In the US, drug overdose deaths surpassed 100,000 each year from 2021 to 2023 (Provisional Drug Overdose Death Counts [Internet], 2025). Opioid overdoses are frequently witnessed, and as such, are amenable to bystander intervention (Lankenau et al., 2013, McCann et al., 2021). Bystander actions during witnessed overdose may include checking for responsiveness in the overdosing person, calling an ambulance, doing rescue breathing or chest compressions, and/or administering naloxone. Studies have found that people who use drugs commonly report using such techniques to respond to witnessed overdoses (Lankenau et al., 2013, Wagner et al., 2014).

Prior studies have found that responding to overdoses is associated with both individual characteristics and social factors. For example, experiencing homelessness and having large social networks have been associated with witnessed overdose response (Bohnert et al., 2012, Wagner et al., 2022), however, response may also be affected by setting-specific factors like naloxone access (Lipira, Leichtling, & Cook, 2021). To our knowledge, no studies have investigated the role of an overdose prevention motivational interviewing intervention on bystander actions taken during witnessed overdose.

The REpeated-dose Behavioral intervention to reduce Opioid Overdose Trial (REBOOT) administered a motivational interviewing intervention for overdose prevention to opioid overdose survivors using non-prescribed opioids in Boston and San Francisco (Repeated-dose Behavioral Intervention to Reduce Opioid Overdose (REBOOT), 2022, McMahan et al., 2022). While the intervention focused on preventing the occurrence of opioid overdose for the participant, a portion of the intervention addressed strategies for responding to witnessed overdose. We first described the occurrence and sociodemographic correlates of recent witnessed overdose and naloxone administration among participants preceding study enrollment. We then assessed whether the REBOOT intervention had an impact on if participants personally responded to witnessed overdose during study follow-up.