Drug overdose among women in intimate relationships: The role of partner violence, adversity and relationship dependencies

Abstract

BackgroundThis study examines the relationship between experiencing intimate partner violence (IPV), exposure to prior childhood adversity, lifetime adverse experiences, drug-related relationship dependencies with intimate partners and overdose, hospitalization for drug use, friends and family members who overdosed and witnessing overdose.MethodologyThis paper included a sample of 201 women who use drugs in heterosexual relationships with criminal justice-involved men in New York City. We included measures of experiencing overdose, hospitalization for drug use, witnessing overdose, and having friends and family who overdosed. Intimate partner violence consisted of either 1) none/verbal only, 2) moderate and 3) severe abuse. Dichotomous indicators of drug-related relationship dependencies included financial support, drug procurement, splitting and pooling drugs. A scale measured cumulative exposure to childhood adversity and lifetime exposures to adverse events. This paper hypothesized that experiencing moderate and severe IPV, drug-related dependencies and exposure to prior childhood and lifetime adversity would be associated with a greater risk of experiencing overdose, hospitalization for drug use, witnessing overdose and having friends and family members who overdosed. Generalized linear modeling with robust variance estimated relative risk ratios that accounted for potential bias in confidence intervals and adjusted for race, ethnicity, education and marital status.ResultsWe found experiencing moderate or severe IPV was associated with ever being hospitalized for drug use and having a family member who experienced overdose. Experiencing moderate IPV was associated with increased risk of witnessing overdose, Partner drug dependencies were associated with overdose, ever being hospitalized for drug use, witnessing overdose, and having a family member or friend who experienced overdose. Childhood and lifetime adversity exposures were significantly associated with increased risk of overdose, ever being hospitalized for drug use, ever witnessing overdose and having a friend and family member who overdosed.ConclusionFindings underscore the intersection of experiencing IPV and drug-related relationship dependencies, childhood adversity and lifetime adversity in shaping experiences of and witnessing overdose among women who use drugs. They highlight the urgent need to address IPV, adversity experiences and drug-related relationship dependencies in overdose prevention for women who use drugs.

Association Between Multiple Experiences of Violence and Drug Overdose Among Black Women in Community Supervision Programs in New York City

“…This study found extremely high rates of severe physical and/or sexual IPV by both male and female partners that were significantly associated with experiencing an overdose and drug use hospitalizations. Although prior studies have found significant associations between IPV by a male partner or by any intimate partner and drug overdose (Ataiants et al, 2020;El-Bassel et al, 2019), to our knowledge this is the first study to find a significant association between IPV by a female partner and drug overdose indicators. The high rate of IPV by same sex partners indicates the need for a better understanding of how IPV may evolve and increase risks for overdose in same sex partnerships versus heterosexual partnerships.…”

“…Despite abundant research linking different experiences of violence to injection heroin use, the use of prescription opioids, benzodiazepines, and cocaine and other drugs responsible for overdose among women in general (Cafferky et al, 2018;El-Bassel et al, 2019;Gilbert et al, 2012Gilbert et al, , 2015Stone & Rothman, 2019) and Black women in particular (Nowotny & Graves, 2013), only a handful of studies have examined the relationship between experiencing different types of violence and drug overdose. The findings from these studies are mixed.…”

Interpersonal Trauma Among Women and Men Receiving Buprenorphine in Outpatient Treatment for Opioid Use Disorder

“…For example, prevalence of intimate partner violence among people with OUD has been reported to be ∼50% (El-Bassel et al, 2005a). IPT and substance use commonly co-occur (Schneider et al, 2009;Williams et al, 2020) and may increase overdose risk (Ataiants et al, 2020;El-Bassel et al, 2019) as well as bring substantial physical and mental health risks (Bacchus et al, 2018;Phares et al, 2019), including homicide (VDH, 2018). Many people with OUD report lifetime IPT (Konkolÿ Thege et al, 2017), and importantly, IPT remains highly prevalent even after engaging with OUD treatment, in part due to inequities in social context (e.g., higher rates of poverty, unemployment, and homelessness) (de Dios et al, 2014;Velez et al, 2006).…”

Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence

“…62,63 Although the causal relationship between IPV and drug overdose among women in general has not been fully established, one study of abused women found an increased risk of overdose among those who had witnessed overdose, had lifetime drug use-related hospitalization, and had a relative or friend who experienced overdose. 64 The postpartum period may be a time of additional risk for pregnancy-associated overdose. Fatal and nonfatal overdose events decrease during the third trimester of pregnancy, with increased risk occurring at 7 to 12 months postpartum.…”

“… 62 , 63 Although the causal relationship between IPV and drug overdose among women in general has not been fully established, one study of abused women found an increased risk of overdose among those who had witnessed overdose, had lifetime drug use-related hospitalization, and had a relative or friend who experienced overdose. 64 …”