Overdose Measures Matter

Indicator Profile

Percent of people you serve who reported they have personally experienced an overdose in the past year

Category: Harm Reduction

Audience: Program Implementer

Data Type: Quantitative

Indicator Overview

Description:

Percent of people you serve who reported they have personally experienced an overdose in the past year

This indicator is intended to be flexible and may be tailored to a program’s unique needs and concerns. Programs may consider counting the number of people instead of calculating a percent, adjusting the timeframe or specifying the use of an overdose reversal drug.

Variations of this indicator include:

  • Number of people you serve who reported they have personally experienced an overdose in the past year (change from percent to a count)
  • Percent of people you serve that reported they have ever personally experienced an overdose (change timeframe)
  • Number of people you serve who reported that they have personally experienced an overdose that someone else reversed with Naloxone/Narcan since their last visit (change from percent to a count, change timeframe, specify reversal)

Programs may also consider asking follow-up questions to glean additional insights into the circumstances of reported overdoses. Potential questions include:

  • Was naloxone/Narcan used to reverse the overdose? If so, who administered the naloxone/Narcan?
  • In what type of setting did the overdose occur?
  • What substances do you believe caused the overdose?
  • How many times have you personally experienced an overdose?
  • What happened following the overdose? Was 911 called? Were they seen by emergency medical services (EMS)? Were they transported to the hospital? Were they connected to any care or treatment?

Rationale:

Harm reduction is an evidence-based approach that focuses on reducing the harms associated with drug use, such as distributing naloxone and educating people about safer drug use. Harm reduction approaches put people first and focus on addressing their direct, immediate needs by meeting people where they are.

Harm reduction strategies have been shown to reduce overdose, increase treatment entry, reduce drug use frequency and improve the health of people who use drugs.1,2,3 These strategies are particularly important for populations disproportionately affected by overdose, such as individuals recently released from incarceration and individuals experiencing homelessness, as they are several times more likely to experience an overdose event.4,5

Understanding the personal experiences program participants may have with overdose allows organizations to gain insight into the people they serve, better address their needs and identify trends in overdose over time.

With this information, organizations may be able to assess the level of overdose risk their clients face, gain insight into the local drug supply and understand the impact of local overdose education and naloxone/Narcan distribution efforts.

In addition, asking program participants about their overdose history may provide an opportunity for staff to discuss strategies for safer use with participants.

Related Indicators:

The following indicators may provide additional insight into the availability of harm reduction resources in the community to help prevent overdoses:

Programs may also want to consider the following alternatives to this indicator to gain insight into their participants’ personal experiences of reversing an overdose or their knowledge of reversing an overdose by tracking the following:

  • Percent of people you serve who reported that they have administered naloxone in the past year. (E.g., Have you reversed an overdose since your last visit? What happened with the overdose or overdoses you reversed?)
  • Percent of people you serve who reported that they know how to administer and respond to an overdose. (E.g., Do you know how to respond to an overdose?)

Programs may tailor these related indicators to their unique needs and concerns by instead counting the number of people rather than calculating a percent or adjusting the timeframe of the indicator.

Indicator Details

Definitions:

People you serve includes all people who use drugs (PWUD) who participate in or are served by your program.

If your program serves people with a broad range of needs and is not limited to PWUD, you may not know if someone is a person who uses drugs. If this is the case, people you serve may instead include all people who participate in or are served by your program (potentially including both people who report using drugs and people who do not report using drugs). It is important to specify your definition when sharing and discussing results.

Numerator and Denominator:

Numerator: Total number of people you serve who were asked about their personal experience with overdose who responded they have personally experienced an overdose in the past year.

Denominator: Total number of people you serve who were asked about their personal experience with overdose.

Note: You may also want to report the total number of people being served by your organization. This would provide greater context for how to interpret this indicator. For example, if you surveyed 20 people (denominator) and of these, 19 (numerator) said they had personally experienced overdose in the past year, you would report that 95% of people surveyed said they had personally overdose in the past year. However, your organization typically serves 100 people. So, although your indicator is “95%,” this only represents a small proportion of people you serve (20 of the 100) and may not accurately reflect the experiences of the larger population.

