Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 18:276:112895.
doi: 10.1016/j.drugalcdep.2025.112895. Online ahead of print.

Opioid withdrawal as a barrier to harm reduction: Examining how overdose prevention behaviors are affected by withdrawal

Grace Yi  1 , Lauren Dayton  2 , Anya Scott-Wallace  2 , Melissa Davey-Rothwell  2 , Seun Falade-Nwulia  3 , Carl Latkin  2
Affiliations

Opioid withdrawal as a barrier to harm reduction: Examining how overdose prevention behaviors are affected by withdrawal

Grace Yi et al. Drug Alcohol Depend. .

Abstract

Background and objectives: In the past decade, the increasing availability and prevalence of fentanyl in the drug supply have heightened the risk of fatal overdose and increased the frequency and severity of opioid withdrawal symptoms. We aimed to examine how opioid withdrawal impacts engagement in harm reduction behaviors among people who use drugs.

Methods: Data came from a community-based research study in Baltimore, Maryland, conducted from 2022 to 2024. Participants were adults who used heroin, fentanyl, or prescription opiates to get high in the past month (N = 676). Structured surveys assessed withdrawal as a barrier to testing drugs for potency and overdose prevention. Logistic regression models were used to identify correlates of engagement in harm reduction during periods of withdrawal.

Results: Half the sample (46.6 %) reported that withdrawal "always" or "often" prevented them from testing drugs, and 66.6 % agreed that withdrawal was a barrier to overdose prevention. Depression symptoms (adjusted odds ratio (aOR): 1.56, 95 % CI 1.09-2.25), increased opioid use per week (aOR: 1.12, 95 % CI 1.03-1.22), and White race (aOR: 1.75, 95 % CI 1.16-2.62) were independently associated with lower engagement in drug testing and overdose prevention during withdrawal.

Conclusions: Withdrawal significantly impacts engagement in harm reduction behaviors, even among those with high awareness and receptivity to drug testing and overdose prevention strategies. Withdrawal management and mental health support are emergent and critical components for harm reduction interventions to prevent overdose morbidity and mortality among people who use drugs.

Keywords: Drug testing; Opioid use; Overdose prevention; Withdrawal.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Administration, U.S. Food and Drug. 2018. “FDA approves the first non-opioid treatment for management of opioid withdrawal symptoms in adults.” FDA News Release.
    1. Andresen Elena M, Malmgren Judith A, Carter William B, and Patrick Donald L. 1994. “Screening for depression in well older adults: evaluation of.” Prev Med 10: 77–84. - PubMed
    1. Björgvinsson Thröstur, Kertz Sarah J, Bigda-Peyton Joe S, McCoy Katrina L, and Aderka Idan M. 2013. “Psychometric properties of the CES-D-10 in a psychiatric sample.” Assessment 20 (4): 429–436. - PubMed
    1. Bluthenthal Ricky N, Simpson Kelsey, Ceasar Rachel Carmen, Zhao Johnathan, Wenger Lynn, and Kral Alex H. 2020. “Opioid withdrawal symptoms, frequency, and pain characteristics as correlates of health risk among people who inject drugs.” Drug and alcohol dependence 211: 107932. - PMC - PubMed
    1. Bouvier Benjamin A, Kinnard Elizabeth N, Yedinak Jesse L, Li Yu, Elston Beth, Green Traci C, Hadland Scott E, and Marshall Brandon DL. 2019. “Prevalence and correlates of depressive symptomology among young adults who use prescription opioids non-medically.” Journal of Psychoactive Drugs 51 (5): 441–452. - PMC - PubMed

LinkOut - more resources