Development of an Opioid-Related Overdose Risk Behavior Scale (ORBS)

Abstract

Background Drug overdose has emerged as the leading cause of injury-related death in the U.S., driven by prescription opioid (PO) misuse, polysubstance use and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations there is a need for a more comprehensive assessment of related risk behaviors. We developed the opioid-related Overdose Risk Behavior Scale (ORBS), drawing on existing research, formative interviews, and discussions with community and scientific advisors. Methods We enrolled military veterans reporting any use of heroin or POs in the past month using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. We assessed internal reliability using Cronbach’s alpha; test-retest reliability using intraclass correlation coefficients (ICCs); and criterion validity using Pearson’s correlations with indicators of having overdosed during the past 30 days. Results Data for 220 veterans were analyzed. The 5 subscales---A. Adherence to Opioid Dosage and Therapeutic Purposes, B. Alternative Methods of Opioid Administration, C. Solitary Opioid Use; D. Use of Non-prescribed Overdose-associated Drugs and E. Concurrent Use of POs, Other Psychoactive Drugs and Alcohol---generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. Conclusions These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research, and could help improve the precision of overdose education and prevention efforts.

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

“…The nation remains in a public health crisis involving opioid-related morbidity and mortality (Seth et al, 2018). With their historically high rates of opioid analgesic use to treat chronic pain, U.S. military veterans represent a population at elevated risk for fatal and non-fatal overdose (OD) (Bennett et al, 2017a;Bennett et al, 2017b;Pouget et al, 2017;Wilder et al, 2016). Despite recent reductions in opioid prescribing for acute and chronic pain (Lin et al, 2017), veterans die from opioid-related OD at roughly twice the rate of the general population, (Bohnert et al, 2011;Bohnert et al, 2012) even in the midst of an opioid crisis impacting a broad cross-section of the U.S. population (Rudd et al, 2016).…”

Psychiatric symptoms and recent overdose among people who use heroin or other opioids: Results from a secondary analysis of an intervention study

“…OD risk screening tools targeted specifically to patients with pain who have been prescribed opioids have proliferated in recent years (e.g., Butler, Fernandez, Benoit, Budman, & Jamison, 2008; Larance et al, 2016; Pouget et al, 2017). In light of our analyses, we believe that screening tools need to be more broadly targeted to a variety of opioid users in treatment as well as opioid and heroin users who come into contact with harm reduction settings (venues such as safe injection sites) and personnel (e.g., emergency responders carrying naloxone).…”

Recent Overdose Experiences in a Community Sample of Military Veterans Who Use Opioids

“…Research is needed to determine whether the increased proportion of participants experiencing one or more overdose events as captured by the new scale is informative for developing overdose prevention and response interventions or helping treatment providers communicate overdose risks with their patients. We are currently utilizing RODES as a measure of the range and frequency of nonfatal overdose events to test biopsychosocial hypotheses regarding causes of overdose risk behaviors and overdose events among veterans over time (Bennett, Elliott, & Golub, 2015; Pouget et al, 2017). …”

“…Survey participants were compensated a total of US$60 for completing the survey (1.5-2 hr) that covered a broad array of topics, including sociodemographic information. Guided by our biopsychosocial life events theoretical model, we also included items and scales regarding potential biological determinants of overdose risk (e.g., pain level, traumatic brain injury history), psychological determinants (e.g., depression self-rating, current mental health treatment), social determinants (e.g., social isolation and support), and important life events (e.g., losing or starting a job, beginning or ending a romantic relationship) (Bennett, Elliott, & Golub, 2015; Pouget et al, 2017). A total of 19 of the in-depth interview participants enrolled in the survey component of the research.…”