Opioid withdrawal as a barrier to harm reduction: Examining how overdose prevention behaviors are affected by withdrawal

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-09-18 DOI:10.1016/j.drugalcdep.2025.112895

Grace Yi , Lauren Dayton , Anya Scott-Wallace , Melissa Davey-Rothwell , Seun Falade-Nwulia , Carl Latkin

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Abstract

Background and objectives

In the past decade, the increasing availability and prevalence of fentanyl in the drug supply have heightened the risk of fatal overdose and increased the frequency and severity of opioid withdrawal symptoms. We aimed to examine how opioid withdrawal impacts engagement in harm reduction behaviors among people who use drugs.

Methods

Data came from a community-based research study in Baltimore, Maryland, conducted from 2022 to 2024. Participants were adults who used heroin, fentanyl, or prescription opiates to get high in the past month (N = 676). Structured surveys assessed withdrawal as a barrier to testing drugs for potency and overdose prevention. Logistic regression models were used to identify correlates of engagement in harm reduction during periods of withdrawal.

Results

Half the sample (46.6 %) reported that withdrawal “always” or “often” prevented them from testing drugs, and 66.6 % agreed that withdrawal was a barrier to overdose prevention. Depression symptoms (adjusted odds ratio (aOR): 1.56, 95 % CI 1.09–2.25), increased opioid use per week (aOR: 1.12, 95 % CI 1.03–1.22), and White race (aOR: 1.75, 95 % CI 1.16–2.62) were independently associated with lower engagement in drug testing and overdose prevention during withdrawal.

Conclusions

Withdrawal significantly impacts engagement in harm reduction behaviors, even among those with high awareness and receptivity to drug testing and overdose prevention strategies. Withdrawal management and mental health support are emergent and critical components for harm reduction interventions to prevent overdose morbidity and mortality among people who use drugs.

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阿片类药物戒断是减少危害的障碍：检查戒断如何影响过量预防行为

背景和目的在过去十年中，芬太尼在药物供应中的可得性和流行程度的增加增加了致命过量的风险，增加了阿片类药物戒断症状的频率和严重程度。我们的目的是研究阿片类药物戒断如何影响吸毒者减少伤害行为的参与。数据来自马里兰州巴尔的摩的一项基于社区的研究，该研究于2022年至2024年进行。参与者是在过去一个月内使用海洛因、芬太尼或处方阿片类药物获得快感的成年人（N = 676）。有组织的调查评估了停药是测试药物效力和预防药物过量的障碍。使用逻辑回归模型来确定在撤离期间参与减少伤害的相关因素。结果半数（46.6%）受访者认为停药“总是”或“经常”阻碍了他们进行药物检测，66.6%的受访者认为停药是预防药物过量的障碍。抑郁症状（调整优势比（aOR）： 1.56, 95% CI 1.09-2.25）、每周阿片类药物使用增加（aOR: 1.12, 95% CI 1.03-1.22）和白人（aOR: 1.75, 95% CI 1.16-2.62）与戒断期间药物测试和过量预防的参与程度较低独立相关。结论戒断对减少伤害行为的参与有显著影响，即使在对药物检测和过量预防策略有较高认识和接受度的人群中也是如此。戒断管理和心理健康支持是减少伤害干预措施的紧急和关键组成部分，以防止吸毒者过量发病和死亡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.