Abstract
This 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. This 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. We 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. Findings 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.
Highlights
This 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
We 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
Summary
In the United States, drug overdose rates among women have increased exponentially over the past two decades.[1][2][3] Overdose rates among women between 30–65 in the United States increased by 260% from 1999–2017 with rates growing the most due to overdose from opioids. [3] Between 1999–2015, opioid overdose deaths increased by 471% among women compared to 218% among men.[4][5] The greatest increase occurred in deaths involving synthetic opioids, which increased by 850% among women during the same period.[4][5] Racial and ethnic disparities exist in the rates of overdose, in that black women are disproportionately impacted by overdose from opioids fentanyl.[6]. The risk environment framework provides a multi-level conceptualization of mechanisms that explain the association between overdose and experiencing IPV, a history of child adversity and adverse life experiences.[7][8][9][10] The risk environment perspective presumes that intrapersonal factors including intimate partner violence, gender norms and relationship power inequities interacts with individual characteristics to shape the occurrence of drug use, and risk of drug-related harms of overdose.[8] A risk environment that includes being forced to have sex against one’s will or without a condom as well as being kicked, slammed against a wall, beaten, punched, and choked is associated with increased substance use dependence, greater frequency/quantity of use among women and may lead to increased risk of overdose.[11][12][13][14][15][16]. This 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
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