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Cleland CM, Bennett AS, Elliott L, Rosenblum A, Britton PC, Wolfson-Stofko B. Between- and within-person associations between opioid overdose risk and depression, suicidal ideation, pain severity, and pain interference. Drug Alcohol Depend 2020; 206:107734. [PMID: 31775106 PMCID: PMC6980716 DOI: 10.1016/j.drugalcdep.2019.107734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To better understand overdose (OD) risk and develop tailored overdose risk interventions, we surveyed 234 opioid-using veterans residing in New York City, 2014-2017. Our aim was to better understand how predictors of OD may be associated with physical and mental health challenges, including pain severity and interference, depression and suicidal ideation over time. METHODS Veterans completed monthly assessments of the Overdose Risk Behavior Scale (ORBS), pain severity and interference, suicidal ideation, and depression for up to two years and were assessed an average of 14 times over 611 days. To estimate between-person and within-person associations between time-varying covariates and opioid risk behavior, mixed-effects regression was used on the 145-person subsample of veterans completing the baseline and at least three follow-up assessments. RESULTS The level of each time-varying covariate at the average of study time (between-person effect) was positively related to ORBS for pain severity and interference, suicidal ideation, and depression. Deviations from individuals' personal trajectories (within-person effect) were positively related to ORBS for pain severity and interference, suicidal ideation, and depression. CONCLUSIONS US military veterans endure physical and mental health challenges elevating risk for opioid-related overdose. When pain severity, pain interference, suicidal ideation and depression were higher than usual, opioid risk behavior was higher. Conversely, when these health issues were less of a problem than usual, opioid risk behavior was lower. Assessing the physical and mental health of opioid-using veterans over time may support the development and implementation of interventions to reduce behaviors that increase the likelihood of overdose.
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Affiliation(s)
- Charles M. Cleland
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012,Department of Population Health, New York University School
of Medicine, 180 Madison Avenue, New York, NY, 10016
| | - Alex S. Bennett
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Luther Elliott
- College of Global Public Health, New York University, 665
Broadway, 11th Floor, New York, NY, 10012,Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
| | - Andrew Rosenblum
- National Development and Research Institutes/USA, New York,
NY, 10010
| | - Peter C. Britton
- VA Center of Excellence for Suicide Prevention, Canandaigua
VA Medical Center, 400 Fort Hill Avenue Canandaigua, NY, USA 14424,Department of Psychiatry, University of Rochester, USA
Rochester, NY
| | - Brett Wolfson-Stofko
- Center for Drug Use and HIV/HCV Research, College of Global
Public Health, New York University,665 Broadway, 11th Floor, New York,
NY, 10012
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Bennett AS, Watford JA, Elliott L, Wolfson-Stofko B, Guarino H. Military veterans' overdose risk behavior: Demographic and biopsychosocial influences. Addict Behav 2019; 99:106036. [PMID: 31494452 PMCID: PMC6791780 DOI: 10.1016/j.addbeh.2019.106036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City. METHODS Participants (n = 218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor. RESULTS Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference. CONCLUSION Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors-including mental health, pain and stressful life events-may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.
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Affiliation(s)
- Alex S Bennett
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America.
| | - J Alexander Watford
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Department of Applied Psychology, Steinhardt School of Culture, Education, and Human Development, New York University, 82 Washington Square E, New York, NY 10003, United States of America
| | - Luther Elliott
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
| | - Brett Wolfson-Stofko
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
| | - Honoria Guarino
- National Development & Research Institutes, 71 W. 23rd St, 4th Fl., New York, NY 10100, United States of America; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11th Fl., New York, NY 10012, United States of America
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Banerjee G, Edelman EJ, Barry DT, Becker WC, Cerdá M, Crystal S, Gaither JR, Gordon AJ, Gordon KS, Kerns RD, Martins SS, Fiellin DA, Marshall BDL. Reply to Ruan et al. (2017): Non-medical use of prescription opioids is associated with heroin initiation among US veterans. Addiction 2017; 112:728-729. [PMID: 28120531 DOI: 10.1111/add.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Geetanjoli Banerjee
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Declan T Barry
- Yale University, New Haven, CT, USA
- APT Foundation Pain Treatment Services, New Haven, CT, USA
| | - William C Becker
- Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA, Connecticut Healthcare System, West Haven, CT, USA
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Julie R Gaither
- Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion (CHERP) and Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Robert D Kerns
- Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA, Connecticut Healthcare System, West Haven, CT, USA
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA
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