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Research Brief: Naloxone Use, 911 Calls, and Emergency Visits After Nonfatal Overdose

Written By: Benjamin Eidman

Study Authors:1 Brendan Saloner, PhD; Peter J. Fredericks, MD; Lauren Byrne, MPH; Adrienne Hurst, LCSW; Lindsey Kerins, MPH; Eric G. Hulsey, DrPH, MA; Julie Rwan, MPH; Sachini Bandara, PhD

Background

Experiencing a nonfatal overdose is a major risk factor for future fatal and nonfatal overdoses.2,3 Nonfatal overdoses also present a critical opportunity to connect survivors with services that reduce future overdose risk and support recovery.2 However, there is limited research on how often people engage with emergency services following overdose events and the extent to which current post-overdose care systems meet the population’s needs.

Study Methods

As part of the Bloomberg Overdose Prevention Initiative, the VOICES project addressed significant gaps in overdose response monitoring through a large-scale survey with people who use drugs. Survey questions focused on participants’ experiences with drug use, harm reduction, and treatment systems. Participants were recruited from 45 harm reduction, treatment, and social service organizations within four areas in states participating in the Bloomberg Overdose Prevention Initiative: 1) Milwaukee, Wisconsin; 2) Flint & Detroit, Michigan; 3) Statewide New Jersey; and 4) Bernalillo County, New Mexico.

Participants were screened for eligibility and completed surveys over a toll-free hotline staffed by trained interviewers. Respondents reporting a nonfatal overdose in the past year were asked whether:

  1. Someone used naloxone during their most recent overdose
  2. 911 was called during their most recent overdose (and if not, why)
  3. They received emergency department treatment after their most recent overdose (and if so, what types of treatments were offered)

Study Findings

About a quarter of respondents reported a nonfatal overdose.

  • Among 2,097 respondents included in the analysis, 25.7% experienced a nonfatal overdose in the past year.

Naloxone was often used to reverse overdoses.

  • 82.1% of respondents with a nonfatal overdose reported that naloxone was administered at their most recent overdose.

911 was not always called, and about half of all overdose survivors were not transported to the emergency department.

  • Only 61.3% of respondents with a nonfatal overdose reported that 911 was called during their most recent overdose.
  • 47.0% of respondents with a nonfatal overdose were transported to the emergency department.

Three reasons most often explained why 911 wasn’t called after a nonfatal overdose.

  • 28.6% reported that they regained consciousness without naloxone.
  • 26.8% reported that a bystander administered naloxone.
  • 21.6% reported fear of law enforcement involvement.

Emergency departments provided harm reduction and treatment services to overdose survivors, although few received medications for opioid use disorder (MOUD).

  • More than half of the respondents transported to the emergency department received take-home naloxone (61.5%) or a drug treatment program appointment (51.9%).
  • Only 21.9% of respondents transported to the emergency department were administered buprenorphine; 16.2% received methadone.

Study Implications

Taken together, these findings underscore:

  • The importance of community access to naloxone and overdose education.
    • The frequent use of naloxone reported by VOICES respondents reinforces the strong existing body of evidence that it’s a vital, life-saving medication.4,5 State and local health departments should maintain naloxone distribution initiatives that can ensure broad access across a variety of settings.
  •  The need to enhance public health overdose surveillance systems.
    • Nearly 40% of VOICES respondents with a prior-year nonfatal overdose reported that 911 was not called during their most recent overdose. This indicates that current surveillance systems, which rely primarily on emergency medical services data, may vastly underestimate the number of nonfatal overdoses. More direct data collection from the broader population of people who use drugs can provide a greater understanding of post overdose experiences and inform ongoing improvements to overdose response practices.
  • The opportunity to improve current overdose response practices.
    • Nearly half of VOICES respondents with a prior-year nonfatal overdose reported that they were not transported to the emergency department. Policymakers and overdose response service providers can explore additional strategies that may help reach more overdose survivors.
    • For example, increasing access to emergency department-based medications for opioid use disorder may improve care experiences for people who use drugs and encourage emergency department transport, and early evidence has shown these programs have potential to reduce post-discharge overdose risk and support retention in follow-up care.6,7
    • Non-hospital-based interventions, such as post-overdose outreach programs,8 may support overdose survivors avoiding emergency care and warrant further evaluation and consideration.

To read the complete paper, visit Jama Network Open.


References

  1. Saloner B, Fredericks PJ, Byrne L, et al. Naloxone use, 911 calls, and emergency visits after nonfatal overdose. JAMA Network Open. 2025;8(10):e2537678. http://dx.doi.org/10.1001/jamanetworkopen.2025.37678. doi: 10.1001/jamanetworkopen.2025.37678.
  2. Mace S, Siegler A, Wu KC. OVERDOSE RESPONSE AND LINKAGE TO CARE: A roadmap for health
    departments. 2021. https://staging.thenationalcouncil.org/wp-content/uploads/2022/02/Overdose-Response-and-Linkage-to-Care-Roadmap-1-November-2021-1.pdf. Accessed January 15, 2026.
  3. Ramirez MP, Lucas GM, Page KR, et al. Predictors of future overdose among people who inject drugs in baltimore, maryland. Drug Alcohol Depend Rep. 2024;13:100286. doi: 10.1016/j.dadr.2024.100286.
  4. Vadiei N, Axon DR, Eckert B. Naloxone distribution models in the united states: A scoping review. Substance use & addiction journal. 2025;46(2):391–404.https://journals.sagepub.com/doi/full/10.1177/29767342241289008. doi: 10.1177/29767342241289008.
  5. Fischer LS, Asher A, Stein R, et al. Effectiveness of naloxone distribution in community settings to reduce opioid overdose deaths among people who use drugs: A systematic review and meta-analysis. BMC Public Health. 2025;25(1):1135–14. https://link.springer.com/article/10.1186/s12889-025-22210-8. doi: 10.1186/s12889-025-22210-8.
  6. Herring AA, Rosen AD, Samuels EA, et al. Emergency department access to buprenorphine for opioid use disorder. JAMA network open. 2024;7(1):e2353771. https://www.ncbi.nlm.nih.gov/pubmed/38285444. doi: 10.1001/jamanetworkopen.2023.53771.
  7. Weiner SG, Little K, Yoo J, et al. Opioid overdose after medication for opioid use disorder initiation following hospitalization or ED visit. JAMA network open. 2024;7(7):e2423954.https://www.ncbi.nlm.nih.gov/pubmed/39037812. doi: 10.1001/jamanetworkopen.2024.23954.
  8. Ferg M, Rapisarda SS, Soranno E, Lewis N, Ottoson A, Tschampl CA. Bridging the gap: An environmental scan of post-overdose program features and evaluation measures. The International journal of drug policy. 2024;134:104651. https://www.clinicalkey.com/#!/content/1-s2.0-S0955395924003359. doi: 10.1016/j.drugpo.2024.104651.

Benjamin Eidman, MSPH, is the Senior Research Program Coordinator for the Bloomberg Overdose Prevention Initiative. He has experience in Medicaid care coordination, implementation science research in surgical and mental health settings, and consulting for state Medicaid agencies. Benjamin works to bridge the research and policy communities, striving for policies that are both practical and informed by evidence.