Understanding ‘never overdosing’ in a cohort of people who inject opioids

Opioid overdose is a major public health problem globally, with overdose incidence and mortality from overdose increasing at rapid rates in North America, with similar trends emerging in Australia. People who inject drugs (PWID) are a key risk group for opioid overdose, with rates of opioid overdose among Australian PWID as high as 50%. But not all PWID experience overdose, despite long injecting careers and high-risk environments. Harm reduction practices are encouraged in order to reduce the harm from non-fatal overdose and rates of fatal overdose, but evidence is limited on the self-acknowledged success of protective efforts that PWID utilise in order to protect themselves from overdose. This project aims to explore the characteristics of PWID who have never overdosed, in comparison to PWID who have. The project will utilise the Burnet Institute’s SuperMIX study, a large prospective cohort study of PWID in Melbourne with over 1200 participants. We will collect and analyse qualitative data from a small sample of SuperMIX participants who have and have not overdosed whilst injecting opioids to determine their self-perceived success in preventing themselves from experiencing overdose through a positive deviance framework.