Development and Validation of a Protective Behavioral Strategies Scale for Individuals who use Opioids: Preliminary Findings and Future Directions

BACKGROUND: Protective Behavioral Strategies (PBS) are individually implemented harm reduction (HR) strategies to reduce the frequency or severity of risks associated with drug use. Existing scales measuring PBS for alcohol and cannabis suggest PBS are associated with reductions in associated problems. Despite many HR strategies related to opioid use, no PBS scale has been developed in the context of opioid use. To address this gap, this study aimed to test and validate a PBS scale for individuals using opioids (PBSO). METHODS: An online survey utilized a 32-item PBS scale for individuals endorsing recent opioid use, and measured opioid use frequency, HR service use, and experience of opioid overdose. PBSO items were rated on a Likert scale ranging from “never” (0) to “always” (6), and an exploratory factor analysis (EFA) examined factor structure. RESULTS: In the current sample (n=499; 32% female), EFA suggested a 3-factor structure among the 28 items retained, accounting for 51% of total variance. Factor 1 reflected health-service seeking, Factor 2 reflected individually-implemented and dose-reduction strategies, Factor 3 reflected social strategies, and Factor 4 reflected strategies related to injection drug use. Endorsement of PBSO items were slightly above “occasional” (3). PBSO use appeared positively related to past-month HR service utilization and negatively related to opioid use frequency. CONCLUSIONS: Findings provide preliminary support for the PBSO scale as a valid and reliable measure. Further work is needed to test this scale in larger samples, and future work should explore the association between PBSO and relevant health outcomes, and whether factor scores differentially impact these outcomes.