Examining potential bystander presence for overdose deaths in Tennessee, 2019-2022

To examine potential bystander presence in fatal drug overdoses in Tennessee by assessing the type of potential bystander, type of responses carried out, reasons for lack of response, and the sociodemographic characteristics of overdose decedents in Tennessee.

We conducted a cross-sectional study to examine potential bystander presence in overdose deaths in Tennessee using 2019-2022 data from the State Unintentional Drug Overdose Reporting System. Descriptive statistics were calculated to compare potential bystander presence by demographic breakdown of decedents, type of potential bystander, and reasons for no response.

We identified 11,970 accidental and undetermined fatal drug overdoses in Tennessee from 2019 to 2022. A potential bystander was present in 24.8 % of deaths. Most potential bystanders were family members (27.4 %), intimate partners (26.5 %), or friends (21.1 %). Overall, potential bystanders called 911 or attempted another type of response in 94.5 % of overdose events. The most frequent reason for no response was being spatially separated from the decedent (34.2 %).

A quarter of drug overdose deaths in Tennessee had a potential bystander present who could have intervened. Continued education about how to identify and respond to an overdose as well as the availability of naloxone should be delivered to potential bystanders. Future qualitative studies should assess bystander knowledge and barriers to responding. Messaging should also encourage people who use substances to avoid using alone, given that most overdose deaths occurred without a bystander present.