Exploring trauma and wellbeing of people who use drugs after witnessing overdose: A qualitative study

Authors

Minna Song, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA. Electronic address: msong26@jhu.edu.
Isha K. Desai, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA; Department of Health Policy and Management, George Washington University, 950 New Hampshire Ave, #2, Washington, DC 20052, USA.
Avery Meyer, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Hridika Shah, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Brendan Saloner, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Susan G. Sherman, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Sean T. Allen, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Catherine Tomko, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Kristin E. Schneider, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Noa Krawczyk, Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10065, USA.
Sara Whaley, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Jade Churchill, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.
Samantha J. Harris, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD 21205, USA.

Document Type

Journal Article

Publication Date

10-25-2023

Journal

The International journal on drug policy

Volume

122

DOI

10.1016/j.drugpo.2023.104239

Keywords

Harm reduction; Injection drug use; Opioids; Overdose; Overdose response; Trauma

Abstract

BACKGROUND: The national overdose crisis is often quantified by overdose deaths, but understanding the traumatic impact for those who witness and respond to overdoses can help elucidate mental health needs and opportunities for intervention for this population. Many who respond to overdoses are people who use drugs. This study adds to the literature on how people who use drugs qualitatively experience trauma resulting from witnessing and responding to overdose, through the lens of the Trauma-Informed Theory of Individual Health Behavior. METHODS: We conducted 60-min semi-structured, in-depth phone interviews. Participants were recruited from six states and Washington, DC in March-April 2022. Participants included 17 individuals who witnessed overdose(s) during the COVID-19 pandemic. The interview guide was shaped by theories of trauma. The codebook was developed using a priori codes from the interview guide; inductive codes were added during content analysis. Transcripts were coded using ATLAS.ti. RESULTS: A vast majority reported trauma from witnessing overdoses. Participants reported that the severity of trauma varied by contextual factors such as the closeness of the relationship to the person overdosing or whether the event was their first experience witnessing an overdose. Participants often described symptoms of trauma including rumination, guilt, and hypervigilance. Some reported normalization of witnessing overdoses due to how common overdoses were, while some acknowledged overdoses will never be "normal." The impacts of witnessing overdose on drug use behaviors varied from riskier substance use to increased motivation for treatment and safer drug use practices. CONCLUSION: Recognizing the traumatic impact of witnessed overdoses is key to effectively addressing the full range of sequelae of the overdose crisis. Trauma-informed approaches should be central for service providers when they approach this subject with clients, with awareness of how normalization can reduce help-seeking behaviors and the need for psychological aftercare. We found increased motivation for behavior change after witnessing, which presents opportunity for intervention.

APA Citation

Song, Minna; Desai, Isha K.; Meyer, Avery; Shah, Hridika; Saloner, Brendan; Sherman, Susan G.; Allen, Sean T.; Tomko, Catherine; Schneider, Kristin E.; Krawczyk, Noa; Whaley, Sara; Churchill, Jade; and Harris, Samantha J., "Exploring trauma and wellbeing of people who use drugs after witnessing overdose: A qualitative study" (2023). GW Authored Works. Paper 3553.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3553

Department

Public Health Student Works