Opioid overdose in the age of fentanyl: Risk factor differences among subpopulations of overdose survivors

•Forty percent of respondents had knowingly used fentanyl and 38% deliberately sought overdose-implicated drugs.•Those with persistent overdoses pre- and post-fentanyl expansion accounted for 44% of all lifetime overdoses.•Individuals with persistent overdose histories were at overdose risk from fentanyl-seeking behaviors and PTSD .•Harm reduction strategies will need to accommodate evolving consumer drug preferences surrounding fentanyl .•Comprehensive interventions for those with persistent overdoses may reduce the overdose burden in affected communities.