Participant Socio-demographic Characteristics, Drug Use, and Drug Treatment and Harm Reduction Access (Table 1a)
Table 1
a. Participant Characteristics in the Total Sample and by Network Characteristics (N=575)
| N (%) in Total Samplea | N (%) with <5 Members in Networkb | PR (95% CI) for Association with <5 Members in Networkc | N (%) with No Support from Using Network Membersd | PR (95% CI) for Association with No Support from Using Networke |
Age Less than 50 Years of Age 50 Years of Age or Older | 255 (44.3) 321 (55.7) | 68 (26.8) 63 (19.6) | Ref 0.73 (0.54, 0.99) | 103 (40.6) 156 (48.8) | Ref 1.20 (1.00, 1.45) |
Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic/Latinx Other | 106 (18.4) 217 (37.7) 229 (39.8) 19 (3.30) | 26 (24.8) 47 (21.7) 53 (23.1) 4 (21.0) | Ref 0.87 (0.58, 1.33) 0.93 (0.62, 1.41) 0.85 (0.33, 2.16) | 46 (43.4) 108 (49.8) 97 (42.7) 6 (31.6) | Ref 1.15 (0.89, 1.48) 0.98 (0.76, 1.28) 0.73 (0.36, 1.46) |
Sex Female Male | 193 (33.5) 379 (65.8) | 43 (22.5) 87 (23.0) | Ref 1.02 (0.74, 1.41) | 90 (27.1) 167 (44.3) | Ref 0.94 (0.78, 1.13) |
Employment Status Unemployed Employed | 445 (77.3) 124 (21.5) | 99 (22.3) 30 (24.2) | Ref 1.08 (0.76, 1.55) | 195 (44.0) 62 (50.0) | Ref 1.14 (0.92, 1.39) |
Currently Homeless No Yes | 402 (69.9) 173 (30.1) | 90 (22.4) 41 (23.7) | Ref 1.06 (0.76, 1.46) | 184 (45.9) 75 (43.4) | Ref 0.76 (0.63, 0.93) |
Ever Incarcerated No Yes | 114 (19.8) 462 (80.2) | 33 (29.0) 98 (21.3) | Ref 0.73 (0.52, 1.03) | 63 (55.8) 196 (42.5) | Ref 0.59 (0.39, 0.89) |
Currently Lives with Romantic Partner No Yes | 426 (74.1) 149 (25.9) | 103 (24.2) 28 (18.8) | Ref 0.78 (0.53, 1.13) | 192 (45.3) 67 (44.7) | Ref 0.99 (0.80, 1.21) |
Currently Lives with Romantic Partner who Uses Opioids No Yes | 473 (82.3) 102 (17.7) | 115 (24.3) 16 (15.7) | Ref 0.64 (0.40, 1.04) | 215 (45.6) 44 (42.7) | Ref 0.94 (0.73, 1.20) |
Currently Lives with Anyone No Yes | 140 (24.4) 434 (75.6) | 30 (21.4) 101 (23.3 | Ref 1.09 (0.76, 1.56) | 67 (48.2) 192 (44.2) | Ref 0.92 (0.75, 1.12) |
Currently Lives with Anyone who Uses Opioids No Yes | 399 (72.0) 155 (28.0) | 98 (24.6) 27 (17.4) | Ref 0.71 (0.48, 1.04) | 186 (46.8) 64 (41.0) | Ref 0.88 (0.70, 1.09) |
Current Living Situation Lives Alone Not with Anyone Who Uses Opioids Someone Who Uses Opioids | 140 (25.3) 259 (46.8) 155 (28.0) | 30 (21.4) 68 (26.2) 27 (17.4) | Ref 1.22 (0.84, 1.79) 0.81 (0.51, 1.30) | 67 (48.2) 119 (46.1) 64 (41.0) | Ref 0.96 (0.77, 1.19) 0.85 (0.66, 1.10) |
Length of Opioid Use History 15 Years of Less 16 – 26 Years 27 – 35 Years 36 Years or Longer | 154 (16.8) 136 (23.6) 147 (25.6) 137 (23.8) | 46 (30.1) 30 (22.1) 32 (21.8) 23 (16.8) | Ref 0.73 (0.49, 1.09) 0.72 (0.49, 1.07) 0.56 (0.36, 0.87) | 71 (46.4) 52 (38.2) 72 (49.0) 64 (47.1) | Ref 0.82 (0.63, 1.08) 1.06 (0.83, 1.34) 1.01 (0.79, 1.30) |
