Abstract
BACKGROUND: People experiencing homelessness are disproportionately affected by opioid use disorder (OUD), yet treatment engagement remains low. Understanding opioid-related health beliefs in this population may inform more tailored interventions.
OBJECTIVE: To characterize opioid-related health beliefs among homeless-experienced individuals with OUD and examine their alignment with opioid use severity.
METHODS: We conducted a cross-sectional survey of individuals initiating opioid treatment at a homeless healthcare program in Boston, Massachusetts. The survey assessed key Health Belief Model domains related to opioid use and incorporated the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) to quantify opioid use severity. We used nonparametric trend tests to examine associations between ASSIST quartiles (Q1 ≤ 23.5, Q2 23.6-33.0, Q3 33.1-38.0, and Q4 > 38.0) and belief domains.
RESULTS: Among 148 participants, the mean age was 41.7 years; 51.4% identified as White, 16.2% as Black, and 38.5% as Hispanic. Higher ASSIST quartiles, indicating higher opioid use severity, were significantly associated with greater perceived threat, including being very worried about opioid use (25% in Q1 vs. 72.7% in Q4; p = 0.001), perceiving very high overdose risk (4.2% vs. 40.9%; p = 0.006), and viewing overdose as very dangerous (87.5% vs. 100%; p = 0.036). Higher ASSIST quartiles were also significantly associated with greater perceived benefits, including that abstaining from opioids (78.3% vs. 100%; p = 0.004) and taking MOUD (69.6% vs. 95.2%; p = 0.016) would improve quality of life.
CONCLUSIONS: Individuals with greater opioid use severity endorsed higher perceived opioid-related threats and treatment-related benefits. Interventions that highlight these beliefs may help enhance treatment engagement in this high-risk population.