Primary Submission Category: Health behaviors
Adverse childhood experiences and lifetime non-fatal overdose among a community-recruited sample of people who use drugs in New York City: A latent class analysis
Authors: Mehrdad Khezri, Fabiha Rahman, Amanda M. Bunting,
Presenting Author: Mehrdad Khezri*
Background: Adverse childhood experiences (ACEs) are linked to a range of negative health outcomes, yet few studies examine distinct ACEs patterns and their association with non-fatal overdose among people who use drugs (PWUD), despite high trauma rates in this population. We examined latent classes of ACEs and their associations with non-fatal overdose in PWUD in New York City (NYC).
Methods: We conducted a latent class analysis of 247 PWUD using self-reported ACEs, including emotional and physical neglect, emotional, physical, and sexual abuse, household mental illness, household substance use, domestic violence, parental separation/death, and household incarceration. Multivariable logistic regression assessed associations of ACEs classes with lifetime non-fatal overdose, adjusting for sociodemographics and substance use severity.
Results: The mean age was 46.1 years, 74.9% were men, and 43.3% reported a lifetime non-fatal overdose. A five-class model best fit the data: 1) no/low ACEs (26.3%), 2) experienced all ACEs (13.0%), 3) household dysfunction (parental separation/death, household substance use) (25.1%), 4) household dysfunction + emotional, physical, and sexual abuse (19.4%), and 5) emotional and physical abuse (16.2%). Compared to no/low ACEs, those in the experienced all ACEs class (aOR 4.92; 95%CI 1.71-14.9) and in the household dysfunction class (aOR 3.14; 95%CI 1.31-7.77) had higher odds of non-fatal overdose. Other factors associated with non-fatal overdose included unstable housing (aOR 2.73; 95%CI 1.40-5.42), moderate/high cocaine use disorder (aOR 2.60; 95%CI 1.05-6.71), and moderate/high opioid use disorder (aOR 4.25; 95%CI 2.07-9.14).
Conclusions: Findings highlight heterogeneity in childhood adversity among PWUD and suggest that those who experience a broad spectrum of ACEs may be at higher risk of non-fatal overdose. Addressing early-life trauma in harm reduction and treatment interventions may help mitigate overdose risk in this population.