Non-Fatal Overdoses (NFODs) remain a critical public health concern in Ireland opioids are the leading cause of overdose globally requiring a comprehensive and multi-faceted response to address the complexities of the opioid crisis. This report integrates data from national and Dublin-specific sources to identify key trends, high-risk populations, and service gaps. It offers evidence-based recommendations to enhance prevention, treatment, and recovery outcomes across diverse populations, from older patients facing polypharmacyrelated risks to younger individuals with hidden or shifting substance use patterns. Among inner-city hospitals, heroin dominated NFOD cases from 2011 to 2020, reaching its peak in the mid-2010s. However, a significant shift occurred in 2021 when methadone overtook heroin as the most commonly involved opioid. In contrast, non-urban hospitals exhibited a different trend, with heroin leading overdose cases until the mid-2010s. Since then, "Other Opioids," including prescription painkillers and synthetic opioids, have become the primary contributors to NFODs in these areas, reflecting distinct challenges in rural healthcare contexts. Dublin’s inner city remains a hotspot for NFODs, driven by socio-economic challenges, limited access to long-term support, and the high prevalence of opioid use. Methadone’s increasing involvement in overdose cases further highlights the need for robust monitoring and continuum of care strategies. Non-urban areas, on the other hand, face rising overdose risks due to ‘other opioids.

A critical service gap identified in inner-city hospitals is the near absence of psychological interventions and social inclusion supports, despite these being essential to addressing underlying mental health and social factors that contribute to addiction and relapse. This lack of support may hinder long-term recovery for many NFOD patients. Compounding these challenges, the post-COVID reduction in the length of hospital stays has highlighted the need to ensure that NFOD patients receive comprehensive care and appropriate followup support. Shorter hospital stays may limit opportunities for certain interventions, making effective coordination of care, particularly post-discharge, essential. Strengthening continuity of care can help mitigate the risk of recurrent overdoses and improve long-term recovery outcomes. These findings underscore the complex nature of NFODs in Ireland and highlight the need for targeted, evidence-based interventions to address diverse risk profiles across urban and rural settings.