Evaluating risk factors and protective clinical interventions for opioid use disorder and overdose in American Indian/Alaska Native populations

American Indian/Alaska Native (AI/AN) populations often experience higher rates of opioid use disorder (OUD) and opioid overdose deaths compared to other racial/ethnic groups. This study evaluates modifiable risk factors and protective clinical interventions for OUD and overdose prevention interventions among AI/AN patients to understand potential points of intervention. This retrospective cohort study utilized electronic health record data from the Oracle Cerner Real-World Database. The sample included AI/AN individuals aged ≥12 years with an index encounter for opioid prescription or a new OUD diagnosis between January 2006 - January 2021. Modifiable risk factors and protective clinical interventions or overdose prevention interventions included opioid and benzodiazepine co-occurrence, polysubstance use, and interventions such as medications for opioid use disorder (MOUD), safe substance use education, naloxone prescription, and urine drug testing. Adjusted hazard ratios (aHRs) were obtained via Cox Proportional-Hazard regressions. Individuals with a co-occurrence of opioids and benzodiazepines had a higher risk of developing OUD (aHR 1.32, 95% CI 1.19-1.45). Polysubstance use was significantly associated with an increased risk of OUD (aHR 1.85, 95% CI 1.58-2.17) and opioid overdose (aHR 1.47, 95% CI 1.04-2.09). Receiving safe substance use education was associated with a 19% lower risk of OUD (aHR 0.81, 95% CI 0.68-0.98). Prescriptions for naloxone (aHR 0.39, 95% CI 0.17-0.89) or MOUD (aHR 0.25, 95% CI 0.13-0.49) were associated with a lower risk for opioid overdose. The findings highlight key clinical practices and patient behaviors that may significantly affect the risk of OUD and overdose for AI/AN populations.