Higher prevalence of non-fatal overdose with opioid and stimulant use compared to use of opioids alone
Year: 2026
Type: article
Abstract: 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.
Source: Drug and Alcohol Dependence
Authors: 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
Institutions: University of Washington, Simon Fraser University, Johns Hopkins University, University of Chicago, University of Kentucky, University of North Carolina at Chapel Hill, RTI International, Fenway Health, Tufts University, University of California San Diego, Case Western Reserve University, University of Alabama at Birmingham, Oregon Health & Science University, University of California, San Francisco, Tulane University, West Virginia University, British Columbia Centre on Substance Use, National Institute on Drug Abuse, University of British Columbia
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,380
Awards: Impacts of universal access to HIV/AIDS care among HIV+ injection drug users, Genes, substance use, and HIV outcomes in people living with HIV across the US, Vancouver Drug Users Study: The Impacts of Evolving Drug Use Patterns on HIV/AIDS, Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE), Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia, Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study, Rural West Virginia Responds to Opioid Injection Epidemics: From Data to Action, Scaling up HPTN 074: a Cluster Randomized Implementation Trial of an Evidence-based Intervention for Antiretroviral Therapy for PWID in Vietnam, Community-based, client-centered prevention homes to address the rural opioid epidemic, Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE), TB AND MAC INFECTION IN HIV INFECTED IV DRUG USERS, Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC), AIDS Linked to the IntraVenous Experience (ALIVE) Study, University of Washington/Fred Hutch Center for AIDS Research, CFAR Network of Integrated Clinical Systems (CNICS), Alcohol Research Consortium in HIV: Ending the HIV Epidemic through interventions and Epidemiology at the intersection of the alcohol and HIV care Continua, HIV and Substance Use Cohort Coordinating Center for Emerging and High Impact Scientific Cross Cohort Studies: HIV SUCCESS, The University of North Carolina Center for AIDS Research, Mentoring Patient-Oriented Research on Advances to Optimize Engagement in HIV Care
OpenAlex ID: W7212120147