Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk?

Tomko, Catherine; Schneider, Kristin E.; Rouhani, Saba; Urquhart, Glenna J.; Park, Ju Nyeong; Morris, Miles; Sherman, Susan G.

doi:10.1016/j.addbeh.2021.107215

Cited by 16 publications

(15 citation statements)

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“…We leveraged data from Peer Harm Reduction of Maryland Outreach Tiered Evaluation (PROMOTE), a multi-method study of people who use opioids in Anne Arundel County and Baltimore City, Maryland [ 25 – 28 ]. Baltimore City is a densely populated urban setting, with approximately 600,000 inhabitants [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

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Background Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men’s selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. Methods Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. Results Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97–0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81–7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05–3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02–3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. Conclusions Synergistic sources of social and structural marginalization—from sexuality to hunger, homelessness, and injection drug use—are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.

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Section: Methodsmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

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“…The PHOENIx intervention and RCT offers a novel, generalist approach instead of the current problem drug use oriented approach which characterises usual care. PHOENIx acknowledges patients’ priorities, and their multiple and competing relational, social care and health problems including maximum levels of frailty, anxiety and depression, which contribute to overdose risk [ 14 ]. People experiencing homelessness are known to have more difficulty using fragmented care systems, as compared with people without multiple health needs [ 62 , 71 , 75 ].…”

Section: Discussionmentioning

confidence: 99%

“…Eighty-five (66.4%) of participants had either self-reported and/or diagnosed depression, 56 (43.7%) had self-reported and/or diagnosed anxiety, 38(29.7%) had a history of suicide/self-harm and 25 (19.5%) had self-reported and/or diagnosed post-traumatic stress disorder. As psychological pain is a predictor of overdose risk [ 14 ], and levels of non-engagement with mental health services, we included the PHQ-4 questionnaire, which determines levels of psychological pain/distress in baseline assessments [ 58 ]. One hundred and twenty-seven (99.2%) participants completed the PHQ-4.…”

Section: Methodsmentioning

confidence: 99%

“…Experiencing a non-fatal overdose increases the odds of a subsequent fatal overdose [ 6 , 11 ] and is associated with multiple physical and mental health problems [ 9 , 10 ]. Multiple severe disadvantages including unmet mental health needs act synergistically to increase the risk of premature mortality from overdose and other causes [ 11 – 14 ]. Timely prevention and treatment of wide-ranging health problems in people with problem opiate use has been suggested as a way to prevent drug-related deaths [ 7 , 12 ], but gold-standard randomised controlled trial evidence of health and housing interventions improving health outcomes is lacking [ 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Management approaches focussed on addressing problem drug use may not address patients’ competing priorities. These include unmet mental and physical health needs or a need for stable housing, which are associated with worse outcomes [ 14 , 16 , 17 , 28 , 29 ]. This suggests merit in offering holistic patient-centred care for those at highest risk of overdose, by addressing competing physical health problems, trauma and associated adverse childhood experiences [ 11 , 30 – 32 ], housing and physical health problems.…”

Section: Introductionmentioning

confidence: 99%

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Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

et al. 2023

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Background Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019.

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Severity of Post-traumatic Stress and Non-medical, Concomitant Opioid and Benzodiazepine Use in a Sample of Women at High Risk of Overdose

Tomko,

Schneider,

Nestadt

et al. 2023

Int J Ment Health Addiction

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Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk?

Cited by 16 publications

References 61 publications

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

Severity of Post-traumatic Stress and Non-medical, Concomitant Opioid and Benzodiazepine Use in a Sample of Women at High Risk of Overdose

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