Abstract
BACKGROUND: Fatal opioid overdoses in the United States have rapidly increased since 1999. While several risk factors for overdose are known, the association of overdose risk perception with subsequent overdose is not well understood. METHODS: We used data from a randomized trial of a counseling intervention to reduce opioid overdose among overdose survivors who use nonprescribed opioids. Participants were followed up for 16 months with visits every 4 months. At study visits participants were asked how likely they were to overdose in the next 4 months (risk perception) and whether they had overdosed since their last visit. Responses of "extremely likely" or "likely" were considered "higher risk perception," and those of "neutral," "unlikely," and "extremely unlikely" were considered "lower risk perception." We conducted an adjusted generalized estimating equation among participants in the control group to examine the association of higher versus lower risk perception and subsequent overdose. We adjusted for visit, recent overdose, and sociodemographic characteristics that were selected a priori due to known associations with risk perception or opioid overdose. RESULTS: Among 135 control participants, median age was 42 years (interquartile range: 34-49) and over half were male (59%). Higher risk perception was associated with 2.65 times the adjusted odds of having a subsequent overdose compared with lower risk perception (95% confidence interval: 1.35-5.23, P = <.01). CONCLUSIONS: Incorporating an assessment of risk perception into opioid overdose prevention efforts may help prioritize prevention efforts.