3a. Overview of Theoretical Model Non-fatal Overdose Among Recent Veterans: Lessons Learned from a Mixed Methods Analysis A.S. Bennett1, L. Elliott1, A. Golub1, E.R. Pouget1, A. Rosenblum1, P. Britton2 National Development and Research Institutes, Inc. (NDRI), New York, NY Center for Excellence for Suicide Prevention Canandaigua VAMC; University of Rochester Medical Center 1. Background In the last decade, alarming rates of prescription opioid (PO) misuse and overdose mortality have emerged as central public health concerns, especially for recent veterans returning from Iraq and Afghanistan. Fatal drug overdoses doubled during the first decade of the new millennium and much of that increase has been attributed to POs, particularly when overprescribed, diverted, or taken with other contraindicated substances such as alcohol or benzodiazepines. With recent restrictions on PO prescribing, some veterans who formerly managed their pain with POs have turned to heroin. 4. Methods The project conducted 50 in-depth interviews with veterans who had survived overdoses involving opioids. Eligibility was established through self-report, using a screening protocol, establishing that the participant’s overdose was opioid related and involved symptoms of severe over-sedation, including falling down, being unable to walk, labored breathing, black/blue fingernails or lips, loss of consciousness, and/or being taken to an emergency room. The project will conduct 250 quantitative baseline and follow-up overdose risk assessments with veterans who reported past month use of opioids recruited using venue based, chain referral sampling. 5b. Results: Qualitative – BPS Over the Life Course: Proximal and Distal Conclusions 1. There is interplay between biological, psychological and social factors at both proximal and distal levels, which may influence overdose risk. A mixed methods approach is especially suited to elucidate the complex relationship between these factors overtime. 2. Preliminary findings are consistent with other research that suggests using alone, off-label use, polydrug use, and mode of consumption are common proximal overdose risk behaviors. 3. The high rate of veterans using alone among this sample suggests a degree of social isolation and that peer check-ups or other such “buddy models” may be beneficial for veterans’ overall health. 4. Our findings also suggest that more targeted outreach and educational campaigns to increase veterans’ knowledge of opioid safety and the risks associated with polydrug use may benefit the larger veteran community. 5. Finally, more research is needed with veterans in other settings beyond New York City to better understand the health needs of this population. RW: White Male, Army, 24 Sociodemographic Characteristics. N = 152 Percent Male 82% Most Recent Branch Percent Hispanic/Latino 22% Army 61% Percent African Am./Black 75% Marines 11% High School/GED 42% Navy 19% Some College or more 55% Air Force 9% Currently Single 50% Active Duty 80% Currently Married 10% Guard/Res 20% 2. Purpose This poster focuses on Veterans’ experiences of non-fatal overdose and overdose risk over time in order to better understand and address the incidence of overdose. Veterans who experience non-fatal overdose can teach us much about precursors and precipitants of overdose, as can the charting of transitions into and out of risky opioid using practices. Biological/Psychological: I was in the Marine Corps, served from '07 to 2011... served four years, got out due to knee injuries, got three knee surgeries, just ready to get out. I had a bilateral left and right knee surgery afterwards and they started to give me the pain medication for surgery and kind of got hooked on the pain medication for a little while, Vicodin, Percocet … Yea I was depressed. Social and Structural : As long as I said I was in pain, I never had a problem getting a script, they first gave me Percocet, Vicodin…I was getting roxy’s on the street, down in Florida where I was living at the time, and I started getting on the blues and doing that, just so I can take care my pain, I was in a lot of pain. 30 milligrams for 20 bucks… and prices went up. Event: I had myself limited to where I was just taking 60mg a day and then it got up to some days I would actually just, I would lose my mind, like I would sit there and like I’ll just chop another one up and my body, like I felt like I was just sitting there, like I was in tears some days and I didn’t know what I was doing to myself and like I know one day I took about 120mg, that was the most I ever took for one day and I just, I was out of there [overdosed]. 5. Results: Quantitative - Most Common Overdose Risk Behaviors at Baseline (Proximal) 3. Theoretical Model Limitations Findings are based on a sample of urban Veterans from New York City and may not be generalizable to veteran populations in other cities or rural areas. 3a. Overview of Theoretical Model The research questions guiding this analysis exemplify the Biopsychosocial model (BPS). This theoretical formulation draws upon research in social and life-course epidemiology, medical research, and psychology to propose research strategies that conceptualize the potential impact of changing life experiences and psychological states on bio-behavioral systems formation (such as those implicated in PO and other substance use and pain management).  PRIMARY FUNDING SOURCE: NIDA , Project #R01 DA036754. Points of view expressed in this paper do not necessarily represent the official position of the U.S. Government, NIDA, nor NDRI. CONTACT INFO: Alex Bennett, NDRI, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, E-mail: Bennett@ndri.org, Tel: 212-845-4473