{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:10:47Z","timestamp":1788772247993,"version":"build-2803163510"},"reference-count":53,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000008","name":"Health Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["General Hospital Psychiatry"],"published-print":{"date-parts":[[2026,9]]},"DOI":"10.1016\/j.genhosppsych.2026.08.005","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T05:56:52Z","timestamp":1785995812000},"page":"137-145","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Crisis within a crisis: Risk factors of overdose among those with severe concurrent disorders"],"prefix":"10.1016","volume":"102","author":[{"given":"Michael","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zayed","family":"Shahjahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina A.","family":"Thiessen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mackillop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonia L.","family":"Nicholls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian G.","family":"Sch\u00fctz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0005","author":"Casey"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0010","author":"BC Coroners Service"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0015","author":"Public Health Agency of Canada"},{"issue":"8","key":"10.1016\/j.genhosppsych.2026.08.005_bb0020","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.31398","article-title":"Trends in fatal poisoning among drug users in France from 2011 to 2021: an analysis of the DRAMES register","volume":"6","author":"Revol","year":"2023","journal-title":"JAMA Netw. Open"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0025","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5114\/ait.2020.94756","article-title":"The opioid crisis in North America: facts and future lessons for Europe","volume":"52","author":"Ayoo","year":"2020","journal-title":"Anaesthesiol Intensive Ther"},{"issue":"9","key":"10.1016\/j.genhosppsych.2026.08.005_bb0030","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/07067437251347150","volume":"70","author":"Russolillo","year":"2025","journal-title":"Can. J. Psychiatr."},{"issue":"19","key":"10.1016\/j.genhosppsych.2026.08.005_bb0035","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.1990.03450190043026","article-title":"Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study","volume":"264","author":"Regier","year":"1990","journal-title":"JAMA"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0040","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2022.109551","article-title":"Prevalence of mental disorders among people with opioid use disorder: a systematic review and meta-analysis","volume":"238","author":"Santo","year":"2022","journal-title":"Drug Alcohol Depend."},{"issue":"4","key":"10.1016\/j.genhosppsych.2026.08.005_bb0045","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00127-021-02199-2","article-title":"Mental disorder and opioid overdose: a systematic review","volume":"57","author":"van Draanen","year":"2022","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0050","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/add.15580","article-title":"Prevalence of co-occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada","volume":"117","author":"Keen","year":"2022","journal-title":"Addiction"},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0055","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1176\/appi.ajp.2011.10101476","article-title":"Risk of death from accidental overdose associated with psychiatric and substance use disorders","volume":"169","author":"Bohnert","year":"2012","journal-title":"Am. J. Psychiatry"},{"issue":"10","key":"10.1016\/j.genhosppsych.2026.08.005_bb0060","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1176\/appi.ps.20230338","article-title":"Prevalence of opioid use disorder and opioid overdose rates among people with mental illness","volume":"75","author":"Chen","year":"2024","journal-title":"Psychiatr. Serv."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0065","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2025.112702","article-title":"Prevalence and risk factors for opioid overdose among women: a systematic review and meta-analysis","volume":"273","author":"Neumaier","year":"2025","journal-title":"Drug Alcohol Depend."},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0070","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/pm\/pnx009","article-title":"Validation of a screening risk index for serious prescription opioid-induced respiratory depression or overdose in a US commercial health plan claims database","volume":"19","author":"Zedler","year":"2018","journal-title":"Pain Med."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0075","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2020.108127","article-title":"Socioeconomic marginalization and opioid-related overdose: a systematic review","volume":"214","author":"van Draanen","year":"2020","journal-title":"Drug Alcohol Depend."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0080","author":"Sch\u00fctz","year":"2025","journal-title":"Can. J Psychiatr. Rev. Can. Psychiatr."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0085","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2021.693673","article-title":"Understanding fatal and non-fatal drug overdose risk factors: overdose risk questionnaire pilot study\u2014validation","volume":"12","author":"Doggui","year":"2021","journal-title":"Front. Pharmacol."},{"issue":"4","key":"10.1016\/j.genhosppsych.2026.08.005_bb0090","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1467-9868.2010.00740.x","article-title":"Stability selection","volume":"72","author":"Meinshausen","year":"2010","journal-title":"J. R. Stat. Soc. Ser. B Stat Methodol."