Increased risk of non-fatal overdose associated with broad adverse childhood experiences among people who use drugs in New York City: a latent class analysis

<i>Background:</i> Adverse childhood experiences (ACEs) are linked to negative health outcomes. Yet how ACEs patterns are associated with non-fatal overdose among people who use drugs (PWUD) is underexplored, despite disproportionate rates of ACEs among this population.<i>Objectives:</i> We examined latent classes of ACEs and their associations with non-fatal overdose in PWUD in New York City (NYC).<i>Methods:</i> We conducted a latent class analysis based on self-reported exposure to ACEs: emotional/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.<i>Results:</i> Of 247 PWUD, 74.9% were men and 43.3% reported a lifetime non-fatal overdose. Identified classes were: 1) no/low ACEs (26.3%), 2) household dysfunction (parental separation/death, household substance use) (25.1%), 3) household dysfunction + emotional, physical, and sexual abuse (19.4%), 4) emotional and physical abuse (16.2%), and 5) experienced all ACEs (13.0%). 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 experiencing a 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).<i>Conclusions:</i> Findings suggest that those who experience a broad spectrum of ACEs may be at higher risk of non-fatal overdose. Addressing early-life adversity in harm reduction and treatment interventions may help mitigate overdose risk in this population.