title: Correlates of overdose risk perception among illicit opioid users.
abstract: BACKGROUND
  Opioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk.
  
  
  METHODS
  We conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose.
  
  
  RESULTS
  Age (aOR=0.96, 95%CI=0.93-1.00) and number of injection days per month (0.91, 0.86-0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception.
  
  
  CONCLUSIONS
  Opioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies.
authors.affiliation: San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA. Electronic address: chris.rowe@sfdph.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rowe
authors.affiliation: San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Glenn-Milo
authors.initials: GM
authors.lastname: Santos
authors.affiliation: San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Behar
authors.affiliation: San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Philip O
authors.initials: PO
authors.lastname: Coffin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000401:mortality / Q000523:psychology*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: Opioid overdose; Risk factors; Risk perception; Substance use