The epidemic of opioid-related overdose is a persistent problem in the US. While several social network characteristics have been found to influence individual overdose risk, the influence of overdose occurring within one?s social network on individual overdose risk has not yet been assessed, and potential mediators or moderators of this effect have not yet been explored. The parent project upon which this Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health- Related Research (F31 - Diversity) application builds is a randomized clinical trial that will assess an intervention to reduce overdose risk among persons at risk of opioid-related overdose. The objective of this proposal is to examine the influence of nonfatal and fatal overdose in social networks (reported at baseline) on individuals? subsequent overdose risk at 6- and 12- months post-baseline. This F31, which is undergirded by Protection Motivation Theory, will augment the existing parent grant by developing and integrating an egocentric network assessment tool into existing assessments in the parent project that occur at baseline; this tool will be used to assess exposure to overdose within one?s social network as well as potential moderators of the effect under study. Semi-structured interviews will also be conducted to probe and explore potential mediators of the effect of nonfatal and fatal overdose in social networks on individual overdose risk, including risk perception, trauma, grief, and disruptions in social support and drug supply. The primary outcome for the proposed project will be the rate of self-reported overdose at 6- and 12- months post-baseline, and the primary analysis will be supplemented with data on nonfatal overdose events occurring within 12 months post-baseline, which will ascertained through a CDC-funded statewide overdose surveillance system. This research will be first to utilize a mixed-methods research design to assess the effect of nonfatal and fatal overdose in social networks on individual overdose risk and explore potential mediators and moderators of the effect under investigation. Those who are at risk of overdose require novel, targeted, and effective overdose prevention interventions to mitigate overdose risk, and the proposed research study is well-poised to inform network-based intervention strategies. If successful, the current study may provide additional evidence to provide survivor-centered harm reduction and treatment outreach to individuals who have overdosed and members of their social network.
This proposal will apply social network analysis and qualitative methods to evaluate the influence of overdose occurring within one?s social network on individual overdose risk, as well as potential mediators and moderators of this effect. Analyses are expected to inform behavioral and network-based interventions that aptly target social network members who are at elevated risk of overdose.