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Opioid overdose is a growing global health crisis that claims more than 120,000 lives annually, of which more than half use opioids alone, without access to bystander intervention. Fatal overdose events are marked by motionlessness, respiratory depression, and hypoxemia, yet current wearable systems often rely on a single biomarker, limiting detection speed and accuracy. We present HypoxSpike, a novel ternary spiking neural network designed for real-time, multi-biomarker overdose detection for low-power neuromorphic hardware, optimized for integration into shoulder-based wearables. HypoxSpike combines motion, respiration, and oxygen saturation signals, while accounting for skin tone and body physiology, thus addressing known racial bias in pulse oximetry. Our research leverages an open-source shoulder-worn dataset from 19 patients experiencing sleep apnea, exploiting the shared physiological mechanisms underlying apnea and opioid overdose. This allows a direct comparison of our model with existing overdose detection approaches. HypoxSpike classifies three stages of hypoxemia with an average accuracy of 94%, outperforming state-of-the-art shoulder-based hypoxemia estimation while reducing false positive alert rates by 23.5%. By minimizing false positives, HypoxSpike supports accurate and power-efficient overdose detection, improving trust and usability for high-risk populations often overlooked by conventional systems.
