Theme: Social Science & Policy Research Year: 2022
Background: Drug-related deaths estimates have been increasing worldwide. Scotland presents
extremely high rates of fatal and non-fatal overdose. The aim of this study was to explore the lived
experience of overdose among people who use drugs and understand the heightened risk of
overdose among this population with qualitative interviews led by peer researchers.
Methods: Semi-structured interviews were conducted by two peer researchers with 20 adults who
used drugs and had experienced at least one non-fatal overdose in the previous six months. The
interviews took place in two injecting equipment provision sites in Dundee, Scotland. Data was
analysed using thematic analysis, using a mainly inductive approach with experiential and
Results: Five themes were identified: 1) Social context, which included risk associated with living in
the city and knowing other drug users, distrusting others, feeling pressured by peers to buy
substances and by the self to use more than others; 2) Personal risk-taking triggers, both automatic
associations in the form of paydays, and emotional triggers such as feeling emotionally
overwhelmed or suicidal; 3) Planned and impulsive consumption, with associated reflective
motivation and personality traits; 4) Risk perception, including general awareness of own and other’s
risk and low awareness of tolerance; 5) Reversing overdose, presenting experience of receiving
Naloxone to reverse an opioid-related overdose and the acceptability of the use of Naloxone on
anyone in need.
Conclusion: A complex interplay of internal and external influences emerged from the interviews.
Social and physical environments played a significant role in risk-taking behaviours. Given the
extensive personal and vicarious experience of overdose, the high perception of susceptibility to
overdose events, and the high acceptability of Naloxone administration, interventions on overdose
risk reduction should shift to target the interpersonal skills involved in drug using behaviours which
lead to increased risk of overdose.
Disclosure of Interest Statement: All authors report no conflict of interest. This study was funded by the Scottish Drug Death Taskforce (Scottish Government). The funder had no involvement in collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the manuscript for publication.