OUD Severity Mild/Moderate Severe | 95 (16.5) 441 (76.6) | 24 (25.3) 93 (21.1) | Ref 0.84 (0.57, 1.24) | 56 (59.0) 186 (42.4) | Ref 0.72 (0.59, 0.88) |
Ever Injected Heroin No Yes | 365 (63.4) 196 (34.0) | 85 (23.3) 39 (20.0) | Ref 0.86 (0.61, 1.20) | 175 (48.2) 75 (38.3) | Ref 0.80 (0.64, 0.98) |
Cocaine Use in Past 30 Days No Yes | 288 (50.0) 288 (50.0) | 77 (26.7) 54 (18.8) | Ref 0.70 (0.52, 0.96) | 139 (48.4) 120 (41.8) | Ref 0.86 (0.72, 1.04) |
Crack Use in Past 30 Days No Yes | 415 (72.0) 161 (28.0) | 95 (23.0) 26 (22.4) | Ref 0.97 (0.70, 1.37) | 197 (47.6) 62 (38.8) | Ref 0.81 (0.65, 1.01) |
Marijuana Use in Past 30 Days No Yes | 358 (62.2) 218 (37.8) | 84 (23.5) 47 (21.6) | Ref 0.92 (0.67, 1.26) | 170 (47.6) 89 (41.1) | Ref 0.86 (0.71, 1.04) |
Benzodiazepine Use in Past 30 Days No Yes | 387 (67.2) 189 (32.8) | 88 (22.8) 43 (22.8) | Ref 1.00 (0.72, 1.38) | 178 (46.2) 81 (42.9) | Ref 0.93 (0.76, 1.13) |
Fentanyl Detected in Urine Analysis No Yes | 268 (46.5) 306 (53.1) | 64 (23.9) 66 (21.6) | Ref 0.90 (0.67, 1.23) | 135 (50.6) 123 (40.3) | Ref 0.80 (0.66, 0.96) |
Oxycodone Detected in Urine Analysis No Yes | 541 (93.9) 33. (5.7) | 123 (22.8) 7 (21.2) | Ref 0.93 (0.47, 1.83) | 247 (45.7) 11 (34.4) | Ref 0.75 (0.46, 1.22) |
Heroin Detected in Urine Analysis No Yes | 79 (13.7) 495 (85.9) | 17 (21.5) 113 (22.9) | Ref 1.06 (0.68, 1.67) | 43 (55.1) 215 (43.5) | Ref 0.79 (0.63, 0.99) |
Stigma (Median ≥13) No Yes | 278 (48.3) 280 (48.6) | 53 (19.1) 68 (24.4) | Ref 1.27 (0.93, 1.76) | 120 (43.2) 127 (45.5) | Ref 1.05 (0.88, 1.27) |
PTSD No Yes | 513 (89.1) 62 (10.8) | 117 (22.8) 14 (22.6) | Ref 0.99 (0.61, 1.61) | 232 (45.4) 27 (43.6) | Ref 0.96 (0.71, 1.29) |
Omnibus Mental Health* | 0.7 (0.25, 1.3) | | Ref 1.02 (0.84, 1.24) | | Ref 0.99 (0.87, 1.12) |
Depression No Yes | 264 (45.9) 69 (54.1) | 62 (23.5) 69 (22.2) | Ref 0.94 (0.70, 1.28) | 115 (43.6) 114 (46.4) | Ref 1.07 (0.89, 1.28) |
Anxiety No Yes | 314 (54.6) 216 (45.4) | 70 (22.3) 61 (23.4) | Ref 1.05 (0.78, 1.42) | 143 (45.5) 116 (44.6) | Ref 0.98 (0.82, 1.17) |
Suicidality No Yes | 546 (95.1) 28 (4.9) | 125 (22.9) 6 (21.4) | Ref 0.94 (0.45, 1.94) | 247 (45.2) 12 (44.4) | Ref 0.98 (0.64, 1.51) |
SEP Visits in Past 3 Months No Yes | 347 (60.2) 170 (29.5) | 88 (25.4) 30 (17.8) | Ref 0.70 (0.48, 1.02) | 172 (49.7) 64 (17.9) | Ref 0.76 (0.51, 0.95) |
Currently Opioid Treatment No Current Treatment Medication Assisted Treatment | 254 (44.2) 321 (55.8) | 71 (28.0) 60 (18.7) | Ref 0.67 (0.49, 0.90) | 104 (41.1) 155 (48.3) | Ref 1.17 (0.98, 1.41) |
Ever Trained to Administer Naloxone No Yes | 193 (33.5) 379 (65.8) | 56 (29.0) 93 (19.3) | Ref 0.66 (0.49, 0.90) | 95 (49.5) 163 (43.1) | Ref 0.87 (0.72, 1.05) |
