Illicit Opioid Users Research Articles

An economic evaluation of community pharmacy-dispensed naloxone in Canada.

To determine the cost-effectiveness of pharmacy-based intranasal (IN) and intramuscular (IM) naloxone distribution in Canada. We developed a state-transition model for pharmacy-based naloxone distribution, every 3 years, to illicit, prescription, opioid-agonist therapy and nonopioid use populations compared to no naloxone distribution. We used a monthly cycle length, lifetime horizon and a Canadian provincial Ministry of Health perspective. Transition probabilities, cost and utility data were retrieved from the literature. Costs (2020) and quality-adjusted life years (QALY) were discounted 1.5% annually. Microsimulation, 1-way and probabilistic sensitivity analyses were conducted. Distribution of naloxone to all Canadians compared to no distribution prevented 151 additional overdose deaths per 10,000 persons, with an incremental cost-effectiveness ratio (ICER) of $50,984 per QALY for IM naloxone and an ICER of $126,060 per QALY for IN naloxone. Distribution of any naloxone to only illicit opioid users was the most cost-effective. One-way sensitivity analysis showed that survival rates for illicit opioid users were most influenced by the availability of either emergency medical services or naloxone. Distribution of IM and IN naloxone to all Canadians every 3 years is likely cost-effective at a willingness-to-pay threshold of $140,000 Canadian dollars/QALY (~3 × gross domestic product from the World Health Organization). Distribution to people who use illicit opioids was most cost-effective and prevented the most deaths. This is important, as more overdose deaths could be prevented through nationwide public funding of IN naloxone kits through pharmacies, since individuals report a preference for IN naloxone and these formulations are easier to use, save lives and are cost-effective. Can Pharm J (Ott) 2024;157:xx-xx.

Fentanyl Exposure and Detection Strategies Utilized by Clinical Trial Participants Seeking Linkage to Opioid Use Disorder Treatment at a Syringe Service Program

IntroductionThe USA continues to face a fentanyl-driven overdose epidemic. Prior research has demonstrated users of illicit opioids are concerned about fentanyl exposure and overdose, but the strategies they report using to detect fentanyl’s presence lack empirical support. This study compares self-report and biologically detected fentanyl use and investigates overdose risk and risk reduction behaviors among a sample of high-risk people who use opioids.MethodsStructured enrollment interviews conducted as part of a larger clinical trial assessed self-reported fentanyl exposure as well as strategies used to determine believed fentanyl exposure and prevent overdose among 240 participants enrolled at a Chicago, IL syringe service program. Urinalysis measured actual fentanyl exposure.ResultsMost participants identified as African American (66.7%) and had considerable overdose experience (76.7% lifetime and 48% in the past year). Most also tested positive for fentanyl (93.75%) despite reporting no past year use of fentanyl or fentanyl-adulterated drugs (64.17%). The most utilized approaches reported for identifying fentanyl exposure were stronger effects of the drug (60.7%), sight or taste (46.9%), and being told by someone using the same drugs (34.2%). Few participants (14%) reported using fentanyl test strips. No significant associations were identified between self-report and urinalysis measures or urinalysis results and risk reduction strategies.ConclusionThis study adds to prior fentanyl exposure risk research. The disconnect between participants’ fentanyl detection methods and reported overdose experiences supports the need for more research to identify and understand factors driving access and use of overdose prevention resources and strategies.

POSB122 Healthcare Resource Use of People Who Use Illicit Opioids in England: A Retrospective Cohort Study Using Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

Health outcomes for opioid users are poor, with high mortality and morbidity for both drug-related diseases, and conditions not typically considered drug-related. However, very little research has investigated how this population engages with the healthcare system, particularly planned and primary care. This study investigates the healthcare resource use (HCRU) of illicit opioid users relative to a matched population of non-users.

Inferring Bivariate Association from Respondent-driven Sampling Data

Abstract Respondent-driven sampling (RDS) is an effective method of collecting data from many hard-to-reach populations. Valid statistical inference for these data relies on many strong assumptions. In standard samples, we assume observations from pairs of individuals are independent. In RDS, this assumption is violated by the sampling dependence between individuals. We propose a method to semi-parametrically estimate the null distributions of standard test statistics in the presence of sampling dependence, allowing for more valid statistical testing for dependence between pairs of variables within the sample. We apply our method to study characteristics of young adult illicit opioid users in New York City.

