Charles M Cleland1, Alex S Bennett2, Luther Elliott2, Andrew Rosenblum3, Peter C Britton4, Brett Wolfson-Stofko5. 1. Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11thFloor, New York, NY, 10012, USA; Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA. Electronic address: Charles.Cleland@nyulangone.org. 2. College of Global Public Health, New York University, 665 Broadway, 11thFloor, New York, NY, 10012, USA; Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11thFloor, New York, NY, 10012, USA. 3. National Development and Research Institutes, New York, NY, 10010, USA. 4. VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Avenue Canandaigua, NY, 14424, USA; Department of Psychiatry, University of Rochester, Rochester, NY, USA. 5. Center for Drug Use and HIV/HCV Research, College of Global Public Health, New York University, 665 Broadway, 11thFloor, New York, NY, 10012, USA.
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.
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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