Care access and provision for persons surviving opioid overdose and toxic brain injury, with recommendations to address the unfolding polycrisis

OBJECTIVES: Escalating rates of opioid overdoses have led to a global public health crisis. With the widespread use of life-saving measures, such as Naloxone, more individuals are surviving overdoses. However, a secondary problem has emerged: many survivors are experiencing anoxic/hypoxic brain injuries (AHBI)-also known as toxic brain injuries-as a consequence of non-fatal overdose. This study aimed to explore the intersection of non-fatal opioid overdose and AHBI, identify barriers and facilitators to care, and inform the future development of an integrated care model for individuals with a history of opioid overdose and AHBI. METHODS: This study employed a mixed-method approach, combining qualitative semi-structured interviews with quantitative survey data. Participants included people with lived experience of non-fatal opioid overdose (PLE) and formal healthcare providers (HCP) from British Columbia, Canada. Data were collected using trauma-informed procedures and analyzed through thematic analysis and statistical methods to reveal key themes relating to service provision and care needs. RESULTS: PLE experienced cognitive challenges but had limited education about the overlap between AHBI and overdose. Significant gaps were identified by PLE in accessing and receiving care for both AHBI and substance use needs. HCPs expressed significant challenges with providing care, emphasizing factors such as limited resources and full caseloads. Both PLE and HCPs expressed that siloed care between brain injury, mental health and substance use was a fundamental, pervasive barrier. CONCLUSIONS: The findings indicate that individuals who survive opioid overdose and AHBI face complex challenges that necessitate integrated and tailored care approaches. To reduce the risk of secondary cognitive impairment and improve long-term recovery outcomes for this vulnerable population, essential steps include removing barriers to receiving and providing care, enhancing education for both patients and healthcare providers, and ensuring well-coordinated, long-term, culturally safe support.