Opioid overdose and mortality among people who use or inject drugs in Myanmar: A large register-based study

Myanmar accounts for over half of global opium production following a 35 % increase in 2023 (UNODC, 2024), and is also a major manufacturer of amphetamine-type stimulants (ATS) (INCB, 2023). National surveillance estimates that over 116,000 people in Myanmar inject drugs (National AIDS Programme, 2023a), equivalent to 0.3 % of the population aged 15–64 years. Drug use is much more prevalent in Kachin and Shan states, where up to one in twenty adult men inject drugs. Together with Sagaing region, these states form the Myanmar segment of the Golden Triangle region where opium cultivation, heroin manufacture, and ATS synthesis are centered and casual and episodic injecting is common (National AIDS Programme, 2019). Opioid availability is extraordinary, with recent field reports indicating highly pure heroin sells for around US $1 per gram (2025 value) and single doses are often cheaper than beer. Overdose is a frequent and preventable cause of morbidity and mortality among people who inject drugs, especially those using opioids (WHO, 2014). Rapid administration of the opioid antagonist naloxone can reverse respiratory depression and avert serious health consequences and death. The United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) recommend making naloxone widely available (UNODC/WHO, 2013). High opioid availability, recent abstinence, and insufficient coverage of opioid-agonist therapy (OAT) are drivers of overdose, whereas scarce access to naloxone chiefly contributes to fatalities (UNODC/WHO, 2013). Other independent risk factors include younger age at drug use initiation (Armoon et al., 2022), lower age (Bergenstrom et al., 2008), unemployment or homelessness (Altekruse et al., 2020; Pear et al., 2019), and combined heroin–benzodiazepine use (Bergenstrom et al., 2008).