Background In the UK and elsewhere, drug-related deaths are at peak levels. Non-fatal overdose is a risk factor for such deaths, but knowledge of how people who use drugs understand this is limited. This study explored non-fatal overdose experiences, aiming to inform novel thinking about overdose prevention.

Method Ten participants were recruited for narrative interviews through third-sector organizations in England, UK. Nine had been heroin-dependent, and all described polydrug use. All were in abstinence-based recovery when interviewed. An inductive narrative thematic analysis was undertaken.

Results Forty-two separate overdose episodes were described. Two major themes emerged: unbounded definitions of overdose, and impacts of overdose. A variety of often unreported experiences, including pleasurable ones, were understood as constituting overdose by people who use drugs. Overdose did not appear to be a turning point away from drug use.

Conclusions Shared understanding of the phenomenon of overdose or its significance as a motivator for change cannot be assumed. A shift from viewing overdose as only a biomedical construct may have harm reduction potential. Barriers and facilitators to the disclosure of events perceived as overdose, pleasure, and key social relationships should each be explored as additional valid priorities for contributing to overdose prevention.