A chain of survival for drug overdose

Drug overdose is a leading global cause of preventable morbidity and mortality and is closely associated with out-of-hospital cardiac arrest. While the American Heart Association’s “chain of survival” has improved outcomes in traditional cardiac arrest, it does not address the unique characteristics and challenges of overdose-related emergencies. In this article, we propose a novel “overdose chain of survival” to emphasize the importance of linking acute care with long-term prevention. This six-link framework includes: (1) prevention, (2) recognition and activation of emergency services, (3) basic first aid, (4) emergency treatment, (5) post-overdose care, and (6) recovery and secondary prevention. Each link highlights opportunities for intervention and coordination across systems of care. The framework is intended to guide clinical care, policy development, education, and research. By viewing overdose through a structured and holistic lens, the overdose chain of survival seeks to improve outcomes not only in the immediate aftermath of an overdose, but also by addressing systemic barriers to sustained recovery. This conceptual model is adaptable to evolving drug trends and highlights the need for integrated, patient-centered approaches to overdose response and prevention.