Administered Naloxone in Past 3 Months No Yes | 474 (82.3) 102 (17.7) | 120 (25.4) 11 (10.8) | Ref 0.42 (0.24, 0.76) | 227 (48.1) 32 (31.4) | Ref 0.65 (0.48, 0.88) |
aMay not sum to 575 due to missing values |
bN=575; 5 members is the 25th percentile [131 (22.7%) with <5 members; 444 (77.1%) with 5+ members] |
cCompared to 5+ Members |
dN=575 [259 (45.0%) have no material or emotional support; 315 (54.7%) have at least one form of support] |
eCompared to those with at least one form of support |
*Median (IQR); scale is standardized |
Table 1
b. Participant Characteristics in the Total Sample and by Unprotected Use and OD Experience in Past 30 Days (N=575)
| N (%) with Unprotected Use | PR (95% CI) for Association Unprotected Use | N (%) with OD Experience | PR (95% CI) for Association with OD Experience |
Age Less than 50 Years of Age 50 Years of Age or Older | 146 (58.4) 219 (68.6) | Ref 1.18 (1.03, 1.34) | 105 (41.3) 80 (24.9) | Ref 0.60 (0.47, 0.77) |
Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic/Latinx Other | 59 (56.2) 153 (71.2) 139 (61.5) 11 (61.1) | Ref 1.27 (1.05, 1.53) 1.09 (0.90, 1.33) 1.09 (0.72, 1.63) | 45 (42.9) 58 (26.7) 78 (34.1) 3 (15.8) | Ref 0.62 (0.46, 0.85) 0.79 (0.60, 1.06) 0.37 (0.13, 1.07) |
Sex Female Male | 117 (61.6) 248 (66.1) | Ref 1.07 (0.94,1.23) | 58 (30.2) 123 (32.4) | Ref 1.07 (0.83, 1.39) |
Employment Status Unemployed Employed | 289 (65.5) 70 (57.8) | Ref 0.88 (0.75, 1.04) | 132 (29.7) 53 (42.7) | Ref 1.44 (1.12, 1.84) |
Currently Homeless No Yes | 264 (66.7) 101 (58.4) | Ref 0.88 (0.76, 1.01) | 133 (33.2) 52 (29.9) | Ref 0.90 (0.69, 1.18) |
Ever Incarcerated No Yes | 74 (66.7) 291 (63.5) | Ref 0.95 (0.82, 1.11) | 36 (31.6) 149 (32.3) | Ref 1.02 (0.76, 1.38) |
Length of Opioid Use History 15 Years of Less 16 – 26 Years 27 – 35 Years 36 Years or Longer | 89 (58.6) 88 (65.2) 92 (62.8) 97 (71.3) | Ref 1.11 (0.93, 1.34) 1.07 (0.89, 1.29) 1.22 (1.03, 1.44) | 66 (42.9) 41 (30.2) 48 (32.6) 30 (21.9) | Ref 0.70 (0.51, 0.96) 0.76 (0.57, 1.02) 0.51 (0.35, 0.74) |
OUD Severity Mild/Moderate Severe | 67 (72.0) 271 (62.2) | Ref 0.86 (0.74, 1.00) | 14 (14.7) 159 (36.1) | Ref 2.45 (1.49, 4.04) |
Ever Injected Heroin No Yes | 255 (70.8) 98 (50.3) | Ref 0.71 (0.61, 0.83) | 107 (29.3) 75 (38.5) | Ref 1.31 (1.03, 1.66) |
Cocaine Use in Past 30 Days No Yes | 196 (68.8) 169 (59.5) | Ref 0.86 (0.76, 0.98) | 82 (28.6) 103 (35.8) | Ref 1.25 (0.98, 1.59) |
Crack Use in Past 30 Days No Yes | 265 (65.0) 100 (62.1) | Ref 0.96 (0.83, 1.10) | 121 (29.2) 64 (39.8) | Ref 0.96 (0.83, 1.10) |
Marijuana Use in Past 30 Days No Yes | 235 (66.2) 130 (60.8) | Ref 0.92 (0.80, 1.05) | 96 (26.9) 89 (40.8) | Ref 1.52 (1.20, 1.92) |
