Stigma and drug use settings as correlates of self-reported, nonfatal overdose among people who use drugs in Baltimore, Maryland

Details

• Alternative Title:
  Int J Drug Policy
• Personal Author:
  Latkin, Carl ; Gicquelais, Rachel ; Clyde, Catie ; Dayton, Lauren ; Davey-Rothwell, Melissa ; German, Danielle ; Falade-Nwulia, Seun ; Saleem, Haneefa ; Fingerhood, Michael ; Tobin, Karin
• Description:
  Background
  
  Fatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs.
  
  Methods
  
  We surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009–2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e. enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose.
  
  Results
  
  Stigma was positively associated with experiencing a nonfatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1–2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1–2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, outside) where participants used drugs was also positively associated with experiencing an overdose.
  
  Conclusions
  
  Stigma related to drug use and using drugs in more settings may increase overdose risk. The effectiveness of overdose prevention and naloxone training may be improved by reducing discrimination against people who use drugs in community and medical settings and diversifying the settings in which overdose prevention trainings are delivered. These efforts may be enhanced by use of peer outreach approaches in which people who use drugs diffuse prevention messages through their social networks and within settings of drug consumption outside the medical setting.
  
  
• Subjects:
  Adolescent Adult Analgesics, Opioid Article Baltimore Case-Control Studies Drug Overdose Drug Users Drug Use Settings Environment Female Humans Male Middle Aged Overdose Self Report Social Stigma Stigma Young Adult

  More +
• Source:
  Int J Drug Policy. 68:86-92
• Pubmed ID:
  31026734
• Pubmed Central ID:
  PMC6535351
• Document Type:
  Journal Article
• Funding:
  R01 DA022961/DA/NIDA NIH HHS/United States ; R01 DA040488/DA/NIDA NIH HHS/United States ; R01 CE003021/CE/NCIPC CDC HHS/United States ; K23 DA041294/DA/NIDA NIH HHS/United States ; R01 DA032217/DA/NIDA NIH HHS/United States ; K01 DA041259/DA/NIDA NIH HHS/United States ; T32 AI102623/AI/NIAID NIH HHS/United States
• Volume:
  68
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:31e501a9395f94227fc170113bd83034c537edcea5173be911ad4e1e4e5972c7
• Download URL:
  https://stacks.cdc.gov/view/cdc/79035/cdc_79035_DS1.pdf
• File Type:
  [PDF - 114.71 KB ]