Reasons for Overdose
•Geographic proximity to Afghanistan and relative purity, low cost and availability of heroin supply in Central Asia
•Mixing heroin with other drugs and alcohol
•High rates of incarceration, which increase the risk of experiencing overdose post-release
Reasons for Fatal Overdose
•Fear of police involvement, arrest, forced detox or being registered as a drug user may deter people from seeking emergency care
•Reluctance of peers and family members to seek emergency care due to fear of arrest from witnessing overdose
•Lack of access to naloxone in ambulances and hospitals and limited peer distribution
•Widespread use of ineffective methods of reversing overdose by IDUs (e.g., injecting saline solution, shower, rolling in snow, shaking person)
•Low quality of medical care related to overdose – Many emergency care providers still rely primarily on cardiamine to treat overdose