Objective: The objective of this study was to characterize drug use behaviors of individuals following the overdose of someone they know (i.e., someone in their social network).
Method: From July to October 2021, we conducted in-person, qualitative interviews with 25 people who use drugs and knew someone who overdosed in the prior 90 days. Participants’ responses were stratified by drug use behaviors following the overdose of a network member (i.e., risk behaviors, protective behaviors, no change; selected a priori) and analyzed to identify salient themes.
Results: We found that knowing someone who overdosed had varying effects on subsequent drug use behaviors and emotional affect. Several participants described increasing their drug use or using more types of drugs than usual to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and increased suicidal ideations following the overdose event. Other participants described reducing their drug use and engaging in other protective behaviors (e.g., using fentanyl test strips) in response to heightened perceived overdose risk and other factors. Finally, some participants reported no change in drug use behaviors, and these participants described already engaging in harm reduction practices, feeling desensitized due to frequent or repeated exposure to overdose, and ambivalence about living.
Implications: Our findings suggest a need for enhanced investment in network-based overdose prevention interventions, as well as more robust integration of bereavement support and mental health services in settings that serve people who use drugs.
Take away: In this qualitative study, we found variation in drug use behaviors following the overdose of a network member, including increased risk behaviors, protective behaviors, and no change in drug use behaviors. Participants who engaged in risk behaviors following the overdose of someone they know described increasing drug use to manage feelings of bereavement and trauma, and a subset of these participants described increased drug use with suicidal intention and suicidal ideations.