{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:40:05Z","timestamp":1792226405999,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To identify heroin overdose and polydrug risk profiles of Australian adults with long\u2010term heroin dependence and assess if psychosocial, treatment, physical and mental health\u2010related covariates were associated with class membership.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>The 18\u201320\u2010year follow\u2010up of the Australian Treatment Outcome Study (ATOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sydney, New South Wales, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>615 people with heroin dependence were recruited in 2001\u20132002, of whom 401 completed the follow\u2010up interview between 2019 and 2021 and were included in this study (mean age: 47.3\u00a0years, standard deviation: 7.4; 66% male).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Latent class analysis used indicator variables of heroin use, overdose history and past\u2010month use of alcohol, benzodiazepines, other opioids, cannabis, amphetamines and cocaine. Odds ratios were estimated for covariates associated with class membership using multinomial logistic regression. Covariates included: age, sex, employment, crime, lifetime incarceration, unstable housing, age of first heroin use under 18\u2009years, use of opioid maintenance therapy, naloxone history, trauma, post\u2010traumatic stress disorder diagnosis, Short Form Health Survey\u201012 scores representing severely poor physical and mental health and depression. All latent class indicator variables and covariates were based on the latest 2019\u20132021 responses, except for three covariates (age of first heroin use, antisocial personality disorder and borderline personality disorder) where responses from 2001to 2002 were retained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three latent classes were identified: high risk (7%), moderate risk (44%) and low risk (49%) of heroin overdose. The 3\u2010class model had a Log Likelihood of \u22122133.31 and Entropy of 0.61. The 3\u2010class model had the lowest sample size adjusted\u2010Bayesian information of 601.02 and the bootstrapped likelihood ratio test suggested the 3\u2010class model fit better than the 2\u2010class model (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The high\u2010risk class was defined by high probabilities of a past\u2010year overdose, more than 10 lifetime overdoses, and 44\u201374% probability of past\u2010month use of heroin, amphetamines, benzodiazepines and other opioids. Individuals in the moderate\u2010 and low\u2010risk class were unlikely to have a past\u2010year overdose. The moderate risk class had 30\u201350% probability of past\u2010month use of heroin, amphetamines, benzodiazepines and other opioids, while the low\u2010risk class had 6\u201317% probability of past\u2010month use of these substances. Past\u2010month crime, past\u2010month depression and lifetime incarceration were associated with moderate\u2010\u00a0and high\u2010risk class membership. Current methadone treatment and lifetime trauma were associated with moderate\u2010risk class membership.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>The Australian Treatment Outcome Study cohort with long\u2010term heroin dependence can be classified into high, moderate and low risk of heroin overdose based on overdose history and polydrug use. People with higher rates of heroin, cannabis, amphetamines, benzodiazepines and other opioid use are more likely to belong to the high\u2010 and moderate\u2010risk class.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70666","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T07:41:04Z","timestamp":1792222864000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heroin overdose risk profiles following long\u2010term heroin dependence: Findings from the 18\u2010 to 20\u2010year follow\u2010up of the Australian treatment outcome study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3345-782X","authenticated-orcid":false,"given":"Jessy S.","family":"Lim","sequence":"first","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1371-6986","authenticated-orcid":false,"given":"Christina","family":"Marel","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1725-9188","authenticated-orcid":false,"given":"Tim","family":"Slade","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-1731","authenticated-orcid":false,"given":"Jack","family":"Wilson","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6744-463X","authenticated-orcid":false,"given":"Maree","family":"Teesson","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8915-8872","authenticated-orcid":false,"given":"Paul S.","family":"Haber","sequence":"additional","affiliation":[{"name":"Drug Health Services Royal Prince Alfred Hospital  Sydney Australia"},{"name":"Department of Medicine and Central Clinical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9714-1832","authenticated-orcid":false,"given":"Katherine L.","family":"Mills","sequence":"additional","affiliation":[{"name":"The Matilda Centre for Research in Mental Health and Substance Use and Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32229-9"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.1214"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0893-133X(01)00367-0"},{"key":"e_1_2_10_5_1","unstructured":"Australian Institute of Health and Welfare (AIHW).Alcohol tobacco & other drugs in Australia: Heroin. Updated2025.https:\/\/www.aihw.gov.au\/reports\/alcohol\/alcohol-tobacco-other-drugs-australia\/contents\/drug-types\/illicit-opioids-including-heroin[last viewed 19 December 2025]"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103584"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2002.00058.x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2021.103245"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.09.001"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11469-024-01257-5"},{"key":"e_1_2_10_11_1","first-page":"1","article-title":"Patterns and predictors of heroin use, remission, and psychiatric health among people with heroin dependence: Key findings from the 18\u201020\u2010year follow\u2010up of the Australian treatment outcome study (ATOS)","author":"Marel C","year":"2023","journal-title":"Int J Ment Health Addict"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1300\/J069v26n01_07"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16377"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14451"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/09595230500286039"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2001.96811135.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2023.208979"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2005.11.009"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-039226"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2015.07.002"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.12860"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2025.209772"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.03.010"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1992.tb02719.x"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2002.tb00357.x"},{"key":"e_1_2_10_27_1","unstructured":"World Health Organisation.Composite international diagnostic interview (CIDI) Core version 2.1 12\u2010month versionGenevaWorld Health Organisation1997"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.168"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.37"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1981.01780290015001"},{"key":"e_1_2_10_31_1","unstructured":"LanzaST DziakJJ HuangL WagnerA CollinsLM.PROC LCA & PROC LTA users' guide (Version 1.3.2). University Park: The Methodology Center Penn State; Updated 2015. Available from:methodology.psu.edu"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004710"},{"key":"e_1_2_10_33_1","unstructured":"DziakJJ BrayBC WagnerAT.LCA_Covariates_3Step SAS macro users' guide (Version 1.0). University Park: The Methodology Center Penn State. Updated 2020.https:\/\/www.latentclassanalysis.com\/wp-content\/uploads\/2021\/01\/LCA_Covariates_3Step_UG_1.0.pdf[last viewed 16 October 2025]"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mph001"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mpq025"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00095-0"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2015.04.008"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13771"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.12400"},{"key":"e_1_2_10_40_1","volume-title":"Measuring alcohol consumption: psychosocial and biochemical methods","author":"Sobell LC","year":"1992"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/10705510701575396"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16200"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.14079"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.70666","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/add.70666","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.70666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T07:41:06Z","timestamp":1792222866000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.70666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,17]]},"references-count":42,"alternative-id":["10.1111\/add.70666"],"URL":"https:\/\/doi.org\/10.1111\/add.70666","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,17]]},"assertion":[{"value":"2025-12-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"add.70666"}}