Benzodiazepine Use in Past 30 Days No Yes | 254 (66.5) 111 (59.4) | Ref 0.89 (0.78, 1.02) | 105 (27.2) 80 (42.3) | Ref 1.56 (1.23, 1.96) |
Fentanyl Detected in Urine Analysis No Yes | 184 (68.9) 179 (59.7) | Ref 0.86 (0.76, 0.98) | 89 (33.2) 95 (31.2) | Ref 0.94 (0.74, 1.19) |
Oxycodone Detected in Urine Analysis No Yes | 344 (63.9) 19 (65.5) | Ref 1.02 (0.78, 1.34) | 172 (31.8) 12 (37.5) | Ref 1.18 (0.74, 1.88) |
Heroin Detected in Urine Analysis No Yes | 49 (62.0) 314 (64.3) | Ref 1.04 (0.86, 1.25) | 32 (40.5) 152 (30.8) | Ref 0.76 (0.56, 1.02) |
Stigma (Median ≥13) No Yes | 167 (60.5) 189 (68.5) | Ref 1.13 (1.00, 1.28) | 84 (30.3) 96 (34.3) | Ref 1.13 (0.89, 1.44) |
PTSD No Yes | 330 (65.0) 35 (57.4) | Ref 0.88 (0.70, 1.11) | 161 (31.4) 24 (38.7) | Ref 1.23 (0.88, 1.73) |
Omnibus Mental Health* | | Ref 0.95 (0.86, 1.04) | | Ref 1.30 (1.14, 1.48) |
Depression No Yes | 172 (65.9) 193 (62.7) | Ref 0.95 (0.84, 1.08) | 66 (24.9) 119 (38.4) | Ref 1.54 (1.20, 1.98) |
Anxiety No Yes | 210 (67.5) 155 (60.1) | Ref 0.89 (0.78, 1.01) | 89 (28.2) 96 (36.9) | Ref 1.31 (1.03, 1.66) |
Suicidality No Yes | 349 (64.4) 16 (59.3) | Ref 0.92 (0.67, 1.27) | 170 (31.1) 15 (53.6) | Ref 1.72 (1.19, 2.49) |
SEP Visits in Past 3 Months No Yes | 251 (73.4) 80 (47.3) | Ref 0.64 (0.54, 0.76) | 95 (27.4) 64 (37.6) | Ref 1.38 (1.06, 1.78) |
Currently Opioid Treatment No Current Treatment Medication Assisted Treatment | 161 (64.1) 204 (64.2) | Ref 1.00 (0.88, 1.13) | 99 (39.1) 86 (26.7) | Ref 0.68 (0.54, 0.86) |
Ever Trained to Administer Naloxone No Yes | 162 (85.3) 200 (53.3) | Ref 0.62 (0.56, 0.70) | 51 (26.4) 132 (34.9) | Ref 1.32 (1.00, 1.74) |
Administered Naloxone in Past 3 Months No Yes | 325 (69.3) 40 (40.0) | Ref 0.58 (0.45, 0.74) | 135 (28.5) 50 (49.5) | Ref 1.74 (1.36, 2.22) |
aMay not sum to 575 due to missing values |
*Median (IQR); scale is standardized |
Of the study population of opioid users, 65.8% were men and 33.5% were women; their mean age was 48.3 years with 55.7% 50 years of age or older; and 39.8% were Hispanic/Latinx, 37.7% were non-Hispanic Black, 18.4% were non-Hispanic white, and 3.3% were categorized as another racial/ethnic background (Table 1). The majority of the sample were unemployed (77.3%), currently homeless (30.1%), and had a history of incarceration (80.2%). The majority of those not experiencing homelessness lived with someone else (75.6%), with one-quarter reporting cohabitation with a romantic partner (25.9%) and 17.7% reported cohabitating with a romantic partner used opioids. Over one-quarter cohabited some someone who uses opioids, including romantic partners (28.0%).
