“I Don’t Go Overboard”: Perceptions of Overdose Risk and Risk Reduction Strategies among People Who Use Drugs in Rhode Island

Abstract

Background: North America experiencing an unprecedented overdose epidemic, with data estimating almost 110,000 overdose deaths occurring in 2022 in the United States (US). To address fatal overdoses in the US, community organizations and local health departments in some jurisdictions have expanded community distribution of naloxone, and increased overdose prevention education, and other harm reduction supplies and services (e.g., fentanyl test strips, drug checking programs) to reduce harm for people who use drugs (PWUD). Objectives: Understanding how PWUD manage overdose risk within the context of these expanded services is important for ensuring public health services are meeting their needs. Semi-structured qualitative interviews were conducted with 25 PWUD who were accessing harm reduction services in Rhode Island. Data were imported into NVivo where they were coded and analyzed thematically. Results: Our findings demonstrate the complexity of managing overdose risk in the context of a fentanyl drug supply. While most participants were concerned about overdosing, they sought to manage overdose risk through their own harm reduction practices (e.g., testing their drugs, going slow) and drug purchasing dynamics, even when using alone. Conclusions: Study findings point to the need to implement and scale-up community-level interventions to better support PWUD within the context of the current US overdose crisis.

Keywords:

• Harm reduction
• overdose risk
• people who use drugs
• qualitative

Acknowledgments

The authors thank the study participants for their contribution to this research. We also thank the community organizations who participated in this project. This study was conducted on the traditional lands of the Narragansett peoples. ABC, HM, and MM are partially supported by the National Institute of General Medical Sciences of the NIH (P20GM125507). ABC is also supported by the Lifespan/Brown Criminal Justice Research Training Program on Substance Use and HIV (R25DA037190).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the Rhode Island Department of Health. ABC, HM, and MM are also partially supported by NIGMS (P20GM125507).