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Background and Aims: Opioid overdose deaths among adolescents and young adults have risen sharply in the United States over recent decades. This study aimed to explore the nature of adolescent and young adult perspectives on overdose experiences. Design This study involved thematic analysis of interviews undertaken as part of a mixed‐methods, randomized trial of extended release naltrexone (XR‐NTX) versus treatment‐as‐usual (TAU) for adolescents and young adults (aged 15–21 years) with opioid use disorder (OUD). Setting: Participants were recruited during a residential treatment episode at Mountain Manor Treatment Center, in Baltimore, MD, USA. Participants/cases: As part of the qualitative component of this study, 35 adolescents/young adults completed up to three interviews: at baseline, 3 and 6 months after release from residential opioid use disorder treatment. Measurements Semi‐structured interviews solicited participant experiences with opioid use disorder treatment; their satisfaction with the medications used to treat opioid use disorder; counseling received; current substance use; issues related to treatment retention; their treatment goals; and their future outlook. Findings Four broad themes emerged: (1) adolescents/young adults had difficulty identifying overdoses due to interpreting subjective symptoms and a lack of memory of the event, (2) this sample had difficulty perceiving risk that is misaligned with traditional understandings of overdose intentionality, (3) adolescents/young adults did not interpret personal overdose events as a catalyst for behavior change and (4) this sample experienced a greater impact to behavior change through witnessing an overdose of someone in their social network. Conclusions: The sample of US adolescents and young adults in treatment for opioid use disorder expressed difficulty identifying whether or not they had experienced an overdose, expressed fluctuating intentionality for those events and did not have clear intentions to change their behavior. Witnessing an overdose appeared to be as salient an experience as going through an overdose oneself. [ABSTRACT FROM AUTHOR]

While the use of visual methods in qualitative research is gaining recognition, there has been less attention to timelines. This paper addresses this gap and contributes to the overall literature on qualitative research design and analysis. In a randomized trial of extended release naltrexone for youth with opioid use disorder timelines were used as a part of the semi-structured interview process. Timelines were constructed in a participatory manner in which both youth and their caregivers were separately asked to recount significant events related to substance use, treatment, and criminal justice involvement that took place between interview time points. This paper suggests that using timelines in qualitative, substance use research offers two main advantages: 1) improving the data collection process, and 2) advancing understandings of temporally contextualized narratives through a visual format. Here, timelines were an integral tool for summarizing and illustrating the complexity of youths' experiences following residential drug treatment. [ABSTRACT FROM AUTHOR]