The impact of long-term opioid use on the risk and severity of COVID-19

Based on evidence of the immunosuppressive effects of chronic opioids, long-term users of prescription and illicit opioids comprise an unrecognized but growing population of Americans with compromised immune function and respiratory depression who may be at high risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)-related hospitalization, prolonged ICU stay, adverse events, and death. This perspective is of broad clinical and public health importance because the US has the highest population of long-term users of prescription opioids, a sequel of a decade-long practice of opioid overprescribing in the US. For long-term opioid users who are hospitalized for COVID-19, clinicians face clinical challenges arising from the suppressive effects of opioids on the respiratory and immune functions, as well as the potential for adverse drug-drug interaction when opioids have to be continued in long-term users. More research is needed to further understand the association of long-term opioid use and susceptibility to COVID-19 and other emerging infections.

Examining Metabolic Profiles in Opioid-‎Dependent Patients ‎

Background: Drug abuse is a social burden and a public health disorder. Previous evidence suggested numerous illicit substances (e.g., opioids, amphetamines, cocaine, & cannabis) affect immune system functions, oxidative stress mechanisms, inflammatory cytokines, and reactive oxygen species production.
 This study aimed to determine the extent of these metabolic parameters in opioid-dependent patients. We also compared these patients with a healthy control group.
 Methods: This study was conducted in Amirie Clinic, Kashan, Iran. Plasma and serum samples from 50 illicit opioid users (study group) and 50 non-opioid users (control group) were studied. Metabolic levels for MDA, NO, TAC, GSH, Insulin, HOMA-IR, and hs-CRP were assessed in both research groups (N=100).
 Results: There was a significant difference in the status of MDA (P=0.003), NO (P=0.01), TAC (P=0.003), GSH (P=0.001), insulin (P=0.04), HOMA-IR (P=0.02), and hs-CRP (P=0.001) between the study and control groups. Furthermore, there was a significant correlation among the duration of illicit opioid use and MDA concentrations (r=-0.424, P=0.002), as well as TAC levels (r=0.314, P=0.02).
 Conclusion: The study results suggested metabolic profiles were impaired in the study group, compared to the controls.

Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids

BackgroundOpioid overdose prevention education and naloxone distribution (OEND) programs include information on general risk factors, overdose recognition, and naloxone utilization. This study evaluated a personally-tailored OEND (PTOEND) intervention designed to promote harm reduction and treatment readiness for illicit opioid users by also including education about personal overdose-risk factors and medication for opioid use disorder (MOUD). MethodA secondary analysis of a randomized controlled trial testing a Peer recovery support service (PRSS) intervention, relative to Control, in adult illicit opioid users reporting treatment for an overdose in the prior 6 months. PTOEND, a 30-minute computer-guided intervention, was administered by a research assistant at the randomization visit to all participants (N = 80). Participants completed a telephone visit 3 weeks post-randomization (n = 74) to assess changes in opioid overdose/MOUD knowledge and treatment readiness. Participants completed in-person visits at 3 (n = 66), 6 (n = 58), and 12 (n = 44) months post-randomization to assess illicit opioid use and naloxone utilization (all time points) and overdose-risk behaviors (12 months). We conducted pre-post analyses of the impact of PTOEND controlling for the PRSS effect. ResultsPTOEND increased knowledge of overdose (79.8% to 81.5%, p < 0.05) and MOUD (66.9% to 75.0%, p < 0.01) and decreased perceived treatment barriers (2.1 to 1.9, p < 0.01); desire to quit all substances increased (7.2 to 7.8, p = 0.05). Self-reported opioid use was significantly decreased at each follow-up (all p < 0.01). Self-reported overdose-risk behaviors decreased significantly (6.2 to 2.4, p < 0.01). A majority of participants (65 %) reported naloxone utilization. ConclusionsPTOEND may be effective for promoting harm reduction and treatment readiness.

