Missed opportunities following overdose among people who use substances in Boston

Abstract

Background: In Boston, there are rising opioid overdoses among Black and Latinx individuals and racial disparities in treatment. Yet little is known about the experiences of Black and Latinx overdose survivors immediately following overdose.

Objective: To understand the experiences of Boston residents during and immediately after an opioid overdose.

Methods: The Boston Overdose Linkage to Treatment Study (BOLTS) is a qualitative study which elicits perspectives about drug use, overdose, and treatment. Between September 2020-September 2021, we interviewed 59 Boston residents, aged ≥18 who survived an overdose in the previous 3 months, were fluent in English or Spanish, and identified as White, Black, and/or Hispanic/Latinx. Participants completed a demographic survey and a 60-minute semi-structured interview. Researchers analyzed data using a collaborative Framework Analysis approach.

Results: Seventy percent of participants were Black or Latinx and 76% were experiencing homelessness. Participants attributed their overdoses to using more or stronger drug than usual, supply issues, lowered tolerance after periods of sobriety, and poor care transitions (e.g., homelessness following jail, detoxification, or residential programs). Twenty-seven percent received no professional care following an overdose; nearly all of these individuals simply went about their days. Sixty-eight percent of participants had an encounter with a professional (e.g., administered naloxone or other acute care). Only 2 of these participants successfully linked to treatment directly following the overdose. Several Black or Latinx participants reported that no one discussed treatment with them following an overdose. Participants reported needing more time to come to the right frame of mind to think about treatment, more proactive offers of treatment, more support to connect to services, and more available treatment programs. Several participants, most of whom were Black or Latinx, described feeling disrespected or stigmatized by medical professionals. Some also described guilt, shame, and embarrassment immediately following revival from overdose (“I looked around, I was abandoned…I felt betrayed, I felt ashamed, I felt stupid, I felt worthless…”).

Conclusions: The post-overdose period is an opportunity to engage survivors in treatment but system gaps and negative experiences, especially for people experiencing homelessness or who are Black and Latinx, contribute to overdose risk. By understanding and incorporating opioid overdose survivor experiences, post-overdose programs can be more person-centered and responsive to the needs of marginalized people.

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