A new opioid overdose study has identified several key risk factors associated with non-fatal overdoses, as well as a significantly higher overdose rate, drawing from a sample of people who use opioids in New Haven.

This work was led by Md. Safaet Hossain Sujan, a Ph.D. student in the Department of Allied Health Sciences, alongside faculty Roman Shrestha, associate professor, and Michael Copenhaver, professor. The study was published in the Journal of Community Health.

Shrestha and Copenhaver have years of experience working with people who use opioids, but they had never looked at non-fatal overdose rates in the population.

In the past year, suspected non-fatal overdoses from opioids increased 39% in Connecticut, based on emergency room admissions data.

“The opioid epidemic, as we know, is a huge public health issue, especially with synthetic opiates like fentanyl that have created even more worrying patterns,” Shrestha says.

The researchers found that nearly half of the 199 participants had experienced a non-fatal overdose in their lifetime. This is significantly higher than the rate observed in previous studies, which found between 11 to 36% of their study population had experienced an overdose.

The researchers hypothesize that the higher rate they observed could be due to a number of factors including ongoing polysubstance use patterns, socioeconomic challenges, homelessness, and lack of access to harm reduction services.

Further, previous studies have taken place in opioid treatment centers where people are already connected to care. This study recruited participants from a syringe services program in New Haven.

“Our study was done in a community-based syringe services program, and not everybody was accessing care, and that may be one of the factors [that could explain why] the rate was higher in this particular study,” Shrestha says.

Doing this kind of study in a setting like a syringe services is critical as only about a quarter of people nationwide with opioid use disorder are accessing care with medications like methadone, which helps reduce opioid withdrawal symptoms. In this study, about a third of participants were involved in a drug treatment program. Nearly 80% reported they had experienced difficulty accessing addiction treatment services in the past year.

The research team identified several important patterns related to non-fatal overdoses, including experiencing suicidal ideation, depressive symptoms, alcohol use disorder, and opioid dependence. Based on previous work with this population, the researchers also know that they experience high rates of domestic violence.

“There are a lot of other concerning factors involved,” Copenhaver says. “So, it really makes it important to figure out how to handle the situation in the best way. We’re trying to get a grip on how to intervene effectively.”

Looking at demographic factors, the researchers found that older participants were less likely to experience an overdose. This may be because older people may be more likely to test their drug supply, the researchers say.

The findings of this study highlight not only the need to increase the number of people able to access treatment, but also the need to address factors like mental health challenges in these settings.

“Getting them into treatment may be the main intervention, because a lot of the factors could be addressed while they’re in treatment,” Copenhaver says. “Not everybody comes in with the same set of problems, but a lot of these do overlap with overdose issues.”

The researchers are working on developing digital tools to help more people access interventions for opioid use disorder, in addition to working with people in-person to encourage them to enroll in treatment.

“We want to make people aware of what is out there and how they can access those services, but making it a low-threshold model, making it easier for the users to access the services,” Shrestha says.

This work relates to CAHNR’s Strategic Vision area focused on Enhancing Health and Well-Being Locally, Nationally, and Globally.

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