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Some authors have stated that accidental overdoses may be a hidden expression of suicidal ideation. This study longitudinally examined the relationship between recent suicidal ideations and non\u2010fatal accidental drug overdoses among street youth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>Between <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>uly 2001 and <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ecember 2005, 858 street youth (14\u201323 years old) were recruited for a prospective cohort study. Youth were eligible if, in the previous year, they had been without a place to sleep more than once or had used the services of street youth agencies on a regular basis (<jats:italic>\u2265<\/jats:italic>3). Participants completed baseline questionnaires and follow\u2010up interviews were carried out every 6 months. Mixed\u2010effect logistic regression models were conducted. Apart from suicidal ideation and accidental drug overdose, variables considered in the model were age, sex, problematic alcohol use, homelessness, injection drug use and polydrug use (<jats:italic>\u2265<\/jats:italic>3 drugs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Accidental drug overdose was significantly associated with suicidal ideation (adjusted odds ratio 1.88; 95% confidence interval 1.23\u20132.54). Homelessness, injection drug use and polydrug use were also significant in the final model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Results show that, during follow up, suicidal ideation independently increased risks of accidental overdose. They also underscore the need for interventions beyond educational prevention. Primary care practitioners should investigate suicidal ideations and behaviours of street youth in treatment for accidental overdose. 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