Non-fatal Overdose Prevalence and Associated Factors among People Who Inject Drugs in Iran

We characterized overdose prevalence and its correlates among people who inject drugs (PWID) in Iran. Our analysis included 2618 PWID with a recent history of drug injection, recruited from 11 cities across Iran using a respondent-driven sampling approach. The primary outcome was a lifetime history of drug-related non-fatal overdose. The nation-wide lifetime prevalence of overdose among PWID was 21.7%, with considerable variations across different cities. In the multivariable analysis, older age, being men, history of homelessness, younger age at injection initiation, recent stimulant injection, recent non-prescribed benzodiazepine use, lifetime suicide attempt, and HIV sero-positivity were positively associated with a history of non-fatal overdose. Our findings underscore the need for comprehensive and tailored approaches to overdose prevention and treatment in Iran, including increased access to take-home naloxone for PWID. The diverse risk profiles of PWID should also be considered in the development of substance use harm reduction policies in Iran, reflecting their varied needs in terms of mental, physical, and social well-being.