebody else have an overdose, (vi) individuals who had used public spaces as primary injection locations, (vii) individuals who reported polydrug use, (vii) use of non-injection methamphetamine, and (viii) high injecting frequency (more than two daily drug injections).Conclusion Harm-reduction programs should consider the provision of education concerning overdose-related risk factors to the vulnerable and hard-to-reach PWUIOs.