},{"issue":"9","key":"10.1016\/j.genhosppsych.2026.08.005_bb0095","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1111\/add.14991","article-title":"Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services","volume":"115","author":"Krawczyk","year":"2020","journal-title":"Addiction"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0100","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11904-018-0390-3","article-title":"The syndemic of opioid misuse, overdose, HCV and HIV: structural-level causes and interventions","volume":"15","author":"Perlman","year":"2018","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0105","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1377\/hlthaff.2018.05232","article-title":"A transitioning epidemic: how the opioid crisis is driving the rise in hepatitis C","volume":"38","author":"Powell","year":"2019","journal-title":"Health Aff. (Millwood)."},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0110","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1093\/eurpub\/cky142","article-title":"Hepatitis C prevalence and associated risk factors among individuals who are homeless and diagnosed with mental illness: at home\/chez soi study, Vancouver, BC","volume":"29","author":"Nikoo","year":"2019","journal-title":"Eur. J. Pub. Health"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0115","doi-asserted-by":"crossref","unstructured":"Cheema E, McGuinness K, Hadi MA, et al. Causes, nature and toxicology of fentanyl-associated deaths: a systematic review of deaths reported in peer-reviewed literature. J. Pain Res. 2020;Volume 13:3281\u20133294. doi:https:\/\/doi.org\/10.2147\/JPR.S280462.","DOI":"10.2147\/JPR.S280462"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0120","article-title":"Impact of hepatitis C serostatus on health service utilization for opioid-related harms among individuals prescribed opioid agonist therapy: a longitudinal prospective cohort study","volume":"16","author":"Guyatt","year":"2025","journal-title":"Drug Alcohol Depend Rep"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0125","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annepidem.2023.02.002","article-title":"Prevalence of hepatitis C virus among fatal drug overdoses in Tennessee: an analysis using 2019\u20132020 Tennessee state unintentional drug overdose reporting system data","volume":"80","author":"Korona-Bailey","year":"2023","journal-title":"Ann. Epidemiol."},{"issue":"7","key":"10.1016\/j.genhosppsych.2026.08.005_bb0130","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1093\/cid\/ciaa105","article-title":"Concurrent initiation of hepatitis C and opioid use disorder treatment in people who inject drugs","volume":"71","author":"Rosenthal","year":"2020","journal-title":"Clin. Infect. Dis."},{"issue":"7","key":"10.1016\/j.genhosppsych.2026.08.005_bb0135","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1093\/cid\/ciaa111","article-title":"Co-located opioid use disorder and hepatitis C virus treatment is not only right, but it is also the smart thing to do as it improves outcomes!","volume":"71","author":"Springer","year":"2020","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0140","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1186\/s12889-022-14506-w","article-title":"Concurrent use of opioids and stimulants and risk of fatal overdose: a cohort study","volume":"22","author":"Palis","year":"2022","journal-title":"BMC Public Health"},{"issue":"5","key":"10.1016\/j.genhosppsych.2026.08.005_bb0145","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1111\/add.14878","article-title":"The rise in non-fatal and fatal overdoses involving stimulants with and without opioids in the United States","volume":"115","author":"Hoots","year":"2020","journal-title":"Addict Abingdon Engl"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0150","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/10550887.2024.2331522","article-title":"Explaining the high mortality among opioid-cocaine co-users compared to opioid-only users. A systematic review","volume":"43","author":"Van Amsterdam","year":"2025","journal-title":"J. Addict. Dis."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0155","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2023.110985","article-title":"Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services","volume":"252","author":"Wagner","year":"2023","journal-title":"Drug Alcohol Depend."},{"issue":"8","key":"10.1016\/j.genhosppsych.2026.08.005_bb0160","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.26544","article-title":"Association of Methamphetamine and Opioid use with Nonfatal Overdose in rural communities","volume":"5","author":"Korthuis","year":"2022","journal-title":"JAMA Netw. Open"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0165","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s00406-022-01495-5","article-title":"Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis","volume":"273","author":"Hogg","year":"2023","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0170","doi-asserted-by":"crossref","DOI":"10.1016\/j.addbeh.2021.106889","article-title":"The association between type of trauma, level of exposure and addiction","volume":"118","author":"Levin","year":"2021","journal-title":"Addict. Behav."},{"issue":"3","key":"10.1016\/j.genhosppsych.2026.08.005_bb0175","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1177\/15248380231205821","article-title":"Association between adverse childhood experiences and opioid use-related behaviors: a systematic review","volume":"25","author":"Regmi","year":"2024","journal-title":"Trauma Violence Abuse"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0180","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugpo.2023.104117","article-title":"Socioeconomic marginalization and risk of overdose in a community-recruited cohort of people who use drugs: a longitudinal analysis","volume":"119","author":"Mitra","year":"2023","journal-title":"Int J Drug Policy"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0185","doi-asserted-by":"crossref","unstructured":"Dobkin PL, De CM, Paraherakis A, Gill K. The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers. Addiction 2002;97(3):347\u2013356. doi:https:\/\/doi.org\/10.1046\/j.1360-0443.2002.00083.x.","DOI":"10.1046\/j.1360-0443.2002.00083.x"},{"issue":"5","key":"10.1016\/j.genhosppsych.2026.08.005_bb0190","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/0306-4603(91)90016-B","article-title":"Social support and relapse: commonalities among alcoholics, opiate users, and cigarette smokers","volume":"16","author":"Havassy","year":"1991","journal-title":"Addict. Behav."