ArticleAddictive behaviors2022
Identifying pathways to recent non-fatal overdose among people who use opioids non-medically: How do psychological pain and unmet mental health need contribute to overdose risk?
Article in Addictive behaviors, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis.Harm reduction journal · 2024Pooled it
- Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial.Harm reduction journal · 2023Trial
- Take-home naloxone (THN) ownership among a community-based cohort of sex workers who use drugs in metro vancouver: longitudinal trends and structural determinants (2017-2024).Harm reduction journal · 2026Article
- Sociodemographic and clinical characteristics associated with overdose among patients with a substance-related diagnosis in the emergency department of Southern California.Harm reduction journal · 2025Article
- Severity of post-traumatic stress and non-medical, concomitant opioid and benzodiazepine use in a sample of women at high risk of overdose.International journal of mental health and addiction · 2025Article
- Article
- Increased risk of non-fatal overdose associated with broad adverse childhood experiences among people who use drugs in New York City: a latent class analysis.The American journal of drug and alcohol abuse · 2025Article
- Multiple material need insecurities and severity of psychological distress during the COVID-19 pandemic among women who use drugs.BMC public health · 2024Article
- Impact of neighborhood-level COVID-19 mortality on the increase in drug overdose mortality in New York City during the COVID-19 pandemic.Injury epidemiology · 2024Article
- Sleep-related impairment among people who use opioids: The critical role of structural vulnerability.Sleep health · 2024Article
- Prevalence and Correlates of Depression and Bipolar Disorder Among Patients Maintained on Methadone and Buprenorphine in Ukraine.International journal of mental health and addiction · 2024Article
- Interest in treatment with injectable diacetylmorphine among people who use opioids in Baltimore City, Maryland (USA).Annals of medicine · 2023Article
- The effect of different types of migration on symptoms of anxiety or depression and experience of violence among people who use or inject drugs in Kachin State, Myanmar.Harm reduction journal · 2023Article
- Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland.Harm reduction journal · 2022Article
- Clinical Characteristics of Patients With Overdose Engaging in Nonmedical Use of Prescription Drugs: A Single-Center Study in Japan.Acute medicine & surgeryArticle
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Authors and funding
7 authors.
Funding
Abstract
backgroundSignificant associations exist between psychological pain, unmet mental health need, and frequency and severity of substance use among people who use drugs (PWUD), but no studies have analyzed the relationship of these variables to non-fatal overdose.
methodsWe conducted a cross-sectional survey of people who used opioids non-medically in Baltimore, Maryland (n = 563) as part of a broader harm reduction-focused evaluation (PROMOTE). The outcome was self-reported recent (past 6 months) non-fatal overdose; exposures of interest were recent self-reported unmet mental health need, experiencing daily "long-lasting psychological or mental pain" (vs. < daily), and daily multi-opioid use (vs. none/one opioid used). Path analysis was used to model direct relationships between these variables, personal characteristics (race, gender, experiencing homelessness, drug injection) and overdose.
results30% of the sample had experienced a recent non-fatal overdose, 46% reported unmet mental health need, 21% reported daily psychological pain, and 62% used multiple types of opioids daily. After adjusting for covariates, daily multi-opioid use (aOR = 1.78, p = 0.03) and unmet mental health need (aOR = 2.05, p = 0.01) were associated with direct, significant increased risk of recent overdose. Significant pathways associated with increased odds of unmet mental health need included woman gender (aOR = 2.23, p = 0.003) and daily psychological pain (aOR = 4.14, p = 0.002). In turn, unmet mental health need associated was with greater odds of daily multi-opioid use (aOR = 1.57, p = 0.05). DISCUSSION: Unmet mental heath need and daily psychological pain are common experiences in this sample of PWUD. Unmet mental health need appears on several pathways to overdose and associated risk factors; improving access to mental healthcare for PWUD (particularly women) expressing need may be an important harm reduction measure.
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