Negative urgency accounts for associations between internalizing symptoms and lifetime nonfatal opioid overdose among patients from three urban Ohio emergency departments.

Abstract

Existing evidence relates internalizing psychopathology to nonfatal opioid overdose. Identifying variables that account for associations between internalizing symptomology and overdose could improve clinical conceptualizations of overdose risk and inform testable, mechanistic hypotheses. Mood-based facets of impulsivity, such as negative and positive urgency, are promising candidate variables that have been linked to both internalizing symptoms and negative substance use outcomes. Therefore, the present study tested whether these facets accounted for internalizing-overdose associations. We conducted a secondary, cross-sectional data analysis of lifetime opioid-exposed patients presenting to three large, urban emergency departments in Ohio. Bivariate associations between measures of internalizing conditions, mood-related urgency, and nonfatal opioid overdose were calculated, and the extent to which negative and positive urgency accounted for associations between internalizing constructs and nonfatal opioid overdose was examined. To determine the specificity of findings, we compared results to other impulsivity facets and models testing internalizing-impulsivity interactions. Negative urgency demonstrated a unique role in accounting for relationships between internalizing constructs and lifetime nonfatal opioid overdose. No other impulsivity facet, including positive urgency, reliably accounted for internalizing-overdose relations. No internalizing-urgency interactions were observed. Negative urgency was the only facet to reliably explain overlap in internalizing-overdose associations. Overdose-prevention efforts should consider the dual roles of internalizing symptoms and negative urgency as risk factors for opioid overdose. Implications for testing causal hypotheses are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).