Opioid Protective Behavioral Strategies Scale (OPBSS)

Abstract

The Opioid Protective Behavioral Strategies Scale (OPBSS), developed by Hurlocker and Pearson (2025), is a specialized psychometric tool designed to quantify the frequency with which individuals who use licit or illicit opioids employ protective behavioral strategies (PBS). The development of the OPBSS was motivated by the success of existing validated PBS measures for alcohol and cannabis, aiming to fill a critical gap in the assessment of opioid-specific risk mitigation behaviors.

The initial development involved adapting items from established PBS measures and synthesizing existing literature on opioid harm reduction, resulting in a 60-item pool. Following rigorous item analysis and exploratory factor analysis (EFA) administered to adults in the U.S. reporting recent opioid use, the scale was refined to its final 46-item structure. The psychometric analyses confirmed a robust two-factor model consisting of Controlled Opioid Use (COU) and Serious Harm Reduction (SHR).

Keywords

Controlled Opioid Use, Serious Harm Reduction, Protective Behavioral Strategies, Opioids, Harm Reduction, Substance Use and Addiction Measures, Opioid Analgesics, Psychometric Evaluation.

Authors

Hurlocker, Margo C., Pearson, Matthew R.

Purpose

The primary objective of the OPBSS is to systematically assess specific behaviors utilized by individuals to reduce the risks associated with opioid consumption. These behaviors, collectively known as protective behavioral strategies, are actions taken before, during, after, or instead of opioid use with the explicit goal of preventing risky or harmful outcomes.

By measuring these strategies, the OPBSS provides researchers and clinicians with a tool to understand individual differences in risk management related to opioid use, which is crucial for developing targeted interventions and evaluating the effectiveness of harm reduction programs.

Construct

The OPBSS measures the construct of Protective Behavioral Strategies (PBS) specifically applied to opioid use. This construct encompasses conscious, deliberate actions taken by users to minimize negative consequences, ranging from minor social or functional impairments to severe health risks like overdose or legal trouble.

The scale is empirically structured around two distinct factors: Controlled Opioid Use (COU), which focuses on managing the timing, quantity, and context of use (e.g., avoiding use before work or to cope with emotions), and Serious Harm Reduction (SHR), which involves critical safety measures aimed at preventing acute, life-threatening harm (e.g., avoiding mixing substances, limiting dosage, using trusted sources).

Validity

The psychometric evaluation provided substantial evidence for the scale’s validity across multiple domains. Criterion-related validity was established by demonstrating significant differences in opioid-related characteristics based on OPBSS factor scores, determined via ANOVAs. Specifically, both COU and SHR factors showed main effects related to opioid type and route of administration (e.g., COU: F(3, 323) 4.13, p= .007; SHR: F(3, 322)= 6.08, p< .001).

Partial support was found for Concurrent and Predictive Validity. OPBSS subscale scores were significantly associated with at-risk opioid use ($Delta F$ (2, 190) = 23.97, $Delta R^2$ = .146) and opioid-related consequences ($Delta F$ (2, 243) = 12.49, $Delta R^2$ = .063) at Time 1. Furthermore, Convergent Validity was supported by expected correlational patterns: the OPBSS factors correlated positively with established alcohol and cannabis PBS measures, and negatively correlated with negative opioid-related outcomes at both time points.

Reliability

The OPBSS subscales demonstrated high Internal Consistency, indicating that items within each factor measure the same underlying construct reliably. This suggests strong cohesion among the items comprising the Controlled Opioid Use and Serious Harm Reduction subscales.

Test-Retest Reliability was assessed over a one-month interval and generally supported the stability of the scale scores, with Intraclass Correlation Coefficients (ICCs) ranging between .40 and .64. However, the reliability analysis flagged two specific items (Items 6 and 37) as demonstrating poor temporal stability.

Factor Analysis

The scale underwent rigorous development utilizing Exploratory Factor Analysis (EFA) to determine its underlying structure. Initial analysis of the 60-item pool, guided by parallel analysis, suggested a two-factor solution (SRMR = .043). Six items were initially removed due to problematic near-equivalent cross-loadings, optimizing the factor clarity.

After re-estimation with 47 items, the two-factor solution was maintained (SRMR = .040). Following the removal of one additional item due to a factor loading below the established threshold of .40, the final EFA confirmed the 46-item measure’s structure, confirming the two distinct factors (COU and SHR) with an acceptable Standardized Root Mean Square Residual (SRMR = .040).

Instrument

Test Type: Original

Format: Items are rated using six response options (1 = Never to 6 = Always).

Language Available: English

Population Group: Human; Male; Female

Age Group: Adulthood (18 yrs & older)

Population Details: The OPBSS was administered to adults in the United States who reported using opioids in the past month.

