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The only SUD diagnosis significantly associated with greater risk of repeat overdose was opioid use disorder (OUD) (aHR 1.51; 95 % CI 1.13-2.01). Before the index overdose, 4.16 % of patients received outpatient substance use services and 1.32 % received buprenorphine. The index overdose was associated with a 5.94 % (standard error 0.77 %) absolute increase in outpatient substance use services and a 1.29 % (standard error 0.15 %) increase in buprenorphine. CONCLUSION Patients with a NFOO and OUD are vulnerable to another overdose. Low