Based on DSM-5 criteria, the majority of the sample had severe OUD (76.6%), with 34.0% reporting lifetime history of heroin injection. Urine-based toxicology indicated 85.9% had recent exposure to heroin, 53.1% to fentanyl, and 5.7% to oxycodone. Substantial proportions reported use of other drugs in the past 30 days including cocaine (50.0%), crack (28.0%), marijuana (37.8%), and a benzodiazepine (32.8%). Participants reported experiencing drug-related stigma (48.6%), depressive symptoms (54.1%), anxiety symptoms (45.4%), PTSD (10.8%), and suicidal ideation (4.9%). Only 29.0% reported SEP use. Of the 575 recruited participants, 65.8% had ever been trained to use naloxone, and 17.7% had administered it in the past three months.
Of those trained to use naloxone (n=379), 80% (302/379) were in possession of a THN kit at the time of the interview. The mean number of days naloxone was reported to be available when using opioids in the past 30 days was 7.9 days. When asked how often naloxone was available during opioid use events in the past 30 days, 45% of all participants reported naloxone was never available during opioid use, 35% it was sometimes, and 20% reported it was always available.
Network Size And Support By Respondent Characteristics (Table A)
The prevalence of respondents with a small network (in the bottom 25th percentile for number in the network; <5 members) was 22.7% (Table 1a). There was evidence that the prevalence of having a small network was lower in those who were 50 years or older (PR: 0.73; 95% CI: 0.54, 0.99), who lived with either a romantic partner or any person who uses opioids (partner: PR: 0.64, 95% CI 0.40, 1.04; any person: 0.71, 95% CI: 0.48, 1.04). Small network size also was less likely for those in MAT (PR: 0.67, 95% CI: 0.49, 0.90) and among those who were trained in and had administered naloxone (trained: PR: 0.66, 95% CI: 0.49, 0.90); (administered: PR: 0.42, 95% CI: 0.24, 0.76). Network size was not correlated with gender, race/ethnicity, socio-economic factors, drug use patterns, or mental health factors.
The prevalence of respondents with no material or emotional support (from either drug using network members or non-drug using network members) was 45.0% (Table 1a). A lack of support was more common among those aged 50 years and older (PR: 1.20; 95% CI: 1.00, 1.45) (Table 1a). Race/ethnicity, gender, and employment were not correlated with having or not having support. Lack of support was less common among respondents who were homeless (PR: 0.76; 95% CI: 0.63, 0.93), those with a history of incarceration (PR = 0.59; 95% CI: 0.39, 1.45), and those with severe OUD (PR: 0.72, 0.59, 0.88). Lack of support also was less likely among those who attended SEPs (PR: 0.76, 95% CI: 0.51, 0.95) and who were trained in and had administered naloxone (trained: PR: 0.87, 95% CI: 0.72, 1.05); (administered: PR: 0.65, 95% CI: 0.48, 0.88).
