WITHDRAWN: Understanding Overdose Experiences and Related Risks Among Homeless Opiate Users in Skid Row, Los Angeles

Background and Purpose: Skid Row, located in downtown Los Angeles contains the largest concentration of individuals experiencing homelessness in the United States. Although drug overdose ranked as the sixth leading cause of premature death for Los Angeles County overall in 2016, in the service planning area where Skid Row is located drug overdose was the second leading cause of premature death. This qualitative study was conducted to understand overdose experiences and related risks among a homeless population of opiate users in Skid Row.

Methods: A total of 50 individuals receiving services from a harm reduction center located in Skid Row in Los Angeles were recruited for focus groups. Individuals over the age of 18 obtaining services from the agency who reported using prescription opiates in the past year were eligible for participation. The University of Southern California Institutional Review Board approved all data collection methods.

Results: The mean age of participants was 43.5 years and the majority of participants identified as male and Hispanic. Many participants reported experiencing an opiate related overdose and most reported knowing peers who overdosed. Themes related to overdose included polysubstance use, peer perceptions, related victimization, and access to naloxone. Individuals reported that overdoses are more likely with heroin compared with prescription opioids in the region, and that individuals may seek out dealers who supplied the heroin associated with an overdose. Fatal and nonfatal overdose experiences were linked with polysubstance use, with the concurrent use of sedative-hypnotics (benzodiazepines) with heroin especially noted. Participants reported that overdose experiences are not talked about within peer groups. Related victimization experiences were discussed included being assaulted or robbed while experiencing an overdose. The naloxone training program available within the agency was credited with fatal overdose prevention.

Conclusions and Implications: Findings highlight the need for a movement toward other services targeting factors creating persistent risk for prescription opioid and heroin users in Skid Row. Providing a safe injection area for individuals in Skid Row could target harms related to heroin injecting such as overdose, HCV/HIV transmission, and syringe sharing risk behaviors through the reduction of public injection practices. Safe injection areas could also address the violence victimization associated with heroin and prescription opioid use in the area, such as being robbed while experiencing an overdose, or being beaten or raped while under the influence.