Examining Factors Associated with Non-Fatal Overdose among People Who Inject Drugs in Rural Appalachia

Otachi, Janet K.; Vundi, Nikita; Surratt, Hilary L.

doi:10.1080/10826084.2020.1781179

Cited by 9 publications

(6 citation statements)

References 66 publications

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“…The estimates of NFOD prevalence observed in our study are significantly higher than recently published estimates of the history of lifetime NFOD in PWUD, which range from 15 to 58% [ 8 , 31 – 34 ]. The rise of fentanyl in the illicit drug supply across the USA has resulted in a high prevalence of NFOD and a sharp rise in fatal OD [ 35 – 37 ].…”

Section: Discussioncontrasting

confidence: 93%

“…Findings from our multivariable regression models also strongly support the association between specific substance use (e.g., heroin use, fentanyl) and use patterns (i.e., injection drug use) with NFOD. These findings are consistent with prior research linking overdose risk to heroin and injection drug use [ 34 , 39 ]. Criminalization of illicit substances can create an environment where people who use drugs opt toward high-risk behavior such as sharing and reusing needles.…”

Section: Discussionsupporting

confidence: 91%

“…Access to medication for opioid use disorders (MOUD) and harm reduction services-two evidence-based overdose prevention measures [43][44][45], have been shown to reduce fatal overdoses in many regions of the USA [9,43,46]. In examining access to harm reduction services among PWUD in MA, we found that a high proportion of participants reported carrying naloxone (62.7%) compared to estimates (17%-48%) from studies in other locations [34,37,47]. This higher prevalence of naloxone access among participants in our sample is likely due to the fact that MA has been at the forefront of public health responses to the opioid overdose epidemic [46,48,49].…”

Section: Discussionmentioning

confidence: 90%

“…It is generally understood that the use of nonprescription buprenorphine is an attempt to self-treat withdrawal symptoms associated with opioid dependence, which is facilitated by buprenorphine's low risk of adverse events, a safety profile as a partial agonist, and greater availability [54][55][56][57]. Prior studies have reported a lower risk of NFOD with non-prescribed buprenorphine use [34,56], though neither were conducted in places where or during periods when fentanyl was the dominant opioid being consumed. As we are unable to establish temporality due to the cross-sectional nature of the study design, it is difficult to disentangle whether the withdrawal symptoms may have played in mediating NFOD risk.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

et al. 2021

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Background People who experience non-fatal overdose (NFOD) are at high risk of subsequent overdose. With unprecedented increases in fentanyl in the US drug supply, many Massachusetts (MA) communities have seen a surge in opioid-related overdoses. The objective of this study was to determine factors associated with lifetime and past year NFOD in at-risk MA communities. Methods We conducted multiple rapid assessments among people who use drugs (PWUD) in eight MA communities using non-probability sampling (purposive, chain referral, respondent-driven) methods. We collected sociodemographic, substance use, overdose history, substance use treatment, and harm reduction services utilization data. We examined the prevalence of NFOD (lifetime and past year) and identified factors associated with NFOD through multivariable logistic regression analyses in a subset of 469 study participants between 2017 and 2019. Results The prevalence of lifetime and last year non-fatal opioid overdose was 62.5% and 36.9%, respectively. Many of the study participants reported heroin (64%) and fentanyl (45%) use during the 30 days preceding the survey. Nonprescription buprenorphine and fentanyl use were independently associated with higher odds of lifetime NFOD, while marijuana use was associated with lower odds of lifetime NFOD (p < 0.05). Injection as the route of administration, benzodiazepine, nonprescription buprenorphine, heroin, and fentanyl use were independently associated with higher odds, while methadone use was associated with lower odds of past year NFOD (p < 0.05). Conclusion We documented a high prevalence of past year and lifetime NFOD among PWUD in MA. Our findings provide indicators that can help inform interventions to prevent overdoses among PWUD, including overdose prevention, medication treatment, and naloxone distribution.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Prevalence and correlates of non-fatal overdose among people who use drugs: findings from rapid assessments in Massachusetts, 2017–2019

et al. 2021

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“…Notwithstanding these limitations, we identified factors that can be used to create risk reduction interventions for both men and women as well as sex-specific interventions. Although those who injected alone had less risk behavior that could transmit infections, there is a high risk of overdose when IDU inject alone, especially given increases in fentanyl use 42 . Harm-reduction supplies and education is critical, including injection supplies, naloxone, drug-testing kits, and safe-injection education for those who inject alone 43,44 .…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Injection Drug Risk Behaviors Among Hospitalized Persons

et al. 2022

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ObjectivesAs opioid use increases, it remains important to assess factors that contribute to injection drug risk behaviors, as sharing needles and other drug use equipment contributes to the spread of human immunodeficiency virus and hepatitis C virus. Such risks may differ by sex and injecting with others. The current study examined factors that contribute to increased injection drug risk separately for men and women.MethodsPeople who inject drugs were recruited at an academic safety-net hospital that reported recent injection drug use. Two main injection outcomes were assessed: (1) human immunodeficiency virus drug risk behaviors as assessed by the Risk Assessment Battery and (2) the number of times participants injected drugs with a needle used by someone else. For each outcome, different models for women and men were conducted to detect differences by sex.ResultsBoth men and women were more likely to inject with a needle used by someone else if they used drugs within a sexual relationship (incidence rate ratio (IRR) = 14.61, P < 0.01; IRR = 7.17, P < 0.05). Being employed was associated with lower risk assessment battery scores among men, and lower mean rates of using a needle used by someone else among women (IRR = 0.22, P < 0.05). Women with post-traumatic stress disorder (PTSD) and men with higher depression scores had higher rates of injecting with a needle used by someone else.ConclusionsPeople who inject drugs who are in intimate relationships report higher injection drug risk behaviors. We found benefits to employment among both men and women. Identifying factors associated with increased injection risk behaviors can be useful for creating interventions tailored by sex.

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