Background:
The United States continues to experience significant overdose mortality driven by frequent changes and disruptions in the street drug supply. Identifying individual-level factors that influence resilience or vulnerability during drug market disruptions is essential to inform public health interventions and reducing overdose risks.
Methods:
We analyzed data from the CARE2HOPE cohort study of 339 people who use drugs in Appalachian Kentucky, focusing on 154 individuals with data across two periods reflecting different drug market conditions: stable supply (October 2019-March 6, 2020) and disrupted supply (March 7-December 2020). Using generalized estimating equations, we assessed seven individual-level characteristics selected a priori for unadjusted and adjusted associations with self-reported past six-month nonfatal overdose.
Results:
During the stable supply period, 20 participants reported a nonfatal overdose, compared to 11 during the disrupted supply period. In unadjusted models, recent houselessness and past three-month incarceration significantly increased the odds of experiencing a nonfatal overdose, whereas higher monthly income and possession of naloxone were protective factors. In the multivariable model, only incarceration remained significantly associated with greater odds of a nonfatal overdose (aOR=12.8, 95% CI=1.0, 158.4).
Conclusion:
Our findings underscore the importance of structural supports and harm reduction access in mitigating overdose risks. Higher income and naloxone availability were identified as key protective factors, whereas incarceration and houselessness significantly increased overdose risk. This study highlights the urgent need for interventions that address social determinants of health and ensure harm reduction access to bolster resilience against overdose amidst a rapidly evolving drug landscape. |