Predictors of Opioid Overdose in High-Risk Users

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Heroin and prescription opioid use were reported by 86.5% of participants, and all patients had reported current or past opioid misuse within 6 months of enrollment.
Heroin and prescription opioid use were reported by 86.5% of participants, and all patients had reported current or past opioid misuse within 6 months of enrollment.

Having a hepatitis C virus (HCV) infection, witnessing a friend or others experiencing a drug overdose, and having a history of frequent buprenorphine treatment are factors that may predict the risk for opioid drug overdose in high-risk opioid users, according to a study published in Addictive Behaviors.

Participants were recruited from an ongoing study in which the efficacy of distributing naloxone kits for reducing opioid overdose was assessed (N=247). Heroin and prescription opioid use were reported by 86.5% of participants, and all patients had reported current or past opioid misuse within 6 months of enrollment. The researchers sought to identify medical, psychosocial, and opioid use characteristics that were predictive of opioid overdose.

Patient characteristics data were obtained from responses on the baseline 30-item Opioid Use Questionnaire, which assessed chronic medical conditions, past and current opioid misuse, sexually transmitted infections (STIs), buprenorphine treatment frequency, and intensive outpatient and rehabilitation treatment history. Participants and family members or friends attended a baseline appointment and naloxone training.

Individuals who were white comprised a significant majority of individuals reporting a past opioid overdose when compared with blacks (96.2% vs 3.8%, respectively; P =.005). More participants who had experienced an opioid overdose in the past 6 months reported using heroin vs prescription opioids only (95.2% vs 4.8%, respectively; P =.001). Participants with a friend who had died from an overdose were also more likely to experience an overdose themselves (89.6% vs 10.4%; P =.001).

In the adjusted analysis, the patient characteristic most associated with experiencing a nonfatal opioid overdose was witnessing a friend overdose (odds ratio [OR] 4.21; 95% CI, 1.99-8.89). Witnessing others overdose (OR 1.42; 95% CI, 1.11-1.82) and having a chronic HCV infection (OR 2.44; 95% CI, 1.20-4.97) were also associated with a higher risk of reporting a prior opioid overdose. Reporting a higher buprenorphine treatment frequency was associated with a greater odds of opioid overdose (OR 1.55; 95% CI, 1.17-2.07), and reporting a high frequency of methadone treatments was associated with a reduction in overdose odds (OR 0.67; 95% CI, 0.49-0.91).

The study was limited by its potential for recall and social desirability bias because of the self-reported nature of the collected participant data.

"Given the high rates of nonfatal opioid overdose, this suggests the need for expanded overdose training and distribution of naloxone," concluded the study authors.

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Reference

Schiavon S, Hodgin K, Sellers A, et al. Medical, psychosocial, and treatment predictors of opioid overdose among high risk opioid users [published online May 30, 2018]. Addict Behav. doi: 10.1016/j.addbeh.2018.05.029

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