Determination of thallium in urine, blood, and hair in illicit opioid users in Iran

Heavy metals, including thallium and lead, are introduced to illicit drug users' body as a result of using drugs such as cocaine and heroin. This study aimed to determine urine, blood, and hair thallium (Tl) concentrations in illicit opioid users along with the relevant clinical signs and symptoms consistent with thallotoxicosis and to compare them with the corresponding variables in the control non-opioid user group. This case-control study was conducted on 50 illicit opioid users who had abused opioids continuously for more than a year, referred to Amirie Drug Abuse Treatment Clinic in Kashan, Iran. The control group included 50 non-opioid users. Thallium concentrations in urine, blood, and hair were assessed in both groups (n = 100) using electrothermal (graphite furnace) atomic absorption spectrometry (ET AAS, GF AAS). In the studied group, the median (interquartile range) concentrations of thallium in urine, blood, and hair were 54.8 ± 79.9 μg/L, 14.5 ± 11.1 μg/L, and 5.4 ± 3.7 µg/g, respectively; these values were 4.8 ± 5.2 μg/L, 2.5 ± 2.4 μg/L, and 1.4 ± 1.1 µg/g, respectively, in the control group. There were significant differences in urine, blood, and hair thallium concentrations between the study group and the control group (p < 0.001). There were significant correlations between duration of illicit opioid use and urine thallium concentrations (r = 0.394, p = 0.005) and hair thallium concentrations (r = 0.293, p = 0.039), but not with blood thallium concentrations (r = 0.246, p = 0.085). Urine and blood thallium concentrations of illicit opioid users with clinical signs and symptoms consistent with thallotoxicosis of weakness (p = 0.01), depression (p = 0.03), and headache (p = 0.03) were higher than users without these problems. The results of the study showed that thallium concentrations in urine, blood, and hair in illicit opioid users were significantly higher than the comparable concentrations in the control group. This can be due to the use of illicit opioids adulterated with thallium. Also, this study showed long-term illicit opioid use may lead to thallium exposure. In addition, cigarette smoking was associated with increased thallium exposure.

Causes of Death in Users of Illicit Opioids

Considerable attention has been directed toward the epidemic of overdose deaths in patients who use opioids outside of a prescription. In a systematic

300. Drug Use Characteristics and Hepatitis C Antibody Prevalence in Southern Illinois

BackgroundHepatitis C virus (HCV) infection rates have increased among younger, rural persons nationally. We report on a preliminary sample of a study examining HCV acquisition risk factors among rural persons who inject drugs (PWID) or person who use opioids (PWUO) non-medically.MethodsWe used respondent-driven sampling (RDS) to recruit PWID/PWUO in southern, rural Illinois as part of a larger study on infectious disease rates among social networks of PWID and illicit opioid users. Participants were surveyed regarding drug and sexual risk behavior, healthcare access, stigma, and social networks, and underwent rapid screening for HCV (OraQuickÒ HCV Rapid Antibody Test) and other infections. Using R software, we generated descriptive statistics to characterize HCV prevalence.ResultsBetween July 2018 and April 2019,135 current PWID/PWUO were recruited, screened, and surveyed (58.5% male; 82.2% white; mean age 40.1 years). HCV rapid tests detected antibodies (HCV+) among 53 of 112 screened (47.3%). HCV+ participants were more likely to be white (96.2% vs. 83.1%, P = 0.006) than HCV antibody negative (HCV-) participants and showed a bimodal age distribution with peaks in the 25–30 and 45–50 age ranges. Reported injection drug use and heroin use in the past 30 days was significantly more common among HCV+ participants (96.2% vs. 72.9%, P = 0.001, and 12.9 vs. 7.9 days, P = 0.024) While HCV+ participants less frequently used methamphetamine compared with HCV -participants, the use of that drug was still high in both groups (11.9 vs. 18.4 days of use in the past 30 days, P = 0.01). HCV+ participants reported fewer social network members than HCV- participants (2.2 vs. 3.0, P = 0.048).ConclusionIn this analysis of a preliminary sample, HCV exposure was high; with those positive for HCV antibody showing a bimodal age distribution, high frequency of multiple drug use, and smaller social network size compared with HCV negative counterparts. Upon RDS-based enrollment completion and pending analysis we will further examine HIV RNA status as well as the specific associations between network size and other risk factors that may inform disease screening and treatment interventions.Disclosures All authors: No reported disclosures.