Ways to Examine the Data:

  1. Participant demographics (e.g., age group, sex, gender, race, etc.)
  2. If naloxone/Narcan was used
  3. Type of setting where overdose occurred (e.g., at home, outdoors, other non-home setting)
  4. Type of drug used
  5. Number of overdoses experienced (i.e., Was this the first overdose they had ever experienced? Was this the first overdose they experienced in the past year?)

Note: Program implementers may consider collecting these additional data points from participants to support further analysis and provide a more in-depth understanding of results.

Learn more about collecting demographic data. This type of data collection may require specialized training, skill and financial resources.

Data Sources:

  • People served by your program

Data Collection Methods:

  • Point in Time (PIT) survey
  • Focus groups
  • Interviews
  • Program intake survey

Application and Considerations

Suggested Use:

  • To communicate the level of overdose risk to program participants face to community partners and funders
  • To gain insight about the use of overdose reversal drugs in the community

Health Access Considerations:

You may want to consider:

  • How will you use this information to improve services for program participants?
  • Do participants’ personal experiences of overdose vary by participant demographics? Is one population more likely to have personally experienced overdose in the past year?
  • How might the way the question is asked (for example, by whom and through what data collection approach) influence how comfortable participants feel in disclosing their overdose history? Are participants given the option to skip this question? (e.g., if administering a survey, including “prefer not to answer” as a response option.)
  • How might access to naloxone and other local policies (e.g., drug-induced homicide laws, “death by distribution”) influence these results?

Evaluation Considerations:

Limitations:

  • Does not track the number of overdoses that participants have experienced
  • Does not track which substance(s) participants believe contributed to the overdose
  • Cannot track or confirm what substance(s) were involved in the overdose
  • Potential for inaccuracies in self-reported data as participants may have difficulty recalling past events or may be unwilling to disclose certain information.

Policy Considerations and Resources:

Additional Resources

Examples:

  • Latkin, C. A., Gicquelais, R. E., Clyde, C., Dayton, L., Davey-Rothwell, M., German, D., Falade-Nwulia, S., Saleem, H., Fingerhood, M., & Tobin, K. (2019). Stigma and drug use settings as correlates of self-reported, non-fatal overdose among people who use drugs in Baltimore, Maryland. The International journal on drug policy, 68, 86–92.
    https://doi.org/10.1016/j.drugpo.2019.03.012
  • Riggs, K. R., Hoge, A. E., DeRussy, A. J., Montgomery, A. E., Holmes, S. K., Austin, E. L., Pollio, D. E., Kim, Y. I., Varley, A. L., Gelberg, L., Gabrielian, S. E., Blosnich, J. R., Merlin, J., Gundlapalli, A. V., Jones, A. L., Gordon, A. J., & Kertesz, S. G. (2020). Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness. JAMA network open, 3(3), e201190.
    https://doi.org/10.1001/jamanetworkopen.2020.1190
  • Wilson, M., Brumwell, A., Stowe, M. J., Shelly, S., & Scheibe, A. (2022). Personal experience and awareness of opioid overdose occurrence among peers and willingness to administer naloxone in South Africa: findings from a three-city pilot survey of homeless people who use drugs. Harm Reduction Journal, 19(1), 17.

References:

  1. Rhodes, T. (2009). Risk environments and drug harms: a social science for harm reduction approach. International journal of drug policy, 20(3), 193-201.
  2. Giglio, R. E., Li, G., & DiMaggio, C. J. (2015). Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis. Injury epidemiology, 2, 1-9.
  3. Hagan, H., McGough, J. P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E. R. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of substance abuse treatment, 19(3), 247-252.
  4. Massachusetts Department of Public Health. (2016, September 16). An assessment of opioid-related deaths in Massachusetts (2013-2014). Boston, MA: Department of Public Health.
    https://www.mass.gov/doc/legislative-report-chapter-55-opioid-overdose-study-september-2016/download.
  5. Baggett, T. P., Hwang, S. W., O'Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., Singer, D. E., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA internal medicine, 173(3), 189–195.
    https://doi.org/10.1001/jamainternmed.2013.1604
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