Experiences of Illicit Drug Overdose: An Ethnographic Study of Emergency Hospital Attendances
Neale, Joanne, Contemporary Drug Problems
To date there are few available data relating to drug users' views and experiences of illicit drug overdose. This paper provides in-depth information relating to the experience of overdose that might help to inform and improve prevention of the problem and responses to it. Research was conducted in five hospitals in two Scottish cities during 1997 and 1998. Data were collected from (i) semistructured interviews with 74 drug users who had overdosed in the previous 48 hours and (ii) fieldnotes written during non-participant observation in the hospital setting. Analysis was undertaken using grounded theory (Glaser & Strauss, 1967) and was assisted by the computer software package WinmaxPro.
Issues considered relate to the overdose incident; subsequent recovery; treatment received; and behavior in the hospital setting. The findings are discussed and some implications for policy and practice are considered.
KEY WORDS AND PHRASES: Drug use; overdose; accident and emergency; hospital; ethnography; treatment.
AUTHOR'S NOTE: The author wishes to thank the Scottish Executive Health Department for funding this study; the 74 drug users for agreeing to be interviewed; the hospital staff for facilitating data collection; and Professor Peter Kemp and two anonymous referees for their helpful comments on earlier versions of the paper. The Centre for Drug Misuse Research is funded by the Chief Scientist Office of the Scottish Executive Health Department, but the views expressed are those of the author.
Illicit drug overdose is a major public health concern across the globe (Kaa, 1992; Davoli et al., 1993; Hser, Anglin & Powers, 1993; Cain, 1994; Marx, Schick & Minder, 1994; Sanchez et ad., 1995; Darke, Ross & Hall, 1996; Hulse, et al., 1999; Powis et al., 1999). Although there is now a large body of overdose research, current knowledge remains limited in two fundamental respects. First, most studies have involved retrospective investigations of fatal rather than non-fatal overdose. Second, existing research has largely been based on data collected from coronial records and hospital admission cards-not from interviews with those who have witnessed or experienced overdoses (Darke et al., 1996). In consequence, the data available are quantitative rather than qualitative, providing little insight into drug users' views and experiences of the problem.
To date there is very little information relating to how drug users feel at the time of, and immediately following, loss of consciousness; why drug users think they have overdosed; the experience of waking up in a hospital ward having overdosed on illicit drugs; victims' views of their needs and concerns; how they feel about the treatment they receive in the hospital setting; or their expectations of future overdose and drug-taking behavior. Equally, there appear to be no sociological accounts either of how drug users behave or what actually happens to them in the emergency ward. In the absence of such qualitative data, there is a danger that public health strategies designed to reduce the incidence of drug overdose-and clinical interventions intended to manage and deal with those who are drug overdose victims-are being formulated and implemented without important background information.
Drug overdose in context
The present paper offers an in-depth insight into the overdose situation that might inform and improve prevention of the problem and responses to it. Providing an important backdrop to this issue are three sources of literature: (i) a growing body of research relating to professionals' attitudes to providing services to drug users; (ii) accounts of the various barriers between drug users and the health care system; and (iii) ethnographic studies conducted within hospitals, particularly in the emergency room. Two key themes underpinning these three sources of literature are "stigma" and "the moral evaluation of patients by professionals. …