1. Preliminary reliability and validity of an opioid overdose risk behavior scale in a community-based sample of recent veterans E.R. Pouget, A.S. Bennett, L. Elliott, A. Golub, A. Rosenblum National Development and Research Institutes, New York, NY
Background
Results
Conclusions
To better understand opioid overdose risks there is a need for a more complete assessment of relevant drug use behaviors. As part of an ongoing cohort study of opioid misuse among recent veterans, we developed an Opioid Risk Behavior Scale (ORBS), based on existing scales for prescription opioid (PO) misuse and other known overdose risks.
Sociodemographic Characteristics. N = 152 U.S. Veterans.
The ORBS preliminarily shows strong evidence of reliability and validity.
It can be used to better understand behavioral risks associated with overdose in order to better target risk reduction efforts.
Mean Age = 37.5 years (Min = 20, Max = 59)
Male gender 82%
Hispanic/Latino ethnicity 22%
African Am./Black race 75%
High School/GED 42%
Some College or more 55%
Currently Single 50%
Currently Married 10%
Most Recent Branch
Army 61%
Marines 11%
Navy 19%
Air Force 9%
Most Recent Component
Active Duty 80%
Guard/Reserves 20%
Limitations
The relatively small N, and the self- reported and cross-sectional nature of the data limit our ability to assess validity.
Methods
Reliability and Validity of ORBS, ORBS Subscales and Validators.
Number Cronbach’s Corr. w/
Scale of Items Alpha EOD, COMM
1. PO use not as prescribed , 0.61
(Greater amount, non-pharmacy source, taken for
enjoyment, to help sleep, to relieve anxiety/depression.
Note. Only those with valid prescriptions [N = 70] provided data)
2. Alternative methods of ingestion , 0.27
(Crushing and inhaling, smoking, injecting)
3. Mixing opioids, other drugs and alcohol , 0.32
(POs, heroin, methadone, buprenorphine, benzodiazepines,
sleep medication, cocaine/stimulants, combinations of these)
4. Solitary opioid use , 0.32
(Solitary PO use, solitary heroin use)
Total ORBS , 0.50
(PO use not as prescribed, Alternate methods of
ingestion, Mixing, Solitary use)
Total Non-prescription ORBS , 0.36
(Alternate methods of Ingestion, Mixing, Solitary use)
Validators _ __
Recent Experiences of Overdose , 0.54
(“Overdosed,” sedated, fingers blue, fell down,
lost consciousness, called for help, used naloxone)
COMM (Butler, et al., 2010) , ---
(Non-pharmacy source, use not as directed, taking those belonging to
someone else, more than prescribed, borrowed from someone else,
used for symptoms other than pain.
We recruited veterans who reported opioid use in the past month using venue-based and chain referral recruitment.
We modified initial items using in-depth interviews with 50 veteran overdose survivors, and 15 pilot assessments.
The ORBS consisted of 19 items that elicited the number of days in the past 30 in which the participant engaged in each specified behavior, grouped into 4 subscales.
We assessed reliability using Cronbach’s alpha.
We assessed validity of the total ORBS and that of its four subscales using Pearson’s correlations with items from an existing scale for opioid misuse (COMM), and with a scale we developed to assess recent experiences of overdose (EOD).
Data were collected face-to-face using an online form on a tablet computer.
Future Research
We will assess the predictive validity of these risk behaviors over time.
We plan to study associations of ORBS data and overdose events with changes in physiological, psychological and social/structural factors over the 2-year follow-up period.
References
Butler SF, Budman SH, Fanciullo GJ, Jamison RN Cross validation of the current opioid misuse measure (COMM) to monitor chronic pain patients on opioid therapy. The Clinical journal of pain 26(9):770.
Acknowledgements
NIDA Grant: R01DA PI: A.S. Bennett
Contact information
Alex S. Bennett, Ph.D.
National Development & Research Institutes
71 West 23rd St., 4th fl, NY NY 10010