Heroin overdose

Background and aims This narrative review aims to provide a brief history of the development of the heroin overdose field by discussing a selection of major ‘classics’ from the latter part of the 20th century. Methods Papers considered landmarks were selected from 1972, 1977, 1983, 1984 and 1999. Results Findings of earlier works suggest much of what later research was to demonstrate. These include arguing that overdoses occurred primarily among tolerant older users, that most ‘overdose’ deaths involved low morphine concentrations, that most overdoses involve polypharmacy, that drug purity has only a moderate influence on overdose rates and that instant death following heroin administration is rare. Conclusions Landmark studies of heroin overdose from the 1970s, 1980s and 1990s laid the foundations for subsequent overdose research, mainly by identifying the major demographic characteristics of overdose cases, risk factors, survival times and behaviours at overdose events.