The Emotional and Mental Wellbeing of Women Who Use Drugs Engaged in Community-Based Overdose Response.

BACKGROUND

Fatal overdose among women in the United States has risen sharply in recent years. Women who use drugs often respond to overdoses within their communities, including administering naloxone and providing peer-based care in contexts shaped by structural vulnerability, stigma, and criminalization. However, the emotional and mental health dimensions of these experiences remain underexplored.

METHODS

This qualitative study draws on in-depth, semi-structured interviews with 27 women in Miami-Dade County, Florida (June 2023 to January 2024). Participants were recruited from the community as part of a larger study of peripregnancy drug use, criminal legal system involvement, and HIV vulnerability. Interviews were conducted by trained peer researchers using trauma-informed, participant-centered approaches. This secondary analysis examined participants' narratives of overdose, including personal, witnessed, and fatal events. Data were analyzed thematically, informed by the social-ecological model.

RESULTS

Participants described overdose as a routine feature of daily life in the context of a fentanyl-driven drug supply. Most reported administering naloxone to peers and strangers, often in resource-constrained and stigmatizing environments. These responses were frequently framed as forms of care work, grounded in responsibility, relational obligation, and mutual aid within gendered risk environments. At the same time, participants described cumulative emotional impacts, including grief, stress, and fatigue associated with repeated exposure to overdose. Some also expressed ambivalence about their own overdose experiences, reflecting blurred boundaries between risk, survival, and intention.

CONCLUSION

Women in this study appear to play an important role in community-based overdose response while navigating conditions of structural constraint. Their accounts highlight both the relational nature of overdose response and the emotional toll of repeated exposure to overdose events. Expanding harm reduction efforts to include mental health support, grief processing, and trauma-informed services may better address the needs of individuals engaged in informal community overdose response.