Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference

Cleland, Charles M.; Bennett, Alex S.; Elliott, Luther; Rosenblum, Andrew; Britton, Peter C.; Wolfson‐Stofko, Brett

doi:10.1016/j.drugalcdep.2019.107734

Cited by 16 publications

(11 citation statements)

References 71 publications

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“…Our ndings that participants with mental health symptoms of depression, anxiety, and suicidality were considerably more likely to have experienced an overdose in the past 30 days is consistent with recent research that shows experiencing anxiety and depression can be a risk factor for overdose [48,49].…”

Section: Discussionsupporting

confidence: 91%

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Bennett

Scheidell

Bowles³

et al. 2021

Preprint

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Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n=575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥50 years (PR: 1.18 (CI: 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI: 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI: 1.00, 1.28); and with small social networks (<5 persons) (APR: 1.14 (CI: 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI: 1.49, 4.04), suicidality (PR: 1.72 (CI: 1.19, 2.49), depression (PR: 1.54 (CI: 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI: 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.

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Section: Discussionsupporting

confidence: 91%

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Bennett

Scheidell

Bowles³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Our findings that participants with mental health symptoms of depression, anxiety, and suicidality were considerably more likely to have experienced an overdose in the past 30 days is consistent with recent research that shows experiencing anxiety, suicidal ideation, and depression can be a risk factor for overdose [54,55]. Additional overdose prevention and naloxone distribution may prove fruitful alongside mental health screenings.…”

Section: Discussionsupporting

confidence: 90%

Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City

Bennett

Scheidell

Bowles³

et al. 2022

Harm Reduct J

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Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n = 575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥ 50 years (PR: 1.18 (CI 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI 1.00, 1.28); and with small social networks (< 5 persons) (APR: 1.14 (CI 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI 1.49, 4.04), suicidality (PR: 1.72 (CI 1.19, 2.49), depression (PR: 1.54 (CI 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.

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“…However, depression or depressive symptoms was previously linked with increased fall and opioid overdose risk 20,41 . Increased pain interference and pain intensity, along with depressive symptoms, were each shown to increase opioid overdose risk behavior 42 . Furthermore, pain interference was also predictive of injurious falls in a large prospective study of community dwelling older adults 43 .…”

Section: Discussionmentioning

confidence: 97%

A pilot study to identify pharmacogenomic and clinical risk factors associated with opioid related falls and adverse effects in older adults

Sheikh,

Fernandez,

Smotherman

et al. 2023

Clinical Translational Sci

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Given the high prevalence of pain in older adults and current trends in opioid prescribing, inclusion of genetic information in risk prediction tools may improve opioid risk assessment. Our objectives were to (1) determine the feasibility of recruiting socioeconomically disadvantaged and racially diverse middle aged and older adult populations for a study seeking to identify risk factors for opioid‐related falls and other serious adverse effects and (2) explore potential associations between the Risk Index for Overdose or Serious Opioid‐induced Respiratory Depression (CIP‐RIOSORD) risk class and other patient factors with falls and serious opioid adverse effects. This was an observational study of 44 participants discharged home from the emergency department with an opioid prescription for acute pain and followed for 30 days. We found pain interference may predict opioid‐related falls or serious adverse effects within older, opioid‐treated patients. If validated, pain interference may prove to be a beneficial marker for risk stratification of older adults initiated on opioids for acute pain.

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Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference

Cited by 16 publications

References 71 publications

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Naloxone protection, social support, network characteristics, and overdose experiences among a cohort of people who use illicit opioids in New York City

A pilot study to identify pharmacogenomic and clinical risk factors associated with opioid related falls and adverse effects in older adults

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