• David Frank, Pedro Mateu-Gelabert, Honoria Guarino, Alex Bennett, Travis Wendel, Lauren Jessell, and Anastasia Teper.
• The Graduate Center, City University of New York, Dept. of Sociology, 365 Fifth Avenue, Room 6112.04, New York, NY 10016, United States; National Development and Research Institutes, Inc., 71 W. 23rd Street, 4th Floor, New York, NY 10010, United States. Electronic address: dfrank40@gmail.com.
• Int. J. Drug Policy. 2015 Jan 1;26(1):84-91.

BackgroundOpioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Yet few studies have examined the overdose knowledge and experience of nonmedical PO users.MethodsIn depth, semi-structured, audio-recorded interviews were conducted with 46 New York City young adults (ages 18-32) who reported using POs nonmedically within the past 30 days. Verbatim interview transcripts were coded for key themes in an analytic process informed by grounded theory.ResultsDespite significant experience with overdose (including overdose deaths), either personally or within opioid-using networks, participants were relatively uninformed about overdose awareness, avoidance and response strategies, in particular the use of naloxone. Overdose experiences typically occurred when multiple pharmaceuticals were used (often in combination with alcohol) or after participants had transitioned to heroin injection. Participants tended to see themselves as distinct from traditional heroin users, and were often outside of the networks reached by traditional opioid safety/overdose prevention services. Consequently, they were unlikely to utilize harm reduction services, such as syringe exchange programs (SEPs), that address drug users' health and safety.ConclusionsThese findings suggest that many young adult nonmedical PO users are at high risk of both fatal and non-fatal overdose. There is a pressing need to develop innovative outreach strategies and overdose prevention programs to better reach and serve young PO users and their network contacts. Prevention efforts addressing risk for accidental overdose, including opioid safety/overdose reversal education and naloxone distribution, should be tailored for and targeted to this vulnerable group.Copyright © 2014 Elsevier B.V. All rights reserved.

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