Importance: Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. Objectives: To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. Design, Setting, and Participants: This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. Main Outcomes and Measures: Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. Results: A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. Conclusions and Relevance: These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population.
Importance: Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. Objectives: To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. Design, Setting, and Participants: This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. Main Outcomes and Measures: Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. Results: A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. Conclusions and Relevance: These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population.
Authors: Stefan G Kertesz; Aerin J DeRussy; Kevin R Riggs; April E Hoge; Allyson L Varley; Ann Elizabeth Montgomery; Erika L Austin; John R Blosnich; Audrey L Jones; Sonya E Gabrielian; Lillian Gelberg; Adam J Gordon; Joshua S Richman Journal: Am J Prev Med Date: 2021-07-15 Impact factor: 6.604
Authors: Ryan McNeil; Taylor Fleming; Alexandra B Collins; Sandra Czechaczek; Samara Mayer; Jade Boyd Journal: Drug Alcohol Depend Date: 2021-03-18 Impact factor: 4.492
Authors: Audrey L Jones; Lillian Gelberg; Aerin J deRussy; Allyson L Varley; Kevin R Riggs; Adam J Gordon; Stefan G Kertesz Journal: J Addict Med Date: 2021 Nov-Dec 01 Impact factor: 3.702
Authors: Audrey L Jones; Adam J Gordon; Sonya E Gabrielian; Ann Elizabeth Montgomery; John R Blosnich; Allyson L Varley; Aerin J deRussy; Erika L Austin; April E Hoge; Young-Il Kim; Lillian Gelberg; Stefan G Kertesz Journal: Med Care Date: 2021-06-01 Impact factor: 3.178
Authors: Sonya Gabrielian; Audrey L Jones; April E Hoge; Aerin J deRussy; Young-Il Kim; Ann Elizabeth Montgomery; John R Blosnich; Adam J Gordon; Lillian Gelberg; Erika L Austin; David Pollio; Sally K Holmes; Allyson L Varley; Stefan G Kertesz Journal: J Prim Care Community Health Date: 2021 Jan-Dec
Authors: Michael Liu; Lucie Richard; Michael A Campitelli; Rosane Nisenbaum; Naheed Dosani; Irfan A Dhalla; Rishi K Wadhera; Salimah Z Shariff; Stephen W Hwang Journal: Addiction Date: 2022-02-14 Impact factor: 7.256
Authors: Lauren Lipira; Gillian Leichtling; Ryan R Cook; Judith M Leahy; E Roberto Orellana; P Todd Korthuis; Timothy W Menza Journal: Drug Alcohol Depend Date: 2021-07-21 Impact factor: 4.852