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

Jaclyn M W Hughto; Patrick J A Kelly; Stephanie A Vento; David R Pletta; Madeline Noh; Joseph Silcox; Josiah D Rich; Traci C Green

doi:10.1016/j.drugalcdep.2024.112501

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

Drug Alcohol Depend. 2024 Nov 19:266:112501. doi: 10.1016/j.drugalcdep.2024.112501. Online ahead of print.

Authors

Jaclyn M W Hughto¹, Patrick J A Kelly², Stephanie A Vento³, David R Pletta⁴, Madeline Noh⁵, Joseph Silcox⁶, Josiah D Rich⁷, Traci C Green⁸

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA. Electronic address: [email protected].
² Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA. Electronic address: [email protected].
³ Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA. Electronic address: [email protected].
⁴ Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA. Electronic address: [email protected].
⁵ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center for Health Promotion and Health Equity, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA. Electronic address: [email protected].
⁶ Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA; University of Massachusetts - Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA. Electronic address: [email protected].
⁷ Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA. Electronic address: [email protected].
⁸ Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA; Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, 1125 North Main Street, Providence, RI 02903, USA; The Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02912, USA; Brandeis University Opioid Policy Research Collaborative, 415 South Street, Waltham, MA, USA. Electronic address: [email protected].

PMID: 39608288
DOI: 10.1016/j.drugalcdep.2024.112501

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.

Keywords: 911; Cocaine; Crack; Emergency response; Methamphetamine; Overamping; Overdose; Stimulants; Toxicity.