Karol Tatiana Walteros Silva - Academia.edu (original) (raw)
Papers by Karol Tatiana Walteros Silva
Background: Nonmedical prescription drug misuse among young adults is a significant public health... more Background: Nonmedical prescription drug misuse among young adults is a significant public health concern. Research has shown great heterogeneity in the types of motivations/factors behind different patterns of prescription drug misuse among young adults and adolescents. Understanding individual-level risk factors (e.g., personalities and predispositions) can help inform the type of prevention or intervention efforts to be targeted for different groups. Moreover, they can assist in delineating appropriate prevention or intervention approaches to be used (e.g., building on specific strengths/characteristics of the individual). Method: Young adults (aged 16 to 25 years) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive groups of nonmedical prescription drug users based on participants' coping and emotion regulation tendencies (N=560). After controlling fo...
Background. Incidence of hepatitis C virus (HCV) has increased among young adults over the past 1... more Background. Incidence of hepatitis C virus (HCV) has increased among young adults over the past 10 years. During this same period, misuse of prescription opioids (PO) has risen among young adults. This analysis compares young injection drug users (IDUs) who have ever injected PO with young IDUs who have not to determine negative health outcomes associated with injecting PO, including HCV. Methodology. Young IDUs were recruited in New York and Los Angeles between 2009-11. Eligible participants had misused any prescription drug at least three times in the past three months. A total of 253 young adults who had ever injected drugs qualified for study enrollment. Multivariate analysis focused on factors associated with ever injecting PO, including patterns of drugs use, syringe sharing, and HCV. Results. A greater proportion of the sample had ever injected PO (60.9%) compared to those who had not (39.1%). Key factors associated with PO injection included: current IDU; ever incarcerated; ...
Introduction: Research has demonstrated associations between substance use and unsafe sexual beha... more Introduction: Research has demonstrated associations between substance use and unsafe sexual behavior. This study examined whether recent substance use predicts unsafe sex among high-risk youth. Methods: Between October 2009 and March 2011, 596 high risk youth (polydrug users, homeless, and injection drug users) aged 16 to 25, were interviewed in Los Angeles and New York City. Use of prescription and illicit drugs, and condoms in the last 90 days, and current psychosocial correlates were assessed. Multivariate logistic regression analysis was conducted with recent unprotected sex regressed on most significant bivariate predictors. Results: 75% of participants reported unsafe sex in the past 90 days. Significant demographic correlates of unsafe sex include a gender (p<0.001), and current injection drug use (p<0.05). Participants reporting unsafe sex exhibited more anxiety and stress symptoms (p<0.05). Use of prescription opioids (p<0.01), heroin (p<0.01), cocaine (p<...
Introduction: The purpose of this study was to examine the relationship between prior physician-p... more Introduction: The purpose of this study was to examine the relationship between prior physician-prescribed medication and initiation and subsequent patterns of misuse of prescription, licit, and illicit drugs among young adults. Methods: A cross-sectional survey design sampled a total of 562 high-risk youth aged 18 to 25 reporting recent prescription drug misuse in LA and NY in 2009-2010. The sample was stratified into four mutually-exclusive groups based on type of medication ever prescribed: pain pills only (group 1); pain pills and tranquilizers or stimulants (group 2); tranquilizers or stimulants only (group 3); and no history of prescription medications (group 4). Groups were analyzed to compare trajectories of drug use and health indicators. Results: Young adults who were prescribed pain pills and tranquilizers or stimulants (group 2) initiated misuse of tranquilizers significantly earlier, had higher rates of recent misuse of pain pills and tranquilizers, and had higher preva...
Introduction: Prevention Point Philadelphia (PPP) has offered overdose prevention program (ODPP) ... more Introduction: Prevention Point Philadelphia (PPP) has offered overdose prevention program (ODPP) since 2006, which teaches intravenous drug users (IDUs) how to respond to an overdose, including administering naloxone. The first aim of this ongoing study is to evaluate knowledge of overdose prevention and to describe response behaviors among trained and untrained IDUs in Philadelphia. Methods: A total of 21 IDUs (6 trained and 16 untrained) were recruited from PPP between October-December 2010. During semi-structured interviews, participants described their responses to recently witnessed overdose. Qualitative and quantitative data were compared. Findings: Several preliminary findings have emerged. 75% of all participants have heard of ODPP, but only 38% know someone who has been trained and/or has naloxone. While 66% of untrained subjects correctly identified naloxone as effective at reversing a opioid overdose, only 10% expressed an interest in receiving training. Participants witn...
International Journal of Drug Policy, 2012
Background-Prescription opioids are the most frequently misused class of prescription drugs among... more Background-Prescription opioids are the most frequently misused class of prescription drugs among young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse among young injection drug users (IDUs) are scarce. Methods-An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse among IDUs aged 16 to 25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. Results-Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant's own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common among those who progressed to sniffing and injecting opioids. Conclusion-Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use among this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.
