Socioeconomic inequalities in fatal opiate and cocaine related overdoses: Transgenerational baggage versus individual attainments

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures.
Methods. Cross-examination of law enforcement and healthcare data sources and of forensic evidence in a nested case-control study design. FOD cases were individually matched with 4 controls, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs. 1,056 controls were compared through conditional logistic regression.
Findings. Being professionally active [OR=0.662 (95% CI 0.446–0.985)], reporting salary as main income source [OR=0.417 (95% CI 0.258–0.674)], and education attainment higher than primary school [OR=0.501 (95% CI 0.344-0.729)] revealed to be protective factors, whereas parental professional status was not associated to FOD.
Discussion. Compared to their peers, drug users with lower socioeconomic profiles show increased odds of FOD. However, actual and self-referred socioeconomic characteristics of drug users, impacting on daily life quality, such as educational attainment, employment and revenue, appeared to be more predictive of FOD than transgenerational factors such as the parental socioeconomic status. Thus, motivational interventions aimed at socio-professional reintegration should be given due attention in dedicated harm prevention policies.