Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: An unexplored dimension of the opioid overdose crisis

We investigated the relationship between overdose events and grief and loss responses among people who inject drugs. We conducted a cross-sectional, tablet-based survey with a convenience sample of people who inject drugs (n=249) from four community-based harm reduction programs in Toronto in 2019. We examined the association between frequency and types of overdose events (own, witnessed, death of significant person) in the last 6 months with grief and loss responses, identified using latent class analysis. Among respondents, 70 (48.6%) reported 2 or more personal overdoses, 173 (79.5%) witnessed 2 or more overdoses, and 69 (41.4%) experienced overdose deaths of 2 or more significant persons in the last 6 months. We identified 2 latent classes with probability of membership of 38.6% (95% confidence interval [CI]=31.0, 46.7) for medium/low intensity of responses to grief/loss and 61.4% (95% CI= 53.3, 69.0) for severe responses to grief/loss. In adjusted Poisson regression models with robust standard error stimators, severe responses to grief/loss were associated with exposure to two or more own overdoses (prevalence ratio [PR] = 1.44; 95% CI=1.12, 1.84, p-value=0.004), and having witnessed one (PR=2.09; 95% CI=1.05, 4.15, p-value=0.04) or witnessed two or more overdoses (PR=2.25; 95% CI=1.24, 4.09, p-value=0.008). Severe grief/loss responses were also more common in individuals exposed to all three types of overdose events (PR=2.42; 95% CI=1.08, 5.41, p-value=0.03). Cumulative overdose events were associated with severe responses to grief and loss. Bereavement interventions should consider the complex nature of grief and loss following overdoses. •This is the first quantitative study of overdose-related grief and loss in people who inject drugs.•A higher burden of overdose events was associated with more severe grief and loss responses.•Bereavement efforts should consider the complex nature of overdose-related grief and loss.