Overdose Risk By Respondent Characteristics (Table B)
When asked how often both naloxone and a person trusted to administer it were present during opioid use events in the past 30 days, 65% reported both naloxone and a person to administer it was never available during opioid use and hence were considered 0% protected from fatal overdose during those events. Having 0% overdose protection was more common among those aged 50 years and older (PR: 1.18, 95% CI: 1.03, 1.34), non-Hispanic Black respondents (PR: 1.27, CI: 1.05, 1.53) was less likely among opioid users who had severe OUD (PR: 0.86, 95% CI: 0.74, 1.00), who injected heroin (PR: 0.71, 95% CI: 0.61, 0.83), and who tested positive for fentanyl (95% CI: 0.86, 95% CI: 0.76, 0.98). There was also evidence that 0% protection was less common among those who used other substances including cocaine (PR: 0.86, 95% CI: 0.76, 0.98) and benzodiazepines (PR: 0.89, 95% CI: 0.78, 1.02) and who had anxiety symptoms (PR: 0.89, 95% CI: 0.78, 1.01). Those who were trained in and who had administered naloxone also were less likely to be 0% protected during opioid use (trained: PR: 0.62, 95% CI: 0.56, 0.70); (administered: PR: 0.58, 95% CI: 0.45, 0.74).
A total of 185 (32%) had an OD experience in the past 30 days at baseline. Having experienced an overdose was less common among those aged 50 years and older (PR: 0.60, 95% CI: 0.47, 0.77) and non-Hispanic Black respondents (PR: 0.62, 95% CI: 0.46, 0.85) and was more common among those who were employed (PR: 1.44, 95% CI: 1.12, 1.84). Overdose experience was more common among opioid users who had severe OUD (PR: 2.45; 95% CI: 1.49, 4.04), and those who injected heroin (PR: 1.31; 95% CI: 1.03, 1.66). There is also evidence that overdose experience was more common among those who used other substances including cocaine (PR: 1.25, 95% CI: 0.98, 1.59), marijuana (PR: 1.52; 95% CI: 1.20, 1.92) and benzodiazepines (PR: 1.56, 95% CI: 1.23, 1.96). Overdose experience was strongly associated with suicidality (PR: 1.72, 95% CI: 1.19, 2.49) and also was associated with symptoms of depression (PR: 1.54: 95% CI: 1.20, 1.98) and anxiety (PR: 1.31, 95% CI 1.03, 1.66). Those who were trained in and who had administered naloxone also were more likely to have more overdose experiences (trained: PR: 1.32, 95% CI: 1.00, 1.74); (administered: PR: 1.74, 95% CI: 1.36, 2.22).Those who tested positive for fentanyl did not have elevated overdose experiences compared with those who tested negative (PR: 0.94; 95% CI: 0.74, 1.19).
