Overdose Risk Factors

Overdose can happen to anyone at any time, but there are factors that increase a person's risk.

An overdose occurs when the body experiences a toxic level of one or more drugs. During an overdose, these substances or medications overpower the brain and other organs, and can prevent them from functioning normally.

Overdose can happen to anyone at any time, but research shows that certain individual and community variables can increase the risk of overdose. By learning what they are, you can help raise awareness and reduce the stigma around who overdose can impact and how to offer support.

Individual Risk Factors
Taking an amount of a drug that is greater than your tolerance level. This may include using drugs after a recent period of abstinence, which may decrease previous tolerance levels. Returning to drug use after leaving jail/prison or healthcare setting where a medication for opioid use disorder was not provided or taken. Returning to drug use before receiving another injection of naltrexone, an FDA-approved medication for opioid use disorder, since the opioid blockage effect of naltrexone will have worn off and prior tolerance levels will have decreased. Taking a drug that is much stronger than what you are used to taking. Using a drug when you have underlying lung or heart conditions that leave you unable to tolerate lower levels of oxygen, such as asthma or sleep apnea. Using a similar drug to the one with which you have experienced a prior overdose. Combining different drugs—for example, opioids with other sedating substances such as benzodiazepines or alcohol. Using drugs alone without notifying someone who can respond using an overdose reversal medication.

Individual Risk Factors

Taking an amount of a drug that is greater than your tolerance level. This may include using drugs after a recent period of abstinence, which may decrease previous tolerance levels.
Returning to drug use after leaving jail/prison or healthcare setting where a medication for opioid use disorder was not provided or taken.
Returning to drug use before receiving another injection of naltrexone, an FDA-approved medication for opioid use disorder, since the opioid blockage effect of naltrexone will have worn off and prior tolerance levels will have decreased.
Taking a drug that is much stronger than what you are used to taking.
Using a drug when you have underlying lung or heart conditions that leave you unable to tolerate lower levels of oxygen, such as asthma or sleep apnea.
Using a similar drug to the one with which you have experienced a prior overdose.
Combining different drugs—for example, opioids with other sedating substances such as benzodiazepines or alcohol.
Using drugs alone without notifying someone who can respond using an overdose reversal medication.

Community Context
Due to clinic closure or inadequate access to health system providers to address pain treatment or OUD treatment, switching from prescription opioids to unregulated street-purchased opioids that have unknown contents and potency. Not having access to drug checking tools to test illicit drugs for contents prior to use. Not having easy and timely access to opioid overdose reversal medications. Not checking for prescriber or pharmacist error, or misunderstanding instructions that can lead to taking a medication more often or at a higher dose than was intended. Using a substance or taking a medication obtained from an unregulated source and not knowing its contents. Using drugs in an unfamiliar or stressful environment, which can reduce awareness of and access to overdose prevention tools

Community Context

Due to clinic closure or inadequate access to health system providers to address pain treatment or OUD treatment, switching from prescription opioids to unregulated street-purchased opioids that have unknown contents and potency.
Not having access to drug checking tools to test illicit drugs for contents prior to use.
Not having easy and timely access to opioid overdose reversal medications.
Not checking for prescriber or pharmacist error, or misunderstanding instructions that can lead to taking a medication more often or at a higher dose than was intended.
Using a substance or taking a medication obtained from an unregulated source and not knowing its contents.
Using drugs in an unfamiliar or stressful environment, which can reduce awareness of and access to overdose prevention tools

From SAMHSA’s updated Overdose Prevention and Response Toolkit, 2024 (PEP23-03-00-001)

Overdose Risk Factors

Individual Risk Factors

Community Context

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