Table 1. SIF overdose events by year, substances used, characteristics and interventions 2004 = OD events 189 ODs/day 0.62 Injections 136,971 ODs/injection{ 1.38 OVERDOSE: SUBSTANCES USED n (%) Cocaine 39 (20.6) Crack cocaine 4 (2.1) Dilaudid 5 (2.6) Heroin 132 (69.8) Methadone 2 (1.1) Crystal meth 1 (0.5) Morphine 3 (1.6) Speedball 11 (5.8) Talwin & Ritalin 0 (0.0) OVERDOSE: CHARACTERISTICS n (%) Unable to speak 9 (4.8) Passed out 8 (4.2) Limp 78 (41.3) Face blue/pale 71 (37.6) Breath slow 106 (56.1) Breath stopped 24 (12.7) Chest tightness 4 (2.1) Seizure 18 (9.5) Vomiting 1 (0.5) Choking 1 (0.5) Sweaty/hot skin 16 (8.5) Cold skin 33 (17.5) Other 24 (12.7) No response to verbal 22 (11.6) stimulus No response to pain 33 (17.5) stimulus OVERDOSE: RESPONSES n (%) 911 call 54 (28.6) CPR 1 (0.5) Oxygen 152 (80.4) Artificial respiration 18 (9.5) Ambulance 14 (7.4) Naloxone 0.4 mg 35 (18.5) Naloxone 0.4 mg62 23 (12.2) Airway inserted 7 (3.7) 2005 246 0.68 178,787 1.38 n (%) 48 (19.5) 1 (0.4) 5 (2.0) 164 (66.7) 1 (0.4) 0 (0.0) 5 (2.0) 30 (12.2) 1 (0.4) n (%) 44 (17.9) 37 (15.0) 120 (48.8) 123 (50.0) 145 (58.9) 52 (21.1) 6 (2.4) 15 (6.1) 1 (0.4) 5 (2.0) 31 (12.6) 37 (15.0) 12 (4.9) 83 (33.7) 110 (44.7) n (%) 123 (50.0) 4 (1.6) 202 (82.1) 54 (22.0) 27 (11.0) 89 (36.2) 44 (17.9) 50 (20.3) 2006 230 0.63 178,847 1.29 n (%) 44 (19.1) 1 (0.4) 4 (1.7) 140 (60.9) 1 (0.4) 2 (0.9) 3 (1.3) 22 (9.6) 0 (0.0) n (%) 48 (20.9) 28 (12.2) 118 (51.3) 120 (52.2) 125 (54.3) 38 (16.5) 3 (1.3) 45 (19.6) 3 (1.3) 3 (1.3) 24 (10.4) 43 (18.7) 21 (9.1) 84 (36.5) 87 (37.8) n (%) 95 (41.3) 1 (0.4) 188 (81.7) 45 (19.6) 32 (13.9) 59 (25.7) 25 (10.9) 50 (21.7) 2007 201 0.55 183,989 1.09 n (%) 24 (11.9) 5 (2.5) 2 (1.0) 144 (71.6) 4 (2.0) 5 (2.5) 8 (4.0) 15 (7.5) 0 (0.0) n (%) 60 (29.9) 27 (13.4) 109 (54.2) 119 (59.2) 117 (58.2) 51 (25.4) 6 (3.0) 30 (14.9) 5 (2.5) 3 (1.5) 42 (20.9) 43 (21.4) 24 (11.9) 71 (35.3) 69 (34.3) n (%) 93 (46.3) 0 (0.0) 176 (87.6) 45 (22.4) 33 (16.4) 56 (27.9) 25 (12.4) 46 (22.9) 2008W 138 0.76 87,892 1.57 n (%) 14 (10.1) 2 (1.4) 3 (2.2) 103 (74.6) 0 (0.0) 1 (0.7) 2 (1.4) 10 (7.2) 0 (0.0) n (%) 51 (37.0) 24 (17.4) 78 (56.5) 45 (32.6) 72 (52.2) 23 (16.7) 1 (0.7) 8 (5.8) 2 (1.4) 3 (2.2) 28 (20.3) 28 (20.3) 13 (9.4) 61 (44.2) 58 (42.0) n (%) 58 (42.0) 0 (0.0) 92 (66.7) 19 (13.8) 22 (15.9) 46 (33.3) 24 (17.4) 26 (18.8) OD Deaths Averted in SIF ALL 1004 0.63 766,486 1.31 n (%) 169 (16.8) 13 (1.3) 19 (1.9) 683 (68.0) 8 (0.8) 9 (0.9) 21 (2.1) 88 (8.8) 1 (0.1) n (%) 212 (21.1) 124 (12.4) 503 (53.1) 478 (47.6) 565 (56.3) 188 (18.7) 20 (2.0) 116 (11.6) 12 (1.2) 15 (1.5) 141 (14.0) 184 (18.3) 94 (9.4) 321 (32.0) 357 (35.6) n (%) 423 (42.1) 6 (0.6) 810 (80.7) 181 (18.0) 128 (12.7) 285 (28.4) 141 (14.0) 179 (17.8) = March 1, 2004 to December 31, 2004/WJanuary 1, 2008 to July 1, 2008/{OD events per 1,000 injections doi:10.1371/journal.pone.0003351.t001 we completed a sensitivity analysis to account for the wide range of non-fatal overdose rates reported in the literature. Model outputs such as the DTES fatal overdose rate and non-fatal to fatal overdose ratio are not substantially different from previous observations in other settings [31], lending credence to the estimate of averted deaths. Furthermore, in every case, we endeavoured to use conservative estimates, for example restricting the definition of a potential on-site overdose death to those characterised by a 911 call, provision of naloxone and/or an ambulance. Finally, there may be effects of the SIF that go beyond their impact on those actively using PLoS ONE | www.plosone.org 3 October 2008 | Volume 3 | Issue 10 | e3351