Route of opioid consumption and association with overdose among people who inject drugs in Seattle, WA: an analysis of the National HIV Behavioral Surveillance survey 2005 – 2022

To better characterize trends in route of opioid consumption and associations with overdose, we analyzed data from six cycles of the National HIV Behavioral Surveillance survey from 2005 to 2022. Respondents reported injection and non-injection use of heroin, prescription opioids, fentanyl, and goofballs as well as overdose in the past 12 months. Proportional odds logistic regression found less heroin injection after the 2012 cycle. Robust Poisson regression found prevalence of overdose was greater among respondents who consumed heroin through both injection and non-injection compared to only non-injection routes, with the largest prevalence ratios favoring non-injection use identified during the 2018 and 2022 cycles. Future research is needed to clarify how routes of fentanyl use are changing and their associations with overdose.