Background Opiate overdoses constitute one of the leading causes of avoidable deaths among people aged 20–40 years old in EU countries. This study aimed to estimate factors associated with ever in life having overdose among injection drug users in Ukraine.

Methods Secondary data analysis was performed with the 2007 dataset of peer-driven intervention among IDUs, who were not involved in harm reduction programmes earlier; recruiting was performed with respondent driven sampling methodology. Subsample of 6902 opiate users was considered. To reveal relationships between OD ever in life, and characteristics of IDUs, binary logistic regression analysis was performed. The study was approved by Ethical Review Board of Ukrainian Sociological Association and Institute of epidemiology and infectious diseases named after L. V. Gromashevskyi.

Results Men-IDUs more likely (35%) suffered overdose (OR = 1.4(1.2–1.7)) than women (23%). Ever use of heroine (OR = 1.7(1.3–2.09)), home-prepared stimulants (OR = 1.4(1.2–1.8)), tramal/tramadol (OR = 1.2(1.0–1.5)), tranquillizers (OR = 1.45(1.1–1.7)), and alcohol (OR = 1.6 (1.3 2.0)) were associated with OD. Those with less than secondary education had higher risk of overdose (OR = 1.3(1.0–1.6)) than all other more educated IDUs. Those divorced, separated, and widowed had higher risk of overdose (OR = 1.4(1.1–1.9)). The probability of having experienced overdose steadily increased with the duration of drug use and reached maximum at the level on 51% among those who have been using drugs for about 20–22 years. In IDUs with longer duration, the probability of overdose was lower.

Conclusions Poly-drug users are at increased risk of having opiate overdose. Those who have not acquired secondary education are at increased risk of overdose as well. Increased risk of overdose in men is partly explained by their more likely use of opiate drugs.