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Title: The role of alcohol in fatal opioid overdose
Author: Lees, Rosemary Jane
ISNI:       0000 0004 2736 8614
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2012
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Fatal opioid overdose is the leading cause of death in UK opioid users, and increasingly a clinical concern for chronic pain management. Concomitant use of central nervous system depressants, in particular alcohol, is identified as a risk factor for opioid overdose. It is plausible alcohol and heroin may interact pharmacologically to enhance overdose risk, however other psychological or social factors may be important. The primary aim of this thesis was to further elucidate the role of alcohol in opioid overdose. Simulating opioid overdose is inherently difficult, so a multi-method approach comprising three complementary studies was used. Firstly, a metabolite of alcohol, ethyl glucuronide, was posed as a tool to provide a drug consumption history in post-mortem opioid overdose samples. Detecting hair ethyl glucuronide did however not prove a sensitive technique for quantitating alcohol history. Secondly a qualitative study was completed to document the behaviours and patterns associated with alcohol use in heroin users. Using focus groups, opioid dependent individuals were interviewed about their alcohol and opioid use. The results of this study indicate alcohol is used very purposefully as a 'substitute' or 'enhancer' to the effects of heroin. This is an important finding and informed the design of the third study presented here, a pharmacological alcohol challenge. In this paradigm alcohol was administered to opioid-dependent individuals to mimic a drinking binge and provide a human model in which to measure the alcohol-opioid interaction. Limited differences were observed between opioid-dependent participants and healthy controls for objective and subjective parameters, providing little support for a pharmacological role of alcohol in opioid overdose. The strong evidence for a role of alcohol in opioid overdose is not fully explained by the findings presented in this thesis. Defining the nature of opioid overdose, and elucidating the differential roles of different risk factors may allow for the development of specific targeted interventions and evidence-based advice for opioid users.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available