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- Title
Associations among drug acquisition and use behaviors, psychosocial attributes, and opioid-involved overdoses.
- Authors
Swartz, James A.; Zhao, Peipei; Jacobucci, Ross; Watson, Dennis P.; Mackesy-Amiti, Mary Ellen; Franceschini, Dana; Jimenez, A. David
- Abstract
Aims: This study sought to develop and assess an exploratory model of how demographic and psychosocial attributes, and drug use or acquisition behaviors interact to affect opioid-involved overdoses. Design: We conducted exploratory and confirmatory factor analysis (EFA/CFA) to identify a factor structure for ten drug acquisition and use behaviors. We then evaluated alternative structural equation models incorporating the identified factors, adding demographic and psychosocial attributes as predictors of past-year opioid overdose. Setting and participants: We used interview data collected for two studies recruiting opioid-misusing participants receiving services from a community-based syringe services program. The first investigated current attitudes toward drug-checking (N = 150). The second was an RCT assessing a telehealth versus in-person medical appointment for opioid use disorder treatment referral (N = 270). Measurements: Demographics included gender, age, race/ethnicity, education, and socioeconomic status. Psychosocial measures were homelessness, psychological distress, and trauma. Self-reported drug-related risk behaviors included using alone, having a new supplier, using opioids with benzodiazepines/alcohol, and preferring fentanyl. Past-year opioid-involved overdoses were dichotomized into experiencing none or any. Findings: The EFA/CFA revealed a two-factor structure with one factor reflecting drug acquisition and the second drug use behaviors. The selected model (CFI =.984, TLI =.981, RMSEA =.024) accounted for 13.1% of overdose probability variance. A latent variable representing psychosocial attributes was indirectly associated with an increase in past-year overdose probability (β =.234, p =.001), as mediated by the EFA/CFA identified latent variables: drug acquisition (β =.683, p <.001) and drug use (β =.567, p =.001). Drug use behaviors (β =.287, p =.04) but not drug acquisition (β =.105, p =.461) also had a significant, positive direct effect on past-year overdose. No demographic attributes were significant direct or indirect overdose predictors. Conclusions: Psychosocial attributes, particularly homelessness, increase the probability of an overdose through associations with risky drug acquisition and drug-using behaviors. Further research is needed to replicate these findings with populations at high-risk of an opioid-related overdose to assess generalizability and refine the metrics used to assess psychosocial characteristics.
- Subjects
DRUG utilization; DRUG overdose; OPIOID abuse; STRUCTURAL equation modeling; CONFIRMATORY factor analysis
- Publication
BMC Public Health, 2024, Vol 24, Issue 1, p1
- ISSN
1471-2458
- Publication type
Article
- DOI
10.1186/s12889-024-19217-y