{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T10:15:20Z","timestamp":1767867320660,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To characterise the clinical condition of rapid onset heroin overdose cases, and to determine the incidence and characteristics of such cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study of witnessed heroin overdose cases over a 12\u2010month period (1 July 2023 to 30 June 2024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The Medically Supervised Injecting Room in Melbourne, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Cases<\/jats:title>\n                    <jats:p>Individuals who experienced a rapid onset overdose. A control group of standard onset cases amongst those same individuals was used for comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The severity of acute opioid toxicity for rapid versus standard onset heroin overdose cases, using a clinical severity scale regularly used at the Medically Supervised Injecting Room.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      From a total of 1727 heroin overdoses, 202 were identified as rapid onset cases that occurred amongst a cohort of 98 individuals. There were 997 standard overdoses from 75 individuals from this same cohort used as a control. Rapid onset overdoses presented with greater severity of respiratory depression. Forty\u2010one percent (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200982) of cases required positive pressure ventilation, including 19% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200938) classified as Grade 2 severity and 22% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200944) classified as Grade 3a severity. The standardised rate of rapid overdoses was approximately doubled on\n                      <jats:italic>High<\/jats:italic>\n                      overdose risk days (0.151\/overdose) compared with that on\n                      <jats:italic>Low<\/jats:italic>\n                      overdose risk days (0.077\/overdose).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rapid onset heroin overdoses typically present as medical emergencies involving severe respiratory depression shortly after heroin administration. Some people appear more likely to experience a rapid onset overdose than others, but factors for this are unclear. Rapid onset heroin overdoses also more commonly occur on some days compared with others, which may indicate an interrelationship between personal risk and the unregulated drug market. Rapid onset overdose cases may play a substantial role in hypoxic\u2010related morbidity and mortality associated with heroin overdoses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70199","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:39:59Z","timestamp":1758883199000},"page":"296-304","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of rapid onset heroin overdose cases from a supervised injecting facility in Melbourne, Australia"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0176-1237","authenticated-orcid":false,"given":"Nathan C.","family":"Stam","sequence":"first","affiliation":[{"name":"Melbourne School of Population and Global Health The University of Melbourne  Melbourne Australia"},{"name":"Medically Supervised Injecting Room North Richmond Community Health  Melbourne Australia"},{"name":"Monash Addiction Research Centre Monash University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2517-4608","authenticated-orcid":false,"given":"Monika","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Medically Supervised Injecting Room North Richmond Community Health  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-7631","authenticated-orcid":false,"given":"Basak","family":"Tas","sequence":"additional","affiliation":[{"name":"National Addiction Centre, Institute of Psychiatry Psychology and Neuroscience King's College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0339-5848","authenticated-orcid":false,"given":"John","family":"Furler","sequence":"additional","affiliation":[{"name":"Medically Supervised Injecting Room North Richmond Community Health  Melbourne Australia"},{"name":"Department of General Practice and Primary Care The University of Melbourne  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-0687","authenticated-orcid":false,"given":"Yvonne","family":"Bonomo","sequence":"additional","affiliation":[{"name":"Department of Addiction Medicine St Vincent's Hospital Melbourne  Melbourne Australia"},{"name":"Women's Alcohol and Drug Service The Royal Women's Hospital  Melbourne Australia"},{"name":"Department of Medicine The University of Melbourne  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5413-2725","authenticated-orcid":false,"given":"John","family":"Strang","sequence":"additional","affiliation":[{"name":"National Addiction Centre, Institute of Psychiatry Psychology and Neuroscience King's College London  London 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