Project Summary/Abstract Drug poisoning (aka “overdose”) is a complex construct, particularly for stimulants. While opioid overdose is generally caused by respiratory depression, stimulant overdose is multi-faceted. Non-fatal events are likely driven by cardiac and psychiatric complaints. However, fatal events are less well understood. Psychological autopsies have been shown to be immensely valuable in understanding opioid overdose deaths, identifying many of the key elements of overdose that still drive overdose prevention efforts today, and we propose to leverage that mechanism to accelerate our understanding of and response to stimulant overdose mortality. For example, cardiac disease has previously been identified as more common among stimulant overdose decedents than heroin overdose or suicide-by-hanging. However, the majority of stimulant overdose deaths lack an additional medical explanation. With psychological autopsies, we can leverage not just medical examiner data, but also medical records and informant interviews to identify cardiac disease and complaints antecedent to death. This approach, responsive to Objective 2 of the RFA, also allows for a detailed understanding of the intent of overdose (i.e. suicidality), as well as an opportunity to determine the intentionality of fentanyl use in stimulant/fentanyl overdose events. We will identify 100 stimulant overdose decedents (divided among cocaine, methamphetamine, and cocaine or methamphetamine with fentanyl), conduct informant interviews (including scales and qualitative data), and gather data from the post mortem investigation (e.g., vital records, toxicology, autopsy, case narrative, death scene photographs) and medical record abstraction. Subsequently, we will conduct qualitative interviews with 40-60 living people who use stimulants (half MA, half cocaine) to explore elements of resilience and risk reduction strategies.