U.S. Opioid Epidemic: Impact on Public Health and Review of Prescription Drug Monitoring Programs (PDMPs).

In recent years, the devastating effects of U.S. opioid epidemic has been making news headlines. This report explores background information and trends on opioid misuse, overdose fatalities and its impact on public health. In addition, various efforts to improve surveillance, timeliness of data and Prescription Drug Monitoring Program (PDMP) integration and interoperability are reviewed. PubMed and internet searches were performed to find information on the U.S. opioid epidemic. In addition, searches were performed to retrieve information about PDMPs and state-specific mandates along with presentation slides and learnings from the 2018 National Rx Drug Abuse & Heroin Summit in Atlanta, GA. It is clear that the U.S. opioid epidemic has a tremendous impact on public health including the next generation of children. Various data, surveillance & technology-driven efforts including CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS) and use of telemedicine for opioid use disorder treatment aim to improve prevention, treatment and targeted interventions. In addition, PDMP integration and interoperability efforts are advancing to provide prescribers meaningful decision support tools. The opioid epidemic has a complex impact on public health intertwined with variable factors such as mental health and social determinants of health. Given the statistics and studies that suggest many of the illicit opioid users start with prescription opioids, continued advancement in the area of PDMP integration and interoperability is necessary. The PDMP integrated clinical decision support systems need to supply to healthcare providers access to complete, timely and evidence-based information that can meaningfully inform prescribing decisions and communication with patients that affect measurable outcomes. While Prescription Drug Monitoring Programs (PDMPs) are valuable tools for providers in making informed prescribing decisions, the variable state mandates and varying degrees of integration and interoperability across states may limit their potential as meaningful decision support tools. Sharing best practices, challenges and lessons learned among states and organizations may inform strategic and systematic use of PDMPs to improve public health outcomes.

An ethnographic decision model of the initiation of gabapentin misuse among prescription and/or illicit opioid (mis)user

AimsGabapentin is used in the treatment of seizures and neuralgia, and it is prescribed off-label to treat substance use disorders and withdrawal symptoms. Recent research documents misuse of gabapentin, especially among prescription opioid misusers. The present study contributes to this literature by examining the initiation of gabapentin misuse. MethodsQualitative interviews were conducted with prescription and/or illicit opioid (mis)users who reported a history of gabapentin misuse (N = 62) and who did not (N = 29). During semi-structured interviews, respondents provided descriptions of the first time they misused gabapentin. An ethnographic decision model was constructed to illustrate the factors that influence the initiation decision. ResultsMultiple individual, social, and environmental factors influence the decision to initiate gabapentin misuse. Respondents described the initiation decision related to: a) wanting to feel a psychoactive high during times of limited access to one’s preferred drug because of institutional barriers (e.g., substance abuse treatment; jail; transitional living facility; N = 18); b) the desire to use multiple drugs, including for experimentation or to potentiate another substance (N = 18); and c) the need to self-treat withdrawal symptoms during periods of opioid nonuse or when opioids were unavailable (N = 16). Respondents also initiated gabapentin misuse to self-treat physical pain (N = 10). ConclusionsMultiple approaches are needed to mitigate gabapentin misuse, including limiting availability in institutional settings and informal channels as well as addressing the needs of drug users who experience physical pain and withdrawal symptoms. Continued research is needed to examine therapeutic uses of gabapentin and behaviors related to misuse.

Self-reported prevalence and severity of opioid and kratom (Mitragyna speciosa korth.) side effects

