ArticleThe International journal on drug policy2019
Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland.
Article in The International journal on drug policy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
51 citing papers in PubMed, 2 syntheses or guidelines pooled it, 98 citations in OpenAlex.
- Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis.Harm reduction journal · 2024Pooled it
- Interventions to reduce self-stigma in people who use drugs: A systematic review.Journal of substance use and addiction treatment · 2024Pooled it
- Promoting substance use stigma resistance through an automated text message intervention (project RESTART): Outcomes of a pilot feasibility trial.Journal of substance use and addiction treatment · 2025Trial
- "The community's memory is timeless": exploring cultural and community context to inform the public health response to the overdose crisis in black communities.Harm reduction journal · 2026Article
- A Novel Index Measure of Housing-Related Risk as a Predictor of Overdose Among Young People Who Inject Drugs and Injection Networks.Journal of urban health : bulletin of the New York Academy of Medicine · 2026Article
- "Stigma's Every Day, All Day Long": A Qualitative Exploration of Experiences of Overlapping Stigmas and HIV Prevention Service Use Among Women Who Use Drugs.Stigma and health · 2026Article
- Patterns of Felt Stigma Among Rural-Dwelling People Who Use Drugs: A Latent Class Analysis.Substance use & misuse · 2026Article
- Amputation trends among people who use drugs in the context of Philadelphia's increasingly xylazine adulterated drug supply.Drug and alcohol dependence · 2025Article
- Enacted Stigma from Family and Drug Use during Opioid Use Disorder Treatment.Stigma and health · 2025Article
- Drug-related stigma among people who inject drugs - development and validation of the drug use stigma scale (DUSS).PloS one · 2025Article
- Characteristics of drug-related deaths where individuals are found submerged in a bath or hot tub in the United Kingdom, 1997-2023.Drug and alcohol review · 2025Article
- An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study.JMIR research protocols · 2024Article
- Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction.International journal of environmental research and public health · 2024Article
- "In Sweden you are worthless. In Denmark you get an identity again" - on being perceived and received as a person who uses drugs in different drug policy settings.Harm reduction journal · 2024Article
- The relationship between felt stigma and non-fatal overdose among rural people who use drugs.Harm reduction journal · 2024Article
- Identifying structural risk factors for overdose following incarceration: a concept mapping study.Health & justice · 2024Article
- "Once I take that one bite": the consideration of harm reduction as a strategy to support dietary change for patients with diabetes.BMC endocrine disorders · 2024Article
- Article
- Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use.Substance use & misuse · 2024Observational
- "We only trust each other": A qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya.PLOS global public health · 2024Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
Abstract
backgroundFatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs.
methodsWe surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009 to 2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e., enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose.
resultsStigma was positively associated with experiencing a non-fatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1-2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1-2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, outside) where participants used drugs was also positively associated with experiencing an overdose.
conclusionsStigma related to drug use and using drugs in more settings may increase overdose risk. The effectiveness of overdose prevention and naloxone training may be improved by reducing discrimination against people who use drugs in community and medical settings and diversifying the settings in which overdose prevention trainings are delivered. These efforts may be enhanced by use of peer outreach approaches in which people who use drugs diffuse prevention messages through their social networks and within settings of drug consumption outside the medical setting.
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Registered trials
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