Overdoses, suicidal behaviour and clinical characteristics in heavy drug users. Studies in the Criminal Justice System

Abstract: Background: Substance use disorders and complications, such as drug overdose (OD) and suicide attempt (SA), are common among criminal justice clients.
Methods: Since 2001, the Swedish Prison and Probation Service has assessed substance-using clients with the Addiction Severity Index (ASI), a semi-structured instrument widely used to examine substance-related problems in different domains of life. This data material is based on 7,085 clients, interviewed mainly in prison (72 %) or while on probation (17 %). Compared to the entire criminal justice system, these subjects represent an oversampling of prisoners and drug users, and a slight oversampling of women (12 %). Logistic regression technique was used in the four studies for the analysis of factors associated with drug OD, SA and repeated SA, and for the analysis of primary amphetamine use compared to heroin and cocaine use.
Results: Primary and current amphetamine use was markedly more common (n=1,396) than heroin use (n=392) and cocaine use (n=119) in this population. Amphetamine users were markedly older, and more likely to be born in the Nordic countries. Compared to heroin users, amphetamine users were more likely to have heredity of alcohol problems, and more likely to report cognitive problems. The overlap in use of the three different drugs was limited. Among recent opioid users (n=1,096), OD history was reported by 55 percent. OD clients were more likely to report a history of injecting, heroin use, and use of tranquillisers, or to report SA or difficulty controlling violent behaviour. In the present data material (n=6,836), 21 percent reported a SA, which was associated with several variables: female gender, several different psychiatric symptoms, history of being abused, heredity, physical disease, alcohol misuse and severe drug use complications. 55 percent of attempters reported two or more SAs, and these clients were more likely to report physical disease, opioid (analgesic) use, delirium tremens, cognitive problems and violent behaviour, while gender and depression were not related to repeated SA.
Conclusions: Abuse of amphetamine, historically the predominating drug among heavy drug users in Sweden, is a substance use pattern relatively separated from other drugs. Drug OD, common in this setting, may possibly have a link to impulse control disturbances, in addition to known substance-related risk factors. SA, also common in this setting, appears to be associated with a large set of variables, including severe substance use complications and adverse life events.