Substance Use
Fatal and non-fatal overdoses among people with HIV enrolled in care in an urban clinic in Baltimore, Maryland, USA, 2019-2025 Catherine Lesko* Catherine Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Lesko Johns Hopkins University
Background: We described incidence of and risk factors for fatal and non-fatal overdose in a cohort of people with HIV (PWH) in routine care in Baltimore, Maryland.
Methods: We included PWH in the Johns Hopkins HIV Clinical Cohort from June 2019-March 2025. Fatal overdoses were identified with cause of death codes. Non-fatal, medically involved overdoses were identified by diagnoses from clinical encounters. A subset of patients also self-reported past-6-months, non-fatal overdoses on tablet-based patient reported outcomes (PRO) surveys. We fit multivariable logistic models for self-reported, non-fatal overdose, after applying inverse odds weights to remove selection bias due to participation in the PROs.
Results: We included 2,549 people, median age 55 years (interquartile range [IQR]: 44, 61), 64% male, 77% Black, and 23% with a history of injection drug use. 1,402 people completed ≥1 PRO. There were 43 fatal overdoses (rate=3.28 per 1000 person-years (PY)), 102 non-fatal, medically involved overdoses (rate=7.7/1000 PY), and 320 self-reported, non-fatal overdoses (rate=78.2/1000 PY). Most fatal overdoses (91%) implicated opioids, although 37% also listed cocaine. 55% of non-fatal, medically involved overdoses were linked to opioids, 22% to psychoactive substances, and 24% to an unspecified drug. Independent risk factors for non-fatal, self-reported overdose included younger age, male sex, unsuppressed viral load, household income >300% of federal poverty level, prior opioid use disorder diagnosis, recent cocaine or opioid use, and recent receipt of MOUD or ever been prescribed a non-MOUD opioid. Non-fatal overdose increased the hazard of fatal overdose by 69% (95% CI: 0.55, 5.18).
Conclusions: Self-reported, non-fatal overdoses are about 10 times as common as non-fatal, medically involved overdoses and 20 times as common as fatal overdoses. We confirmed previously identified risk factors for non-fatal overdose, including stimulant (cocaine) involvement.