Associations: Network and Support Factors and 0% Protection (Lacks Naloxone and/or Person to Administer It) During Opioid Use (Table 2)
Table 2
Associations between Network and Support Factors and Never Protected with Naloxone and a Person to Administer during Opioid Use Events in Past 30 Days
| N (%) with No Protection | PR (95% CI) | APR (95% CI)a |
Network Size (Injecting) More than 1 0 in Network | 64 (43.8) 38 (69.1) | Ref 1.58 (1.22, 2.03) | Ref 1.61 (1.23, 2.11) |
Network Size (Opioid-Using) More than 5 <5 in Network | 275 (62.5) 90 (69.8) | Ref 1.37 (0.90, 2.09) | Ref 1.14 (0.98, 1.31) |
Network Size (Opioid Using, Excluding Injectors) More than 5 <5 in Network | 201 (71.3) 62 (72.10 | Ref 1.01 (0.87, 1.18) | Ref 1.03 (0.88, 1.21) |
Non-using Network Gave Place to Stay in Past 3 Months No Yes | 248 (65.1) 117 (63.2) | Ref 0.97 (0.85, 1.11) | Ref 1.08 (0.93, 1.24) |
Non-using Network Gave Money in Past 3 Months No Yes | 133 (62.7) 229 (64.9) | Ref 1.03 (0.91, 1.18) | Ref 1.07 (0.93, 1.22) |
Non-using Network Gave Emotional Support in Past 3 Months No Yes | 80 (61.1) 281 (65.2) | Ref 1.06 (0.92, 1.24) | Ref 1.17 (0.99, 1.38) |
Using Network Gave Place to Stay in Past 3 Months No Yes | 267 (65.4) 98 (61.2) | Ref 0.94 (0.81, 1.08) | Ref 1.03 (0.88, 1.20) |
Using Network Gave Money in Past 3 Months No Yes | 211 (68.5) 154 (59.5) | Ref 0.87 (0.76, 0.98) | Ref 0.85 (0.75, 0.98) |
Using Network Gave Emotional Support in Past 3 Months No Yes | 144 (72.0) 221 (60.2) | Ref 0.84 (0.74, 0.94) | Ref 0.87 (0.76, 0.99) |
Support from Networks No Support At Least One Form of Support from Using At Least One Form of Support from Non-Using At Least One From of Support from Both | 41 (69.5) 16 (48.5) 174 (62.6) 132 (68.0) | Ref 0.70 (0.47, 1.03) 0.98 (0.80, 1.19) 0.90 (0.74, 1.09) | Ref 0.70 (0.47, 1.04) 1.00 (0.82, 1.24) 0.95 (0.77, 1.16) |
Currently Lives with Romantic Partner No Yes | 277 (65.8) 88 (59.5) | Ref 0.90 (0.78, 1.05) | Ref 0.89 (0.76, 1.04) |
Currently Lives with Romantic Partner who Uses Opioids No Yes | 312 (67.0) 53 (51.5) | Ref 0.77 (0.63, 0.94) | Ref 0.77 (0.62, 0.95) |
Currently Lives with Anyone No Yes | 92 (66.7) 272 (63.3) | Ref 0.95 (0.83, 1.09) | Ref 0.99 (0.85, 1.15) |
Currently Lives with Anyone who Uses Opioids No Yes | 267 (68.1) 82 (52.6) | Ref 0.77 (0.66, 0.91) | Ref 0.79 (0.66, 0.94) |
Current Living Situation Lives Alone Not with Anyone Who Uses Opioids Someone Who Uses Opioids | 92 (66.7) 175 (68.9) 82 (52.6) | Ref 1.03 (0.89, 1.19) 0.79 (0.65, 0.95) | Ref 1.06 (0.91, 1.24) 0.82 (0.67, 1.01) |
aAdjusted for age, sex, race/ethnicity, current homelessness, and OUD severity |
Network Size.
In both unadjusted analyses and in multivariable analyses adjusting for age, sex, race/ethnicity, current homelessness, and OUD severity, among injectors, having no person in one’s injection network was associated with moderate increases in the prevalence of having no protection during opioid use events (APR: 1.61, 95% CI: 1.23, 2.11) (Table 3). In the sample overall, when including injecting and non-injecting participants, the APR for the association between small network size (<5 persons) and never being protected during opioid use was 1.14 (95% CI: 0.98, 1.31).
