The Relationship Between Overdose Experience and Social Functional Impairment in Individuals With a History of Substance Use

Background: Substance-use disorders can profoundly affect nearly every aspect of an individual’s life. The threat of drug overdoses, driven primarily by illicit fentanyl, remains a major public health crisis. Functional disability refers to limitations in performing everyday tasks and participating in life situations. We examined the association between overdose experiences (such as naloxone administration, medical intervention, unintentional fentanyl exposure, or recent overdoses) and functional disability, manifested in both social and family domains, in a population of individuals with a history of substance use. Methods: Overdose experiences, functional disability, and sociodemographic factors were analyzed from selected survey instruments, including overdose Questionnaire, Sheehan Disability Survey, and Demographics Survey, administered as part of a battery of questionnaires in a prospective longitudinal multisite cohort study of individuals with severe mental health and substance-use disorders (ROAR CANADA). Impairment in social life and family responsibilities were examined in relation to various overdose experiences among individuals with substance-use disorder backgrounds. Results: Female sex was the strongest and most consistent correlate of disability, with higher adjusted odds of greater social (OR=2.61: CI: 1.75, 3.89) and family disability (OR=2.47; CI: 1.65, 3.67). Unintentional fentanyl consumption was associated with greater social disability (OR=1.63; CI: 1.07, 2.48) and remained a stable predictor of markedly impaired social and family functioning across Elastic Net resampling analyses. Conclusion: Among treatment-seeking individuals with severe concurrent mental health and substance-use disorders, greater functional disability was most consistently associated with female sex, while unintentional fentanyl exposure was associated with greater social disability. These cross-sectional findings identify clinically relevant correlates of impaired social and family functioning and support longitudinal research to clarify temporal relationships and evaluate targeted functional assessment and rehabilitation approaches.