Stimulant Overdoses and Calls to Emergency Services Among Individuals With Recent Stimulant Use

The use of stimulants and stimulant-related overdoses is increasing, and many overdose deaths involving opioids also involve stimulants. Identifying severe overdoses from stimulants may be difficult, and there are other personal and social factors that can interfere with calling emergency medical services (EMS). Using respondent-driven sampling, 222 people from four cities in Massachusetts and Rhode Island with past-30-day illicit stimulant use were surveyed in 2022–2023. Severity of overdoses was categorized using 16 self-reported symptoms.

• Among people who use stimulants (PWUS), 35 percent reported experiencing an overdose and 42 percent reported witnessing an overdose. Most overdoses involved crack cocaine (49 percent of those experiencing and 42 percent of those witnessing overdose).
• During their most recent overdose experience, 82 percent of respondents reported moderate-to-severe symptoms, including 36 percent who reported extremely severe symptoms (e.g., seizure, loss of consciousness, apparent heart attack, or stroke).
• For the most recent overdose, 34 percent of those experiencing an overdose and 48 percent of those witnessing an overdose reported that EMS were called.
• In multivariable models, severity of overdose symptoms and higher educational levels were independently associated with calling EMS, while witnessing higher numbers of overdoses and the use of crack cocaine were negatively associated with calling EMS.

Comments: Among this sample of people with high rates of stimulant use, experiencing and witnessing stimulant overdoses was common. To better determine whether the proportion of overdoses resulting in calls to EMS calls is appropriate, medical assessments of overdose severity would be informative to corroborate the severity of symptoms reported by PWUS. Nonetheless, structural and educational interventions to facilitate calls to EMS seem warranted.

Timothy S. Naimi, MD, MPH

Reference: Hughto JMW, Kelly PJA, Vento SA, et al. Characterizing and responding to stimulant overdoses: Findings from a mixed methods study of people who use cocaine and other stimulants in New England. Drug Alcohol Depend. 2025;266:112501.