Distinguishing clinical factors associated with unintentional overdose, suicidal ideation, and attempted suicide among opioid use disorder in-patients

Stover, Amanda N.; Rockett, Ian Richard Hildreth; Smith, Gordon S.; LeMasters, Traci; Scott, Virginia; Kelly, Kevin C.; Winstanley, Erin L.

doi:10.1016/j.jpsychires.2022.06.039

Cited by 8 publications

(8 citation statements)

References 55 publications

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“…Results from this study confirm that lifetime heroin use is associated with an increased likelihood of an overdose event. Brandt and colleagues [ 58 ] and Stover and colleagues [ 19 ] have demonstrated increased risk of opioid overdose events in patients with a history of heroin use. Surprisingly, and in contrast with the literature, neither depression nor recent alcohol or benzodiazepine use were associated with overdose events in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Suicidal thoughts might increase the risk of non-fatal overdose and potentially elevate the risk for future intentional overdose or unintentional overdose. Because suicidal ideation and intent may underlie many overdose events [ 17 ], studies have shed light on the importance of further characterizing overdose events with the final goal of deploying specific prevention strategies to individuals with suicidal risk and intent [ 16 , 18 , 19 ]. While these are important contributions that have brought attention to suicidality as an overdose risk factor, these analyses have been limited to single-site or single system studies, have focused on small samples of OUD patients with self-reported intentionality and outcomes, and have been constrained by patient recall.…”

Section: Introductionmentioning

confidence: 99%

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Suicidality as a Predictor of Overdose among Patients with Substance Use Disorders

Horigian

Schmidt

Shmueli-Blumberg

et al. 2022

JCM

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Increasing rates of overdose and overdose deaths are a significant public health problem. Research has examined co-occurring mental health conditions, including suicidality, as a risk factor for intentional and unintentional overdose among individuals with substance use disorder (SUD). However, this research has been limited to single site studies of self-reported outcomes. The current research evaluated suicidality as a predictor of overdose events in 2541 participants who use substances enrolled across eight multi-site clinical trials completed within the National Drug Abuse Treatment Clinical Trials Network between 2012 to 2021. The trials assessed baseline suicidality with the Concise Health Risk Tracking Self-Report (CHRT-SR). Overdose events were determined by reports of adverse events, cause of death, or hospitalization due to substance overdose, and verified through a rigorous adjudication process. Multivariate logistic regression was performed to assess continuous CHRT-SR score as a predictor of overdose, controlling for covariates. CHRT-SR score was associated with overdose events (p = 0.03) during the trial; the likelihood of overdose increased as continuous CHRT score increased (OR 1.02). Participants with lifetime heroin use were more likely to overdose (OR 3.08). Response to the marked rise in overdose deaths should integrate suicide risk reduction as part of prevention strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Suicidality as a Predictor of Overdose among Patients with Substance Use Disorders

Horigian

Schmidt

Shmueli-Blumberg

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Some portion of the overdoses in our sample may have been attempts at suicide, and ACEs have been found to be strongly associated with suicidal behaviors ( 38 ). For example, ACEs were found to be positively associated with lifetime attempted suicide reported during adulthood after adjusting for age, race/ethnicity, gender, marriage, and educational attainment ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…The outcome variable of interest was self-report of having a history of one or more overdoses. Because multiple drugs are often detected in patients who overdose ( 15 , 38 , 44 – 46 ), we did not disaggregate by substance involved in overdose. Self-report for drug use experience has been found to be generally reliable ( 47 , 48 ).…”

Section: Methodsmentioning

confidence: 99%

“…Bórquez-Infante and colleagues identified ACEs as a risk factor for psychotic episodes among patients with SUD ( 37 ). However, we found only one study that looked at the relationship between ACEs and overdose in a population with SUD ( 38 ). Specifically, Stover and colleagues found higher mean ACE scores among two subgroups who reported suicide ideation and/or suicide attempts in addition to intentional or unintentional overdose compared to those who reported only unintentional overdose ( 38 ).…”

Section: Introductionmentioning

confidence: 99%

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Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders

et al. 2022

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IntroductionAlmost no previous studies explored the relationship between adverse childhood experiences (ACEs) and overdose risk for individuals with substance use disorders (SUDs), and these did not focus on a Latinx population. This study examined the relationship between ACEs, reporting PTSD symptoms, and lifetime experience of overdose in a sample (n = 149) of primarily Latinx adults seeking treatment for substance use disorder (SUD).Materials and methodsAdministrative data from an integrated behavioral health and primary care treatment system in Massachusetts were analyzed through bivariate analyses and multiple logistic regression. The final model examined the association between self-reported ACEs, PTSD screen, and lifetime drug overdose. We controlled for demographic characteristics and heroin use and explored alternative measure specifications.ResultsACEs scores were high with 58% having experienced 4+ ACEs. Female gender was associated with a 24% higher ACE score than male gender (p < 0.01). In the multiple logistic model each additional ACE was associated with 1.3 times greater odds of overdose (p < 0.01). Those reporting heroin use had 8.8 times greater odds of reporting overdose compared to those reporting no heroin use (p < 0.001). Gender, age, Puerto Rican ethnicity, years of cocaine use, receiving public assistance income, and a positive initial PTSD screen were not significant. Findings were robust in sensitivity testing.Discussion and conclusionWe found the number of ACEs and reported heroin use significantly and positively associated with self-report of overdose in both bivariate and multiple logistic regression analyses. In contrast, a positive initial screen for PTSD was only significantly associated with overdose in the bivariate analysis. Increased screening for ACEs is warranted and ACE-specific treatment is suggested for SUD treatment programs offering trauma-informed services for adults.

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The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis

Stocchero,

Rothmann,

Portolan

et al. 2024

Child Abuse & Neglect

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Distinguishing clinical factors associated with unintentional overdose, suicidal ideation, and attempted suicide among opioid use disorder in-patients

Cited by 8 publications

References 55 publications

Suicidality as a Predictor of Overdose among Patients with Substance Use Disorders

Suicidality as a Predictor of Overdose among Patients with Substance Use Disorders

Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders

The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis

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