Test Methodology: Test Validity; Concurrent Validity; Convergent Validity; Criterion Validity; Predictive Validity; Test Reliability; Internal Consistency; Test-Retest Reliability; Factor Analysis; Exploratory Factor Analysis

Keywords

Controlled Opioid Use, Serious Harm Reduction, Protective Behavioral Strategies, Opioids, Harm Reduction, Substance Use and Addiction Measures, Opioid Analgesics, Psychometric Evaluation.

Authors

Author ORCID Identifier: http://orcid.org/0000-0002-9744-8551 (Margo C. Hurlocker)

Affiliation Email addresses: [email protected]

Correspondence Address: University of New Mexico, Center on Alcohol, Substance Use, and Addictions, 2650 Yale Boulevard Southeast, MSC11 6280, Albuquerque, New Mexico, United States, 87106.

Permissions & Fee and Test Year

• Commercial: No

• Fee: No

• Permissions: May use for Research/Teaching purposes.

• Test Year: 2025

Reference’s

Hurlocker, M. C., & Pearson, M. R. (2025). Opioid Protective Behavioral Strategies Scale (OPBSS): Development and psychometric evaluation. Experimental and Clinical Psychopharmacology, 33(1), 100–108. https://doi.org/10.1037/pha0000738

Items of the Opioid Protective Behavioral Strategies Scale (OPBSS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

This measure consists of 46 items. The specific items are available in Table 2, Pages 104-105 of the source document (2025-17774-001).

• Factors and Subscales: Controlled Opioid Use (COU); Serious Harm Reduction (SHR).

Instructions: Please indicate how often you have used each of the following strategies in the past 30 days. Use the following scale:

1 = Never
2 = Rarely
3 = Occasionally
4 = Sometimes
5 = Usually
6 = Always

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Controlled Opioid Use

In the past 30 days, how often have you…

1. Only used opioids after completing all of the day’s responsibilities?

2. Avoided using while spending time with family?

3. Avoided using opioids before work or school?

4. Avoided using opioids to cope with emotions such as sadness or depression?

5. Used a designated driver (i.e., someone who has not used) after using opioids?

6. Limited use to weekends?

7. Avoided using opioids habitually (i.e., every day or multiple times a week)?

8. Avoided using opioids early in the day?

9. Avoided using opioids for several days in advance of a big test, interview, performance, or other engagement for which you needed to be crisp and were being evaluated?

10. Avoided buying opioids?

11. Avoided using opioids if currently taking any kind of prescription drug that might intensify the effects (e.g., make them feel more tired)?

12. Only used at night (i.e., not during the day)?

13. Stopped using opioids if you became anxious or paranoid?

14. Avoided using opioids in public places?

15. Taken periodic breaks if it felt like you were using opioids too frequently?

16. Bought less opioids at a time so you used less?

17. Excused yourself from the room if people were using opioids and you felt uncomfortable or did not wish to be offered opioids?

18. Avoided situations that you anticipated being pressured to use opioids?

19. Taken a break from using if feeling a loss of motivation?

20. Only used when you had nothing important to do for the rest of the day/night?

21. Avoided using opioids out of boredom?

22. Only used one time during a day/night?

23. Avoided using when feeling anxious (e.g., using to calm yourself down or stop worrying)?

24. Only used before special events (e.g., movies, concerts) or on special occasions?

25. To decrease tolerance, taken a break for a week or two, or taken longer breaks than usual between use?

26. Avoided using opioids before engaging in physical activity (i.e., exercise, hiking)?

27. Had a friend let you know when you’ve had enough?

28. Made sure that you went home with a friend?

29. Refused to ride in a car with someone who has been using opioids?

30. Had your drugs tested for fentanyl?

31. Avoided using opioids to manage pain?

Serious Harm Reduction

In the past 30 days, how often have you…

1. Avoided mixing opioids with alcohol?

2. Avoided bringing opioids into events or venues where you were likely to be searched?

3. Only purchased opioids from a trusted source?

4. Used only at home?

5. Avoided possibilities of legal repercussions (e.g., used in a safe place like home, avoided having opioids where you might get searched)?

6. Only used opioids on private property?

7. Limited the amount/dose of opioids you used in one sitting?

8. If attending a party or going out to a social event (e.g., bar), decided in advance whether you wanted to use opioids or not?

9. Used your own opioids (if alone or sharing with friends) so you knew what you were using?

10. Only used opioids in safe environments?

11. Determined not to exceed a set amount/dose of opioids?

12. Avoided combining opioids with benzodiazepines (like Valium, Xanax, Ativan, Klonopin, etc.)?

13. Avoided combining opioids with cocaine (i.e., speedballing)?

14. Made sure you used opioids with people who could take care of you if you used too much?

15. Avoided using injectable opioids?