Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco.

AIMS: Assessment of young injectors' exposure and response to others' heroin-related overdose. DESIGN: Cross-sectional survey. SETTING: San Francisco, CA, United States. PARTICIPANTS: Nine hundred and seventy-three street-recruited current injectors under 30 years old. MEASUREMENTS: Self-reported experiences of witnessing heroin-related overdoses from structured interviews. FINDINGS: Seven hundred and nine of 973 (73%) had ever witnessed at least one heroin-related overdose, and 491 of 973 (50%) had witnessed an overdose in the last 12 months. Fourteen per cent of those who had witnessed an overdose in the past year reported that the outcome of the overdose was death. Emergency services were called to 52% of most recent witnessed overdoses. Cardiopulmonary resuscitation (CPR) or expired air resuscitation (EAR or 'rescue breathing') was performed in 61% of cases. Inappropriate strategies such as injection with stimulants or application of ice were rare. In 67% of cases in which emergency services were not called the witness said this was because the victim regained consciousness. In the remaining 33%, 56% stated emergency services were not called due to fear of the police. CONCLUSIONS: Respondents were willing to act at overdoses at which they were present, but frequently did not do so in the most efficacious manner. Fear of police was identified as the most significant barrier to the ideal first response of calling emergency services.