Perceived Severity of and Susceptibility to Overdose Among Injection Drug Users: Relationships With Overdose History

ABSTRACT

Background: Overdose is relatively common among injection drug users (IDUs) yet little is known about how overdose-related health beliefs influence overdose experiences or risk reduction. Objectives: This study examines the association of perceived susceptibility to and perceived severity of nonfatal overdose with overdose history among IDUs attending needle exchange programs (NEPs) to inform prevention efforts. Methods: In 2009–2010, IDUs (N = 91) attending NEPs completed self-report surveys. Negative binomial regression modeled the association between demographics, age of injection initiation, length of time attending the NEP, perceived severity of overdose, and perceived susceptibility to overdose with lifetime history of nonfatal overdose. Results: Over half (55%) of participants reported lifetime overdose, with a mean of 2.9 overdoses. A multivariable negative binomial regression model revealed that younger current age, older age of first injection, non-Caucasian race, higher perceived severity of overdose, and lower perceived susceptibility to overdose were significantly correlated with fewer lifetime overdoses. Conclusions: Although our methodology precludes causal inferences, these findings are consistent with the hypothesis that perceived severity and perceived susceptibility are among several factors associated with IDUs' use of protective behaviors, which could influence the likelihood of overdose. Future prospective research to explore the impact of this and other health beliefs on risk behaviors and overdose could help improve the effectiveness of behavioral interventions.

KEYWORDS:

• Injection drug use
• overdose
• health beliefs
• severity
• susceptibility

Additional information

Notes on contributors

Erin E. Bonar

Erin E. Bonar, Ph.D., is an Assistant Professor in the Department of Psychiatry and the Addiction Center at the University of Michigan Medical School. She received her doctorate in clinical psychology from Bowling Green State University. Her research focuses on the prevention and treatment of substance use disorders and related consequences among populations ranging from adolescents to adults. She is particularly interested in the co-occurrence of substance use and HIV risk behaviors, including injection drug use.

Amy S. B. Bohnert

Amy S. B. Bohnert, Ph.D., M.H.S., is a health services researcher who focuses on epidemiology and behavioral interventions regarding substance use and related disorders. She is an Assistant Professor in the Department of Psychiatry and the Addiction Center at the University of Michigan and is also an investigator with the Department of Veterans Affairs Center for Clinical Management Research (CCMR), an HSR&D Center of Innovation located in Ann Arbor, Michigan. She has led a number of projects related to overdose and prescription drug safety. A focus of this research has been specifically aimed at improving care occurring in primary care and addictions treatment settings.