Why Overdose Prevention Matters for People Living with HIV/AIDS

By Rob Banaszak on December 4, 2012 in Harm Reduction

by Leilani Attilio, MPH, RN
Overdose Prevention Coordinator
North Carolina Harm Reduction Coalition

Prescription drug overdoses (OD) have reached epidemic proportions1, 2 and is the fastest growing drug problem in the United States1.  OD deaths are the second leading cause of unintentional injury3.  Among rural states, North Carolina, has one of the highest percentage increases of unintentional OD deaths from opiate drugs2.  In the most recent issue of the New England Journal of Medicine, a research study found that abuse-deterrent formulations of OxyContin, an opiate, has generated unintended negative outcomes4.  Although there has been a significant decrease in OxyContin use, heroin use nearly doubled simultaneously4.  Heroin use poses dangerous consequences to include contracting the Hepatitis C Virus and HIV due to high-risk drug behaviors such as needle sharing5.  As a result, harm reduction organizations, drug treatment centers, and AIDS groups understand the importance of a comprehensive program planning in HIV/AIDS treatment, which includes OD prevention for people living with HIV/AIDS.

OD prevention encompasses rescue breathing and the distribution of naloxone, which is a highly effective antidote to an opioid OD.  Naloxone is not a controlled substance, nor can a person become high and thus, has no potential for abuse.  It can be safely administered to clients as a rescue medication in the event of a respiratory arrest6.  Outlined are several reasons OD prevention is an important topic among people living with HIV/AIDS.

1.) OD prevention services act as a bridge between people who use drugs and HIV prevention, drug treatment, and primary healthcare8.  Globally these programs draw new clients into their HIV prevention services and thereby, enabling HIV prevention to expand beyond traditional services in order to mitigate the HIV epidemic.

2.) Nonfatal overdose outcomes (e.g., pneumonia, acute renal failure) can be worse in people living with HIV8.  Hospitalizations can interrupt the HIV treatment regimen and may induce HIV-related diseases such as tuberculosis and bacterial pneumonia.

3.) HIV drug regimens may block the breakdown of opioids in the system and ultimately, putting the client at risk for an overdose8.  Opioid medications are routinely administered for their analgesic effects to people living with HIV/tuberculosis co-infection.   Many of these people also have a substance use disorder and would benefit from overdose prevention education.

4.) There is a disproportionate number of overdoses among HIV positive injection drug users8.  Since injection drug use is a the third leading cause of HIV in North Carolina7, HIV services should prioritize overdose prevention support to their clients who are using drugs.

5.) Overdose prevention empowers people that use drugs who are at-risk for acquiring HIV8.  Research suggests that people who use drugs are as skilled as medical providers in correctly recognizing overdose and determining appropriate use of naloxone9.

6.) Policies that increase HIV infection risk among people who inject drugs also increase the risk of overdose8.  For example, the release from prison greatly increases the risk of overdose for people who inject drugs10.  Health and social programs who serve inmates inside or exiting from these settings are in an opportune position to support those at greatest risk for overdoses.

7.) People living with HIV and use drugs are concerned about overdose8.  In a study among people who inject drugs in the United States, almost all (87%) were strongly in favor of participating in overdose prevention education and training in resuscitation techniques11.

OD deaths are a major public health issue.  By bridging people who use drugs to necessary social services and empowering the most vulnerable, OD prevention not only is effective and feasible, but most importantly humane piece in HIV/AIDS programming.

The North Carolina Harm Reduction Coalition is a grantee of AIDS United


1. Paulozzi L, Baldwin G, Franklin G, et al. CDC Grand Rounds: Prescription Drug Overdoses-A U.S. Epidemic. Atlanta: Centers for Disease Control and Prevention; January 13 2012.

2. Sanford K. An Unrelenting Epidemic of Deaths from Prescription Drugs in North Carolina. 2008; http://www.ncmedboard.org/articles/detail/an_unrelenting_epidemic_of_deaths_from_prescription_drugs_in_north_carolina/. Accessed July 16, 2012.

3. Paulozzi L, Annest J. Unintentional Posoning Deaths-United States 1999-2004. Atlanta: Centers for Disease Control and Prevention; March 28 2007.

4. Cicero TJ, Ellis MS, Surratt HL. Effect of abuse-deterrent formulation of OxyContin. N Engl J Med. Jul 12 2012;367(2):187-189.

5. CDC. Hepatitis C Information for Health Professionals. 2011; http://www.cdc.gov/hepatitis/HCV/index.htm. Accessed July 16, 2012.

6. Tobin KE, Sherman SG, Beilenson P, Welsh C, Latkin CA. Evaluation of the Staying Alive programme: training injection drug users to properly administer naloxone and save lives. Int J Drug Policy. Mar 2009;20(2):131-136.

7. Foust E, Clymore J. Epidemiologic Profile for HIV/STD Prevention & Care Planning. Raleigh: State of North Carolina Department of Health & Human Services;2011.

8. Curtis M, Dasgupta N. Why Overdose Matters for HIV. 2010; http://www.soros.org/publications/why-overdose-matters-hiv. Accessed July 16, 2012.

9. Green TC, Heimer R, Grau LE. Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States. Addiction. Jun 2008;103(6):979-989.

10. Binswanger IA, Stern MF, Deyo RA, et al. Release from prison–a high risk of death for former inmates. N Engl J Med. Jan 11 2007;356(2):157-165.

11. Seal KH, Downing M, Kral AH, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area. J Urban Health. Jun 2003;80(2):291-301.


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