"We were focused so long on opioids that stimulants have always been under the rug": Adapting post-overdose outreach for cocaine- and methamphetamine-involved events.

BACKGROUND

Post-overdose outreach programs have expanded in the United States to connect individuals who survive an overdose with harm reduction, treatment, and recovery supports. Despite increased involvement of stimulants (e.g. cocaine and methamphetamine) in overdose morbidity and mortality, these programs have focused almost exclusively on opioids. This qualitative study examines outreach staff perspectives on potential adaptations to better address stimulant-involved overdose following the introduction of a toolkit of stimulant-focused supports.

METHODS

Semi-structured interviews were conducted with staff across 11 Massachusetts post-overdose outreach programs. Transcripts were deductively and inductively coded using framework analysis and organized using the Consolidated Framework for Implementation Research.

RESULTS

Across 21 interviews, multiple factors shaped proposed adaptations. At the community level, staff highlighted evolving stimulant use patterns, widespread polysubstance involvement, and persistent gaps in awareness of stimulant-involved overdose risks. At the program level, teams faced challenges identifying stimulant-involved events, limited organizational capacity, and opioid-focused program design that constrained reach. Staff identified the need for training, resources, and stronger referral networks. Staff also described engagement strategies considered essential for broadening outreach to include people who use stimulants.

CONCLUSIONS

Post-overdose outreach programs, historically focused on opioid-involved overdose, may be ill equipped to address cocaine- or methamphetamine-involved overdose. This study points to the need for substantial program adaptations, workforce development, and strengthened referral pathways along with sustained investment in harm reduction infrastructure and policy guidance that acknowledges stimulant-involved overdose as a component of the overdose crisis.