ABSTRACT
BACKGROUND: Understanding opioid overdose risk perception may inform overdose prevention strategies. METHODS: We used baseline data from a randomized overdose prevention trial, in San Francisco, CA, and Boston, MA, among people who used nonprescribed opioids, survived an overdose in the past 3 years, and had received naloxone. Participants were asked how likely they were to overdose in the next 4 months. We combined "extremely likely" and "likely" (higher risk perception) and "neutral," "unlikely," and "extremely unlikely" (lower risk perception). We performed bivariate analyses and separate multivariable logistic regression models of risk perception across (1) sociodemographic, (2) substance use, and (3) overdose risk behavior measures. Covariates were selected a priori or significant in bivariate analyses. RESULTS: Among 268 participants, 88% reported at least 1 overdose risk behavior; however, only 21% reported higher risk perception. The adjusted odds ratio (AOR) of higher risk perception was 2.41 (95% confidence interval [CI]: 1.10-5.30) among those unhoused in the past 4 months, 2.06 (95% CI: 1.05-4.05) among those using opioids in a new place, and 5.61 (95% CI: 2.82-11.16) among those who had overdosed in the past 4 months. Living in Boston was associated with higher risk perception in all 3 models (AOR = 2.00-2.46, 95% CI: 1.04-4.88). CONCLUSIONS: Despite prevalent risk behaviors, a minority of participants perceived themselves to be at higher risk of overdose. Nonetheless, some known risk factors for overdose were appropriately associated with risk perception. Fentanyl has been prevalent in Boston for longer than San Francisco, which may explain the higher risk perception there.
ABSTRACT
BACKGROUND: Non-fatal overdoses are underreported and there is no accepted and feasible self-report research measure of non-fatal opioid overdose. Timeline follow-back (TLFB) calendar-based questionnaires assess self-reported risk behaviors. We assessed feasibility and acceptability of a new TLFB research measure for opioid use, non-fatal opioid overdose, and substance use disorder treatment among opioid overdose survivors. METHODS: For the Repeated-dose Behavioral Intervention to Reduce Opioid Overdose Trial (REBOOT) study among opioid overdose survivors, we developed a TLFB questionnaire to assess daily non-prescribed opioid use, opioid overdose, facility stays, medications/behavioral treatment for opioid use disorder, and COVID-19 history during the previous 120 days. Staff assessors administered TLFB at four-monthly visits over the 16-month study participation period. To measure feasibility, we estimated TLFB completion time using an electronic timestamp tool. To measure acceptability, we administered a satisfaction survey to 103 participants who completed REBOOT. RESULTS: Among 525 TLFB assessments conducted in 174 participants from January 2021-January 2023, opioid use was reported in 510 assessments, medication for opioid use disorder (MOUD) in 331 assessments, and ≥ 1 overdose in 107 assessments. Median TLFB completion time was 11 (IQR: 6-17) minutes for sections administered to all participants; detailed overdose questions administered to those reporting overdose took an additional 3 (IQR: 2-6) minutes. Report of ≥ 1 overdose and MOUD use were significantly associated with increased TLFB completion time. 88 % of participants reported that TLFB was very/somewhat acceptable. CONCLUSIONS: Among opioid overdose survivors, REBOOT TLFB was a feasible and acceptable research measure, with similar completion time as other TLFB assessments of substance use.
