Validation of the Opioid Overdose Risk Behavior Scale, version 2 (ORBS-2)

Area of Science:

• Public Health
• Epidemiology
• Psychometrics

Background:

• Opioid-related overdose remains a critical public health issue in the U.S.
• Existing instrumentation for assessing behavioral risk factors is limited.
• The opioid overdose risk behavior scale (ORBS-1) was revised and expanded (ORBS-2) for broader application.

Purpose of the Study:

• To examine the factor structure of the revised and expanded opioid overdose risk behavior scale (ORBS-2).
• To assess the associations between ORBS-2 subscales and known overdose indicators and clinical constructs.

Main Methods:

• Adults (N=575) reporting current unprescribed opioid use in NYC were recruited via respondent-driven sampling.
• Participants completed the ORBS-1, ORBS-2, and clinical measures, with follow-up assessments over 13 months.
• Principal components analysis was used to identify ORBS-2 subscales.

Main Results:

• Six ORBS-2 subscales were identified: Prescription Opioid Misuse, Risky Non-Injection Use, Injection Drug Use, Concurrent Opioid and Benzodiazepine Use, Concurrent Opioid and Alcohol Use, and Multiple-Drug Polysubstance Use.
• Five subscales significantly correlated with self-reported non-fatal overdose (p < .01).
• The Risky Non-Injection Use subscale showed the strongest association with past-month overdose indicators.

Conclusions:

• The psychometric properties of the ORBS-2 subscales support their utility in epidemiological research and clinical practice.
• The ORBS-2 provides insight into proximal, behavioral factors crucial for overdose risk communication and minimization.
• This instrumentation can help reduce overdose mortality.