Building connection: overdose survivors' and professional service providers' perspectives on immediate post-overdose care.

Background: Nonfatal overdose is a risk factor for future fatal overdose and represents a critical touchpoint for engaging survivors and making connections to treatment and harm reduction resources. The aim of this study was to understand survivors' experiences and preferences in the immediate post-overdose period, and to elucidate survivors' and professionals' perspectives on improving care provision at this interaction point.

Methods: In 2020-2021, we conducted semi-structured qualitative interviews with opioid overdose survivors (n = 59) and professionals (n = 28) who respond to overdoses or interact with survivors in Boston, MA. When reviewing coded data early in the analytical process, we identified a strong emphasis on the importance of immediate post-overdose experiences in influencing engagement in care. Subsequent in-depth analysis then identified common experiences and factors related to service engagement in this acute time period.

Results: Among 59 overdose survivors, most identified as Black or Latinx (70 %) due to purposive sampling. Most were also unhoused (75 %) and reported at least three past-year overdoses (69 %). Many participants described intense physical pain and/or emotional distress immediately following overdose reversal, which reduced their desire and ability to engage with service providers. Several experienced disrespect and stigma from overdose responders, which negatively impacted their experience. However, some participants expressed wanting to be offered services immediately post-overdose, stating that providers should always "extend the branch". Professionals reinforced survivors' perspectives, explaining how trauma and stigma reduce survivors' willingness to accept service information and referrals; they also highlighted systemic challenges in standard overdose response processes that impede effective engagement.

Conclusion: To better engage survivors, overdose response processes should prioritize survivors' physical and emotional comfort and seek to build trust by utilizing person-centered, trauma-informed, and non-stigmatizing approaches.