Table 2 Summary of themes

PWUD as peer overdose responders

Perceived role in overdose response and impressions of overdose response services rendered by EMS. Participants broadly described significant experience and personal investment in responding to overdose, citing a strong sense of personal responsibility and confidence in overdose response skills, although some participants reported negative emotional impacts from frequently witnessing overdoses.

PWUD role in emergency medical services response

As frequent bystanders, participants said they felt responsible for making decisions around EMS involvement in overdose response, weighing the benefits with potential consequences (fear of negative repercussions, exposure to stigma), and noting that overdoses are often successfully reversed by bystanders without EMS.

Fear of police response among peer overdose responders

Police response was a primary factor discouraging PWUD from calling EMS during an overdose. Participants broadly perceived police overdose response as unhelpful and unsafe.