Mental health status, health service utilization, drug use behaviors associated with non-fatal overdose among people who use illicit drugs: A meta-analysis

Background: The present study aims to determine mental health conditions, service use determinants, and drug use behaviors associated with non-fatal overdose among people who use illicit drugs (PWUIDs). Methods: 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 PWUIDs. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, and Outcomes (PICO) criteria. The present study applied OR to measure the effect size with 95% CI. For data analysis, R 3.5.1 with the "meta" package was used to conduct the meta-analysis. Results: After a detailed assessment of more than 13,845 articles, a total of 60 studies met the eligibility criteria. We found that non-fatal overdose was independently and positively associated with various factors considered and was, as expected, most strongly associated with being male, needs help injecting, needle sharing, overdose experience in past 12 months, alcohol abuse, had mental health diagnosis, depression, and anxiety disorders, suicide (ideation or attempt), inpatient detoxification, benzodiazepine use, and emergency department visit or hospitalization. Conclusion: 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.