Table 3
Associations between Network and Support Factors and Any OD Experiences in Past 30 Days
| N (%) with OD Experience | PR (95% CI) | APR (95% CI)a |
Network Size (Injecting) More than 1 0 in Network | 65 (44.5) 15 (27.3) | Ref 0.61 (0.38, 0.99) | Ref 0.80 (0.51, 1.26) |
Network Size (Opioid Using) More than 5 <5 in Network | 143 (32.3) 42 (32.1) | Ref 0.99 (0.75, 1.32) | Ref 1.04 (0.79, 1.36) |
Network Size (Opioid Using, Excluding Injectors) More than 5 <5 in Network | 79 (27.7) 26 (29.2) | Ref 1.05 (0.72, 1.53) | Ref 1.12 (0.78, 1.60) |
Non-using Network Gave Place to Stay in Past 3 Months No Yes | 104 (26.9) 80 (43.0) | Ref 1.60 (1.26, 2.02) | Ref 1.42 (1.10, 1.83) |
Non-using Network Gave Money in Past 3 Months No Yes | 60 (27.9) 122 (34.3) | Ref 1.23 (0.95, 1.59) | Ref 1.05 (0.81, 1.36) |
Non-using Network Gave Emotional Support in Past 3 Months No Yes | 29 (21.8) 152 (34.9) | Ref 1.60 (1.13, 2.27) | Ref 1.41 (0.99, 2.00) |
Using Network Gave Place to Stay in Past 3 Months No Yes | 111 (26.9) 73 (45.3) | Ref 1.69 (1.34, 2.13) | Ref 1.52 (1.18, 1.95) |
Using Network Gave Money in Past 3 Months No Yes | 92 (29.4) 92 (35.4) | Ref 1.20 (0.95, 1.53) | Ref 1.22 (0.96, 1.55) |
Using Network Gave Emotional Support in Past 3 Months No Yes | 54 (26.7) 129 (34.8) | Ref 1.30 (1.00, 1.70) | Ref 1.27 (0.96, 1.67) |
Support from Networks No Support At Least One Form of Support from Using At Least One Form of Support from Non-Using At Least One Form of Support from Both | 8 (13.3) 13 (39.4) 57 (28.9) 104 (37.1) | Ref 2.95 (1.36, 6.40) 2.17 (1.10, 4.29) 2.78 (1.43, 5.41) | Ref 2.79 (1.31, 5.93) 1.89 (0.97, 3.67) 2.30 (1.20, 4.39) |
Currently Lives with Romantic Partner No Yes | 133 (31.3) 52 (34.7) | Ref 1.11 (0.85, 1.45) | Ref 1.11 (0.95, 1.46) |
Currently Lives with Romantic Partner who Uses Opioids No Yes | 148 (31.4) 37 (35.9) | Ref 1.14 (0.86, 1.53) | Ref 1.00 (0.72, 1.39) |
Currently Lives with Anyone No Yes | 41 (29.3) 144 (33.2) | Ref 1.13 (0.85, 1.51) | Ref 1.02 (0.75, 1.39) |
Currently Lives with Anyone who Uses Opioids No Yes | 121 (30.4) 58 (37.2) | Ref 1.22 (0.95, 1.57) | Ref 1.09 (0.83, 1.44) |
Current Living Situation Lives Alone Not with Anyone Who Uses Opioids Someone Who Uses Opioids | 41 (29.3) 80 (31.0) 58 (37.2) | Ref 1.06 (0.77, 1.45) 1.27 (0.91, 1.76) | Ref 0.98 (0.71, 1.36) 1.08 (0.75, 1.54) |
aAdjusted for age, sex, race/ethnicity, current homelessness, and OUD severity |
Cohabitation Romantic and Non-Romantic Partners.
There was evidence that cohabitation with a romantic partner is protective against having 0% protected opioid use events (APR: 0.89, 95% CI: 0.76, 1.04). Living with a partner who also uses opioids was associated with a 23% reduction in the hazard of having no protection during opioid use (APR: 0.77, 95% CI: 0.62, 0.95). While there was a weak and non-significant relationship between living with anyone and protected events (APR: .99, 95% CI: .85, 1.15), living with anyone who uses opioids was associated with having more than 25% more protected use events.
Associations: Network And Support Factors And Overdose (Table )
Network Size.
In both unadjusted and adjusted analyses, among injectors, there was little evidence of an association between network size and overdose risk.
Cohabitation Romantic and Non-Romantic Partners.
Cohabitation with a romantic partner, with a partner who also uses opioids, or with anyone was not associated with overdose experiences.