Lydia N Drumright, Kanna Hayashi, Shruti H Mehta, Mai T Pho, Kora DeBeck, Heidi M Crane, Becky L Genberg, Hannah Cooper, Sonia Napravnik, William Zule, Kenneth H Mayer, Thomas J Stopka, Laura Bamford, William C Miller, George Yendewa, Vivan F Go, Greer Burkholder, P Todd Korthuis, Katerina Christopoulos, David W Seal, Judith Feinberg, Peter D Friedmann, Wing Yin Mok, Oluwaseun Falade-Nwulia, Ryan P Kyle, Gordon S Smith, Jeanne C Keruly, Rob J Fredericksen, Andrew W Hahn, Bridget M Whitney, L Sarah Mixson, Raul N Mandler, Richard D Moore, Michael S Saag, M-J Milloy, Gregory D Kirk, Joseph Ac Delaney, Geetanjali Chander, Judith I Tsui
Among 7573 people who use drugs (PWUD), mean age was 44.7 (SD+13.6) years; 71.4% were men, 60.8% reported White, 24.0% Black, and 7.1% Latine/Hispanic race/ethnicity; 44.1% had HIV; and 13.7% reported a non-fatal overdose at their last study visit. In pooled analyses, PWUD who reported using stimulants and opioids had greater non-fatal overdose prevalence, compared to opioids only (PR=2.26, 95% CI: 1.56-3.27).
BACKGROUND: Fatalities from accidental drug overdose remain a major public health crisis in both the United States and Canada. Prior non-fatal overdose is an important risk factor for subsequent fatal overdose. Improved understanding of non-fatal overdose risk with respect to substance use patterns could support efforts to prevent overdose fatalities.
METHODS: We examined associations between polydrug use and non-fatal overdose using data from four cohorts including people who use drugs (PWUD): ACCESS/VIDUS/ARYS (2018-2024), ALIVE (2018-2024), CNICS (2019-2025), and ROI (2018-2020). Cohorts collected data on drug use and non-fatal overdose in the past 6 months. Drug use was categorized as opioids only; opioids and stimulants; opioids and non-stimulant drugs; and non-opioid drugs. Relative risk regression models estimated prevalence ratios (PR) of nonfatal overdose by drug use adjusted for age, sex, race/ethnicity, and study time. Generalized estimating equations were used to examine repeated measures for ALIVE, CNICS, and ACCESS/VIDUS/ARYS. Random effects meta-analysis was used to obtain pooled estimates across cohorts.
RESULTS: Among 7573 people who use drugs (PWUD), mean age was 44.7 (SD+13.6) years; 71.4% were men, 60.8% reported White, 24.0% Black, and 7.1% Latine/Hispanic race/ethnicity; 44.1% had HIV; and 13.7% reported a non-fatal overdose at their last study visit. In pooled analyses, PWUD who reported using stimulants and opioids had greater non-fatal overdose prevalence, compared to opioids only (PR=2.26, 95% CI: 1.56-3.27).
DISCUSSION: The higher prevalence of non-fatal overdose with opioids and stimulants compared to opioids alone across four diverse cohorts has implications for overdose prevention efforts.