Ethnopharmacological relevanceMitragyna speciosa (Korth.) is a traditional medicinal plant widely used in Southeast Asia for its opioid-like effects. Although kratom produces analgesia through binding of mitragynine and other alkaloids at the mu-opioid receptor (MOR), the association of long-term kratom use with adverse opioid-like effects remains unknown.Aim of the study: To determine the self-reported prevalence and severity of opioid-related adverse effects after kratom initiation in a cohort of illicit opioid users. Materials and methodsA total of 163 illicit opioid users with current kratom use history were recruited through convenience sampling from the northern states of Peninsular Malaysia. Face-to-face interviews were conducted using a semi-structured questionnaire. ResultsRespondents were all males, majority Malays (94%, n = 154/163), with a mean age of 37.10 years (SD = 10.9). Most were single (65%, n = 106/163), had 11 years of education (52%, n = 85/163) and employed (88%, n = 144/163). Half reported using kratom for over >6 years (50%, n = 81/163), and 41% consumed >3 glasses of kratom daily (n = 67/163). Results from Chi-square analysis showed kratom initiation was associated with decreased prevalence of respiratory depression, constipation, physical pain, insomnia, depression, loss of appetite, craving, decreased sexual performance, weight loss and fatigue. ConclusionsOur findings indicate that kratom initiation (approximately 214.29 mg of mitragynine) was associated with significant decreases in the prevalence and severity of opioid adverse effects.

Prevalence of recent fentanyl use among treated users of illicit opioids in England: based on piloted urine drug screens

Objective: To use a pilot of national fentanyl screening to establish the current prevalence of recent fentanyl use among treated users of illicit opioids in the English treatment system and inform the design of a full study.Design: Cross-sectional fentanyl metabolite urine screening in randomly-selected study sites, stratified to cover all nine geographical regions of England, supplemented with self-report subsequent to a positive fentanyl test.Patients: 468 adult (18 years of age and above) patients receiving treatment for opioid use disorder, screened December 2017 to May 2018.Results: The fentanyl-positive rate in patients receiving treatment for opioid use disorder in the English treatment system was 3% (15/468, 95% CI 1.8% to 5.2%) with a per-site range (for the 10 sites in 9 regions where fentanyl was detected) of between 2% (1/57) and 15% (4/27). Self-report data indicated that the majority of fentanyl-positives (12/15, 80%) was unaware of having purchased fentanyl.Conclusions: Despite alerts already in place, patients receiving treatment for opioid use disorder, who were fentanyl-positive, were unwittingly purchasing and consuming fentanyl.

Ageing opioid users’ increased risk of methadone-specific death in the UK

BackgroundThe first evidence that the hazard ratio (HR) for methadone-specific death rises more steeply with age-group than for all drug-related deaths (DRDs) came from Scotland’s cohort of 33,000 methadone-prescription clients. We aim to examine, for England, whether illicit opioid users’ risk of methadone-specific death increases with age; and to pool age-related HRs for methadone-specific deaths with those for Scotland’s methadone-prescription clients. MethodsThe setting is all services in England that provide publicly-funded, structured treatment for illicit opioid users, the methodology linkage of the English National Drug Treatment Monitoring System and mortality database, and key measurements are DRDs, methadone-specific DRDs, or heroin-specific DRDs, by age-group and gender, with proportional hazards adjustment for substances used, injecting status and periods in/out of treatment. ResultsLinkage was achieved for 129,979 adults receiving prescribing treatment modalities for opioid dependence during April 2005 to March 2009 and followed-up for 378,009 person-years (pys).There were 1,266 DRDs: 271 methadone-specific (7 per 10,000 pys: irrespective of gender) and 473 heroin-specific (15 per 10,000 pys for males, 7 for females). Methadone-specific DRD-rate per 10,000 person-years was 3.5 (95% CI: 2.7–4.4) at 18–34 years, 8.9 (CI: 7.3–10.5) at 35–44 years and 18 (CI: 13.8–21.2) at 45+ years; heroin-specific DRD-rate was unchanged with age.Relative to 25–34 years, pooled HRs for UK clients’ methadone-specific deaths were: 0.87 at <25 years (95% CI: 0.56–1.35); 2.14 at 35–44 years (95% CI: 1.76–2.60); 3.75 at 45+ years (95% CI: 2.99–4.70). ConclusionInternational testing and explanation are needed of UK’s sharp age-related increase in the risk of methadone-specific death. Clients should be alerted that their risk of methadone-specific death increases as they age.

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

BackgroundIllicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island. MethodsA mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants. ResultsStudy participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n=61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR)=4.07, 95% CI: 1.24–13.3, p=0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs. ConclusionAmong illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths.

The association of psychedelic use and opioid use disorders among illicit users in the United States.

