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.
