Characterizing and responding to stimulant overdoses: Findings from a mixed methods study of people who use cocaine and other stimulants in New England

Abstract

Purpose

To explore people who use stimulants’ (PWUS) stimulant overdose experiences and identify factors associated with calling 911 for personal and witnessed stimulant overdoses.

Methods

From 2022–2023, 222 people in Massachusetts and Rhode Island with past-30-day illicit stimulant use were surveyed. Adjusted multivariable logistic regression models examined the association between sociodemographics, substance use, and stimulant overdose history and whether 911 was called for participants’ last personally experienced and witnessed stimulant overdoses.

Results

Overall, 42.2 % of PWUS witnessed- and 34.5 % personally overdosed on stimulants. Nearly half (48.7 %) of participants who overdosed used crack cocaine prior, 35.5 % reported extremely severe symptoms (e.g., heart attack, stroke, seizure, loss of consciousness), and 34.2 % said 911 was called at their last overdose. Among those who last witnessed a stimulant overdose, 41.5 % reported crack cocaine involvement, and 47.9 % said 911 was called (20.0 % personally called). Higher educational attainment and experiencing extremely severe symptoms were positively associated with 911 being called at participants’ last stimulant overdose, whereas the number of overdoses witnessed and crack cocaine use by the person overdosing were negatively associated with 911 being called at participants’ last witnessed stimulant overdose (all p-values<.05).

Conclusion

Stimulant overdoses were common. Most participants reported moderate-to-severe symptoms, yet 911 was called in less than half of personal or witnessed stimulant overdoses. Emergency help-seeking also varied by symptom severity, stimulant type, and the sociodemographics of the person overdosing. Research is needed to understand barriers to formal help-seeking and the practices PWUS engage in to prevent fatal stimulant overdoses.