Preliminary studies show psychedelic compounds administered with psychotherapy are potentially effective and durable substance misuse interventions. However, little is known about the association between psychedelic use and substance misuse in the general population. This study investigated the association between psychedelic use and past year opioid use disorders within illicit opioid users. While controlling for socio-demographic covariates and the use of other substances, the relationship between classic psychedelic use and past year opioid use disorders was analyzed within 44,000 illicit opioid users who completed the National Survey on Drug Use and Health from 2008 to 2013. Among respondents with a history of illicit opioid use, psychedelic drug use is associated with 27% reduced risk of past year opioid dependence (weighted risk ratio = 0.73 (0.60-0.89) p = 0.002) and 40% reduced risk of past year opioid abuse (weighted risk ratio = 0.60 (0.41-0.86) p = 0.006). Other than marijuana use, which was associated with 55% reduced risk of past year opioid abuse (weighted risk ratio = 0.45 (0.30-0.66) p < 0.001), no other illicit drug was associated with reduced risk of past year opioid dependence or abuse. Experience with psychedelic drugs is associated with decreased risk of opioid abuse and dependence. Conversely, other illicit drug use history is largely associated with increased risk of opioid abuse and dependence. These findings suggest that psychedelics are associated with positive psychological characteristics and are consistent with prior reports suggesting efficacy in treatment of substance use disorders.

Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain.

More than 100 million adults in the United States experience chronic pain, and prescription opioids are the third most widely prescribed class of medications. Current opioid overdose prevention efforts almost exclusively target illicit opioid users, and little is known about the experience of overdose among patients being treated for chronic pain (CP) with a prescription opioid. Patients experiencing CP for three or more months and receiving a prescription opioid for pain management (N = 502) completed a self-report survey that asked questions about opioid overdose history, past 30-day risk factors, and knowledge of opioid overdose, overdose risk, and naloxone. Approximately one in five CP participants reported experiencing a lifetime overdose. CP participants reported engaging in several behaviors associated with overdose risk and were unlikely to have been trained to administer naloxone. Fewer than 50% of participants answered any knowledge item correctly. The likelihood of having experienced an overdose increased as the scores on the SOAPP-R and DSM-5 opioid use disorder checklist increased, and a SOAPP-R score of 7 or higher or meeting DSM-5 mild opioid use disorder criteria were significantly associated with reporting a lifetime overdose (85% and 84% of participants who experienced an overdose, respectively). Opioid overdose occurs at a high rate among CP participants, and this group is relatively uninformed about risk factors for overdose. Established SOAPP-R and DSM thresholds provide an opportunity to identify participants at elevated risk for having experienced an opioid overdose. These data support development of additional concentrated efforts to prevent overdose among chronic pain patients.

Brief Opioid Overdose Knowledge (BOOK): A Questionnaire to Assess Overdose Knowledge in Individuals Who Use Illicit or Prescribed Opioids.

Background:Opioid overdose is a public health crisis. This study describes efforts to develop and validate the Brief Opioid Overdose Knowledge (BOOK) questionnaire to assess patient knowledge gaps related to opioid overdose risks.Methods:Two samples of illicit opioid users and a third sample of patients receiving an opioid for the treatment of chronic pain (total N = 848) completed self-report items pertaining to opioid overdose risks.Results:A 3-factor scale was established, representing Opioid Knowledge (4 items), Opioid Overdose Knowledge (4 items), and Opioid Overdose Response Knowledge (4 items). The scale had strong internal and face validity. Patients with chronic pain performed worse than illicit drug users in almost all items assessed, highlighting the need to increase knowledge of opioid overdose risk to this population.Conclusions:This study sought to develop a brief, internally valid method for quickly assessing deficits in opioid overdose risk areas within users of illicit and prescribed opioids, to provide an efficient metric for assessing and comparing educational interventions, facilitate conversations between physicians and patients about overdose risks, and help formally identify knowledge deficits in other patient populations.

Correlates of overdose risk perception among illicit opioid users

BackgroundOpioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk. MethodsWe conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose. ResultsAge (aOR=0.96, 95%CI=0.93–1.00) and number of injection days per month (0.91, 0.86–0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception. ConclusionsOpioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies.