Developing and Piloting a Method to Identify Warning Signs for Opioid Overdose among Adults Presenting to the Emergency Department
Opioid overdose resulted in at least 47,600 deaths in 2017. In the Midwest specifically, there was a 70% increase in treated opioid overdoses from 2016 to 2017. Thus, understanding how to address this rapidly evolving health crisis is highly important. Deaths by opioid overdose are not limited to those that were unintentional (accidental). Concealed within the number of opioid overdose deaths are those that were intentional (suicide), which are not always included in overdose surveillance reports. Given initial evidence of overlapping risk factors, and problems in classification of intent, the Directors of NIDA and NIMH recently highlighted the need for research to incorporate an underrecognized contributor, the degree to which an opioid overdose was intentional, to tackling the opioid epidemic. Additionally, there has been little research attention to understanding risk for opioid overdose across the full continuum of intentionality. What research exists has largely identified sub-groups at elevated risk for opioid overdose based on largely non-modifiable characteristics (e.g., male, history of opioid use disorder). To prevent overdose, it is particularly important to identify near-term (within hours/days) risk factors (referred here as warning signs [WS]) for opioid overdose, which can answer “Why did an individual overdose today compared with a previous day, when she/he didn’t overdose?” For WS to be useful for risk recognition and treatment, they must distinguish periods of acute heightened risk (e.g., 24 hours prior to the overdose) from periods of lower risk (where an overdose didn’t occur; e.g., a 24-hour control period) within high-risk individuals. No prior study has empirically examined acute within-person changes across behavioral/experiential, cognitive, and affective domains to determine WS for opioid overdose, yet they are of key clinical importance.
Aim 1: To develop and pilot the Warning Signs for Opioid Overdose (WS-OOD) Interview in preparation for its use in a large-scale study to determine near-term risk factors for opioid overdose among individuals treated for an opioid overdose. We will adapt Dr. Bagge’s Timeline Follow-Back for Suicide Attempts methodology (TLFB) to specifically focus on a recent opioid overdose event (accounting for the nuanced, full spectrum of intentionality), and include potential WS (relevant contextual factors [e.g., location], behaviors, events, cognitions, and affective states) pertinent to opioid overdose.
Aim 2: To determine the feasibility of methodology and the acceptability of the WS-OOD for obtaining participant responses of opioid overdose WS, as well as participants’ interest in future interventions, under different recruitment strategies. Indicators will include consent and assessment completion rates, interview time requirement, participant responses to open-ended questions about the interview/study experience, as well as responses regarding interest in potential types/models of interventions to prevent future opioid overdose.
Aim 3: To use qualitative interview methods to identify novel WS candidates for the WS-OOD.
Exploratory Aim: To determine whether WS-OOD factors show within-person changes to opioid overdose status, as well as their relations with historical and other event-based factors.
Participants will be adults aged 18+ who presented to an emergency department (ED) due to a recent opioid overdose and will be recruited using a variety of methods. Key assessments include the Warning Signs for Opioid Overdose (WS-OOD) Interview, measures of index overdose characteristics, including intentionality, and historical factors (e.g., prior history of suicidal ideation and behavior, overdose, and substance use/misuse broadly). Participants will complete qualitative interviews regarding study experience, satisfaction, and thoughts about inclusion of additional WS factors and interest in potential types/models of interventions to prevent future opioid overdose. Key outcomes will include consent and assessment completion rates, interview time requirement, and participant responses to open-ended questions about the interview/study experience.