PURPOSE: Opioid overdose survivors are vulnerable to fatal overdose, particularly in the weeks following overdose, a period when health service use is often low. This study explores post-overdose health/medical services engagement among a diverse sample of survivors.
METHODS: We conducted semi-structured interviews with 23 recent opioid overdose survivors across seven states. We asked about service utilization and drug use history, contextual factors related to the overdose, service use immediately after and in the months following, and the impact on wellbeing.
RESULTS: Over half of participants described calls to 911 (n = 13), and one-third went to the hospital (n = 8). Six key themes guided by Levesque’s patient-centered access to care framework emerged. Several themes explored why participants did not seek medical services following an overdose, including 1) the belief they could manage at home, 2) a lack of trust in responders, often based on prior negative experiences, 3) concern about unintended consequences such as legal issues, and 4) the financial, social, and opportunity costs associated with calling 911 or going to the hospital. Of those who did receive emergency services, some declined transport to the hospital for similar reasons, including potential repercussions from their treatment program if they were notified. A fifth theme focused on interactions with providers in the hospital, where individuals were rarely offered medications for opioid use disorder or connected to treatment. Interactions with providers were largely negative, though participants reported more positive experiences with social workers and peer support specialists. A few had early discharges, often due to feelings of vulnerability, unmanaged withdrawal symptoms, or poor interactions with providers. Last, the sixth theme focused on substance use treatment engagement. Treatment engagement was often delayed but was facilitated by factors like a social worker following up, longer hospital stays, or the participant seeking treatment on their own.
CONCLUSIONS: Most of the sample did not engage with hospital or substance use treatment services after a nonfatal overdose. Negative prior experiences and fear of negative consequences were major barriers in this sample.
“I didn’t want to go through the whole rigmarole”: A qualitative exploration of overdose survivor service engagement experiences following nonfatal overdose in seven U.S. states
Journal of Substance Use and Addiction Treatment, 191, 210093. doi: 10.1016/j.josat.2026.210093.