The overdose crisis is often discussed in terms of the substances involved, particularly synthetic opioids like fentanyl. But overdose risk does not exist by itself. A person’s mental health, physical health, trauma, housing situation, and access to social support can all be part of a much larger picture.

New research published in General Hospital Psychiatry helps illustrate just how interconnected these factors can really be. Researchers looked at 326 people receiving treatment for severe concurrent disorders. This means they were experiencing both serious substance use and mental health disorders. Among the participants, 65% reported experiencing at least one nonfatal overdose during their lifetime, with a median of two overdoses.

Recent fentanyl or heroin use emerged as the strongest predictor of frequent overdose in the study. Participants who reported using fentanyl or heroin during the 30 days before entering treatment had nearly seven times the odds of frequent overdose compared with those who did not. Recent crack cocaine use was also significantly associated with frequent overdose. The researchers noted the growing role of polysubstance use and responses to the overdose crisis should consider the risks associated with both opioid and stimulant use.

The study also identified factors that may be less obvious when we think about overdose prevention.

  • Trauma– A history of physical trauma was significantly associated with frequent overdose, while sexual trauma was also identified as an important marker in the researchers’ statistical analysis.
  • Physical Health– Participants diagnosed with hepatitis C had approximately four times the odds of frequent overdose.
  • Housing– Being single and being unhoused/hospitalized before entering treatment were among the factors associated with frequent overdose.
  • Social Support– Having someone who could help a person get to a doctor was associated with a lower likelihood of frequent overdose.

The findings offer an important reminder that overdose prevention cannot focus on a single risk factor. People experiencing substance use disorders may simultaneously be navigating mental illness, trauma, unstable housing, physical health conditions, isolation, or barriers to healthcare. Addressing only one of those challenges may leave other important needs unmet. There is a need for an integrated approach that considers substance use, co-occurring health conditions, trauma, and social support together.

References:

Song, M., Shahjahan, Z., Thiessen, K. A., Schmid, L., Mackillop, J., Nicholls, T. L., & Schütz, C. G. (2026). Crisis within a crisis: Risk factors of overdose among those with severe concurrent disorders. General Hospital Psychiatry, 102, 137–145. https://doi.org/10.1016/j.genhosppsych.2026.08.005