ArticleHarm reduction journal2026
Understanding the role of overdose witnesses: responses and characteristics of people who inject drugs in Oakland and San Francisco.
Article in Harm reduction journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOverdose is a significant cause of mortality in the United States. People who inject drugs (PWID) are uniquely positioned to witness and reverse overdoses. This study assesses overdose responses and factors associated with witnessing overdose among PWID.
methodsData originate from baseline surveys for a longitudinal study of PWID in Oakland and San Francisco, California, collected between April 2024 and March 2025. Multivariable logistic regression identified factors associated with witnessing overdoses.
resultsOf 597 PWID, 464 (77.7%) witnessed at least one overdose in the past 3 months, with an average of 13.4 (SD = 28.2) and a median of 6 (IQR = 3-15) overdoses. Among those, 30 (6.5%) reported only calling 911, 50 (10.8%) reported taking no action, 172 (37.2%) reported only using naloxone to reverse overdoses, and 210 (45.5%) used naloxone in conjunction with calling 911. The adjusted odds of witnessing overdoses were 2.2 times higher among unsheltered PWID (vs. sheltered, p < 0.001), 3.1 times higher among those in San Francisco (vs. Oakland, p < 0.001), 4.6 times higher among those who experienced non-fatal overdose themselves (vs. not, p = 0.002), 2.8 times higher among those sharing needles (vs. not, p = 0.015), and 1.9 times higher among those injecting fentanyl (vs. did not, p = 0.006) in the past 3 months.
conclusionsNearly four in five PWID in Oakland and San Francisco recently witnessed an overdose. Witnesses are at greater risk of non-fatal overdose and may be the first to respond when those they inject with overdose. Targeting naloxone distributions to PWID who are characteristically more likely to witness overdoses may prevent additional drug-related deaths.
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