Exploring risk tolerance among individuals who use opioids.

Higher overdose risk may be influenced by risk tolerance, which may influence risky behaviors for individuals who misuse opioids and/or stimulants. We investigate overdose-related risk tolerance in this population. Adults (18-75 years, N = 181) with past-month opioid misuse and phone access remotely completed a questionnaire on demographics, substance use, preferred opioid, and an overdose probabilistic discounting task (i.e., risk tolerance). Regression models compared opioid preferences (street vs. prescription) and/or costimulant use (vs. no use) on the outcome of risk tolerance. In the sample, 53% and 47% preferred to use/misuse street and prescription opioids, respectively. Overdose risk tolerance was significantly higher for individuals who use street opioids compared to individuals who use prescription opioids (p < .001). Risk tolerance was significantly higher among those who used fentanyl (area under the curve [AUC] M ± SD = 0.56 ± 0.23) compared to heroin (AUC M ± SD = 0.44 ± 0.24; p = .031), prescription opioids (AUC M ± SD = 0.24 ± 0.21; p = .032), and medication for opioid use disorder (AUC M ± SD = 0.38 ± 0.27; p = .004). Street opioids (F = 35.09, p < .0001) and stimulant use severity (F = 4.51, p = .035) were significantly associated with increased risk tolerance. Individuals who prefer fentanyl and those with high stimulant use severity show the highest overdose risk tolerance and should continue to be prioritized for interventions to reduce overdose risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).