Violence Exposure, Mental Distress, Substance Use Behaviors, and Overdose Experiences Among People who Inject Drugs.

Rates of exposure to traumatic events are up to two times higher among people with substance use disorders (SUDs) compared to the US general population. Overdoses (OD) and overdose fatalities have continued to increase nationally and in Kentucky and are associated with elevated trauma symptoms. This paper examines the impacts of witnessing and experiencing OD among people who inject drugs (PWID) in Kentucky. Data were derived from a NIDA-funded study of people who inject drugs (PWID) in three Appalachian counties. Study participants were recruited via Respondent-Driven Sampling techniques supplemented with direct community outreach. Utilizing a multinomial logistic regression analysis, we examined the interconnections between demographics, physical and mental health related factors, substance use behaviors, and violence experience with OD exposure. Our findings showed that participants reporting past year severe mental health distress and lifetime violence exposure had higher odds of both witnessing and experiencing OD. Additionally, participants who reported early abuse had higher odds of both witnessing and experiencing OD as did participants with early onset injection drug use. The findings highlight the high risk of repeated exposure to violence victimization and OD-related traumas among PWID. This suggests the need for incorporating knowledge about trauma into policies, procedures, and practices in treating SUD among PWID, as well as employing strategies that prevent re-traumatization in treating SUDs among PWIDs.