ArticleDrug and alcohol dependence2026
Higher prevalence of non-fatal overdose with opioid and stimulant use compared to use of opioids alone.
Article in Drug and alcohol dependence, 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
backgroundFatalities 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.
methodsWe 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.
resultsAmong 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.
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