Military veterans' overdose risk behavior: Demographic and biopsychosocial influences

Addict Behav. 2019 Dec;99:106036. doi: 10.1016/j.addbeh.2019.106036. Epub 2019 Jun 25.


Background: U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City.

Methods: Participants (n = 218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor.

Results: Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference.

Conclusion: Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors-including mental health, pain and stressful life events-may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.

Keywords: Biopsychosocial framework; Opioid misuse; Opioids; Overdose; US military veterans.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Analgesics, Opioid / poisoning
  • Analgesics, Opioid / therapeutic use*
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Benzodiazepines / therapeutic use
  • Chronic Pain / drug therapy*
  • Chronic Pain / physiopathology
  • Depression / epidemiology
  • Depression / psychology
  • Drug Administration Routes
  • Drug Overdose*
  • Female
  • Health Risk Behaviors*
  • Homeless Persons / statistics & numerical data
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Opioid-Related Disorders*
  • Pain Measurement
  • Patient Health Questionnaire
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology
  • United States
  • Veterans / psychology
  • Veterans / statistics & numerical data*
  • Young Adult


  • Analgesics, Opioid
  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Benzodiazepines