},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0195","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1080\/26408066.2022.2150530","article-title":"Transportation barriers to outpatient substance use treatment programs: a scoping review","volume":"20","author":"Harwerth","year":"2023","journal-title":"J Evid-Based Soc Work"},{"issue":"5","key":"10.1016\/j.genhosppsych.2026.08.005_bb0200","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1080\/10826084.2021.1892137","article-title":"Cannabis use and nonfatal opioid overdose among patients enrolled in methadone maintenance treatment","volume":"56","author":"Bryson","year":"2021","journal-title":"Subst. Use Misuse"},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0205","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s12954-017-0183-9","article-title":"Rationale for cannabis-based interventions in the opioid overdose crisis","volume":"14","author":"Lucas","year":"2017","journal-title":"Harm Reduct. J."},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0210","doi-asserted-by":"crossref","unstructured":"Lake S, Walsh Z, Kerr T, et al. Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: a longitudinal analysis. Alegria M, ed. PLoS Med. 2019;16(11):e1002967. doi:https:\/\/doi.org\/10.1371\/journal.pmed.1002967.","DOI":"10.1371\/journal.pmed.1002967"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0215","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2020.108420","article-title":"Cannabis use is associated with reduced risk of exposure to fentanyl among people on opioid agonist therapy during a community-wide overdose crisis","volume":"219","author":"Soc\u00edas","year":"2021","journal-title":"Drug Alcohol Depend."},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0220","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/15504263.2018.1518553","article-title":"A review of integrated Care for Concurrent Disorders: cost effectiveness and clinical outcomes","volume":"15","author":"Karapareddy","year":"2019","journal-title":"J Dual Diagn"},{"issue":"1","key":"10.1016\/j.genhosppsych.2026.08.005_bb0225","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/1039856213510580","article-title":"Debate: clinical risk categorization is valuable in the prevention of suicide and severe violence? Yes","volume":"22","author":"O\u2019Connor","year":"2014","journal-title":"Australas Psychiatry"},{"key":"10.1016\/j.genhosppsych.2026.08.005_bb0230","series-title":"Brief Trauma Questionnaire","author":"Schnurr","year":"2012"},{"issue":"2","key":"10.1016\/j.genhosppsych.2026.08.005_bb0235","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/pmh.1570","article-title":"Normative data for the LPFS-BF 2.0 derived from the Danish general population and relationship with psychosocial impairment","volume":"17","author":"Weekers","year":"2023","journal-title":"Personal. Ment. Health"},{"issue":"12","key":"10.1016\/j.genhosppsych.2026.08.005_bb0240","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1046\/j.1360-0443.1998.9312185711.x","article-title":"The Maudsley addiction profile (MAP): a brief instrument for assessing treatment outcome","volume":"93","author":"Marsden","year":"1998","journal-title":"Addiction"},{"issue":"9","key":"10.1016\/j.genhosppsych.2026.08.005_bb0245","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"issue":"6","key":"10.1016\/j.genhosppsych.2026.08.005_bb0250","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/01.HTR.0000300227.67748.77","article-title":"Initial reliability and validity of the Ohio State University TBI identification method","volume":"22","author":"Corrigan","year":"2007","journal-title":"J. Head Trauma Rehabil."},{"issue":"9","key":"10.1016\/j.genhosppsych.2026.08.005_bb0255","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.addbeh.2014.02.013","article-title":"Examination of a short English version of the UPPS-P impulsive behavior scale","volume":"39","author":"Cyders","year":"2014","journal-title":"Addict. Behav."},{"issue":"5","key":"10.1016\/j.genhosppsych.2026.08.005_bb0260","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1093\/arclin\/acx020","article-title":"Validation of the NIH toolbox in individuals with neurologic disorders","volume":"32","author":"Carlozzi","year":"2017","journal-title":"Arch. Clin. Neuropsychol."},{"issue":"11_supplement_3","key":"10.1016\/j.genhosppsych.2026.08.005_bb0265","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1212\/WNL.0b013e3182872e11","article-title":"Emotion assessment using the NIH toolbox","volume":"80","author":"Salsman","year":"2013","journal-title":"Neurology"}],"container-title":["General Hospital Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0163834326001702?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0163834326001702?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T08:41:49Z","timestamp":1788770509000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0163834326001702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":53,"alternative-id":["S0163834326001702"],"URL":"https:\/\/doi.org\/10.1016\/j.genhosppsych.2026.08.005","relation":{},"ISSN":["0163-8343"],"issn-type":[{"value":"0163-8343","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Crisis within a crisis: Risk factors of overdose among those with severe concurrent disorders","name":"articletitle","label":"Article Title"},{"value":"General Hospital Psychiatry","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.genhosppsych.2026.08.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}