Title : Person, drugs, and place: Developing a survey tool to measure overdose risk using a reddit survey panel
Abstract:
Research Objective: One of the most difficult overdose-related issues to disentangle empirically has been the independent contribution of person-level factors from drug or environmental characteristics. This study’s purpose was to develop and validate an instrument to measure overdose risk factors.
Study Design: We conducted an online Reddit survey to empirically compare factors surrounding (1) a recent overdose, (2) a non-overdose involved drug use event among overdose survivors, and (3) a drug use event among those with no recent overdose history. We developed a set of conceptually grounded items related to drugs used, the context in which drugs were used, and individual susceptibility to harmful outcomes from drug use based on findings from qualitative interviews conducted in a prior phase of the present study. We tested and refined survey questions through cognitive interviews before fielding the survey on Reddit. Following data collection, we examined the psychometric properties of survey items and contrasted differences in survey responses to questions about drugs used, the environment, and person-level risk factors across these three conditions.
Population Studied: Our sample included 458 US-based respondents who were engaged with Reddit forums related to drug use, harm reduction, and substance use treatment. Participants were eligible if they experienced an overdose within the past 12 months and/or a non-overdose related drug use event within the past 30 days.
Principal Findings: Over a third reported a past-year overdose (n=175). The sample was predominantly White (91.5%) and male (62.7%). Most respondents resided in metropolitan areas (91.4%). Opioid use and injection drug use were most common among overdose survivors. Half of overdose survivors noted drugs were stronger than expected at the time of their most recent overdose compared to very few reporting as such at their most recent drug use. All respondents mostly used drugs at home, but overdose survivors were more likely to report using drugs in a car, hotel, or other public space at the time of overdose. People without recent overdose history were more likely to report using drugs alone at the time of last drug use. Compared to people with no overdose history, overdose survivors at both the time of the recent overdose and last drug use were more likely to be engaged with services, and to report employment, financial, interpersonal, criminal-legal system, and mental health challenges.
Conclusions: Findings suggest opioid use, changes in the drug supply, contextual factors, and life challenges are interrelated contributors to overdose.
Implications for Policy or Practice: Targeted strategies should focus on reducing overdose risk in specific places and contexts, such as at motels. This survey tool could be used to assess overdose risk in clinical settings.
