Correlates of overdose risk perception among illicit opioid users

Abstract

Background Opioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk. Methods We conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose. Results Age (aOR=0.96, 95%CI=0.93-1.00) and number of injection days per month (0.91, 0.86-0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception. Conclusions Opioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies.

High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City

“…There is a need for treatment efforts to carefully screen for and address dual dependence and concomitant use of benzodiazepines and opioids (Ghitza, Epstein & Preston, 2008; Toblin et al, 2010; White & Irvine, 1999; Wolf, Lavezzi, Sullivan, & Flannagan, 2005). Benzodiazepines, when used alone, rarely lead to death, and it is perhaps this lack of overdose-associated mortality that allows users to view concurrent use of benzodiazepines with other drugs as safe (Mcgregor et al, 1998; Neira-León et al, 2006; Rowe, Santos, Behar & Coffin, 2016). However, when used with other depressant drugs and/or alcohol, benzodiazepines can increase respiratory depression, thereby potentially increasing both the likelihood and lethality of overdose episodes (White et al, 1999).…”

Hypothesizing That Neuropharmacological and Neuroimaging Studies of Glutaminergic-Dopaminergic Optimization Complex (KB220Z) Are Associated With “Dopamine Homeostasis” in Reward Deficiency Syndrome (RDS)

“…The abuse of tobacco, alcohol, and illicit drugs in the United States causes greater than $700 billion per year in costs associated with crime, lost work throughput, and health care. With almost one trillion dollars in annual productivity costs as well as thousands of individuals dying every day in America (25,000 deaths in 2015), it behooves us to understand that all addictive behaviors result from a real brain disorder (Rowe et al, 2015). …”

Beliefs about the consequences of using benzodiazepines among persons with opioid use disorder

“…Persons with opioid use disorders tend to underestimate their risk of opioid-related overdose (Frank et al, 2015; Wilder et al, 2016), and those opioid users who also use BZDs further underestimate their risk for overdose (i.e., present optimistic bias) (Rowe, Santos, Behar, & Coffin, 2016). Perceptions of risk are a key driver of behavior and thus represent an important target for prevention strategies (for review see Clark, Wilder, & Winstanley, 2014).…”