Development of an opioid-related Overdose Risk Behavior Scale (ORBS)

ABSTRACT

Background: Drug overdose has emerged as the leading cause of injury-related death in the United States, driven by prescription opioid (PO) misuse, polysubstance use, and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations, there is a need for a more comprehensive assessment of related risk behaviors. Drawing on existing research, formative interviews, and discussions with community and scientific advisors an opioid-related Overdose Risk Behavior Scale (ORBS) was developed. Methods: Military veterans reporting any use of heroin or POs in the past month were enrolled using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. Internal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectivelyInternal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectively. Results: Data for 220 veterans were analyzed. The 5 subscales—(A) Adherence to Opioid Dosage and Therapeutic Purposes; (B) Alternative Methods of Opioid Administration; (C) Solitary Opioid Use; (D) Use of Nonprescribed Overdose-associated Drugs; and (E) Concurrent Use of POs, Other Psychoactive Drugs and Alcohol—generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. Conclusions: These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research and could help improve the precision of overdose education and prevention efforts.

KEYWORDS:

• Drug use
• opioids
• overdose
• risk behavior

Funding

This research was supported by National Institute on Drug Abuse grant R01DA036754 (Principal Investigator [PI]: A. Bennett); Career Development Award from the Department of Veterans Affairs Office of Research Development, Clinical Science Research and Development (CSR&D) IK2CX000641 (PI: P. C. Britton); and institutional training award T32DA007233 (B. Wolfson-Stofko). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors declare they have no conflicts of interest.

Author contributions

E.R.P. performed the statistical analyses, wrote the initial draft, and contributed to the development of the scale; A.S.B. was responsible for the initial conception of the study and was the Principal Investigator and contributed to the writing and scale development; L.E. was the Project Director and contributed to the writing and scale development; B.W.-S. contributed to the writing; R.A., P.C.B., and A.R. contributed to the writing and scale development.