BACKGROUND: Drug overdose has emerged as the leading cause of injury-related death in the U.S., driven by prescription opioid (PO) misuse, polysubstance use and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations there is a need for a more comprehensive assessment of related risk behaviors. We developed the opioid-related Overdose Risk Behavior Scale (ORBS), drawing on existing research, formative interviews, and discussions with community and scientific advisors.
METHODS: We enrolled military veterans reporting any use of heroin or POs in the past month using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. We assessed internal reliability using Cronbach’s alpha; test-retest reliability using intraclass correlation coefficients (ICCs); and criterion validity using Pearson’s correlations with indicators of having overdosed during the past 30 days.
RESULTS: Data for 220 veterans were analyzed. The 5 subscales-A. Adherence to Opioid Dosage and Therapeutic Purposes, B. Alternative Methods of Opioid Administration, C. Solitary Opioid Use; D. Use of Non-prescribed Overdose-associated Drugs and E. Concurrent Use of POs, Other Psychoactive Drugs and Alcohol-generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56.
CONCLUSIONS: These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research, and could help improve the precision of overdose education and prevention efforts.
Development of an Opioid-Related Overdose Risk Behavior Scale (ORBS)
Substance Abuse, 38 (3), 239-244. doi: 10.1080/08897077.2017.1282914. PMCID: PMC5522769.