AIDS and Behavior, 2014
This study examined the relationship between prescription drug misuse and sexual risk behaviors (... more This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N=191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6% engaged in UAI. After adjusting for sociodemographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.
Journal of Addiction, 2014
Background. Prescription opioids are the most frequently misused class of prescription drug among... more Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses.Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days.Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantl...
Journal of Public Health Research, 2012
Background Prescription drug misuse among young adults is increasingly viewed as a public health ... more Background Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurre...
Drugs: Education, Prevention and Policy, 2014
Objective-Hepatitis C virus (HCV) incidence has been increasing among young injection drug users ... more Objective-Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. Methods-Young IDUs (n = 162) aged 18-25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009-2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. Results-A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p<0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p<0.05), growing up in a lower social class (AIRR: 1.67, p<0.05), age (AIRR: 1.12, p<0.05), age of injection initiation (AIRR: 0.87, p<0.001), and history of being prescribed stimulants (AIRR: 0.64, p<0.05) were independently associated with HCV positivity. Conclusions-Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US.
Pain Medicine, 2012
Objectives. An exploratory study was undertaken to examine how being denied prescription opioids ... more Objectives. An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. Design. Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings. Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. Participants. One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures. Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. Results. Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Selfmedication often coincided with initiation of new risk behaviors and more intensive drug use. Conclusion. Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors.
Journal of Urban Health, 2012
Misuse of prescription drugs and injection drug use has increased among young adults in the USA. ... more Misuse of prescription drugs and injection drug use has increased among young adults in the USA. Despite these upward trends, few studies have examined prescription drug misuse among young injection drug users (IDUs). A qualitative study was undertaken to describe current patterns of prescription drug misuse among young IDUs. Young IDUs aged 16-25 years who had misused a prescription drug, e.g., opioids, tranquilizers, or stimulants, at least three times in the past 3 months were recruited in 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analyzed both quantitatively and qualitatively. Most IDUs sampled were both homeless and transient. Heroin, prescription opioids, and prescription tranquilizers were frequently misused in the past 30 days. Qualitative results indicated that young IDUs used prescription opioids and tranquilizers: as substitutes for heroin when it was unavailable; to boost a heroin high; to self-medicate for health conditions, including untreated pain and heroin withdrawal; to curb heroin use; and to reduce risks associated with injecting heroin. Polydrug use involving heroin and prescription drugs resulted in an overdose in multiple cases. Findings point to contrasting availability of heroin in North American cities while indicating broad availability of prescription opioids among street-based drug users. The results highlight a variety of unmet service needs among this sample of young IDUs, such as overdose prevention, drug treatment programs, primary care clinics, and mental health services.
Journal of Psychoactive Drugs, 2013
Prescription drug misuse among young adults, especially opioids, is a substantial public health p... more Prescription drug misuse among young adults, especially opioids, is a substantial public health problem in the United States. Although risks associated with injection of illicit drugs are well established, injection and sexual risks associated with misuse of prescription drugs are understudied. Forty young injection drug users aged 16 to 25 who reported injection of a prescription drug were recruited in 2008-09 in Los Angeles and New York City. Descriptive quantitative and qualitative data were analyzed to illustrate risky injection and sexual behaviors reported in this sample. Over half of participants engaged in risky injection behavior, three-quarters engaged in risky sexual behavior, nearly half reported both risky behaviors, and five did not report either risk behavior while misusing a prescription drug. Prescription opioids, tranquilizers, and stimulants were misused in the context of risky sexual behaviors while only opioids were misused in the context of injection risk behaviors. Access to clean syringes, attitudes and beliefs regarding hepatitis C, and risk reduction through partner selection were identified as key themes that contextualized risk behaviors. Although these findings help identify areas to target educational campaigns, such as prevention of sexually transmitted infections, risk behaviors specifically associated with prescription drug misuse warrant further study.
Journal of Drug Issues, 2013
Nonmedical use of prescription drugs has become the fastest growing drug problem in the United St... more Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug mis...
Journal of Community Health, 2012
In response to the growing public health problem of drug overdose, community-based organizations ... more In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n=30) trained by two OPPs in Los Angeles were interviewed in 2010-11 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPP. Injecting the victim with naloxone was the most common recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPP, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques.
Drug and Alcohol Dependence, 2013
Background-Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and b... more Background-Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations. Methods-Young adults aged 16-25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N = 560).
Addictive Behaviors, 2012
Objective-Prescription drug misuse is an important public health problem in the U.S, particularly... more Objective-Prescription drug misuse is an important public health problem in the U.S, particularly among adolescents and young adults. Few studies have examined factors contributing to initiation into prescription drug misuse, including sexual orientation and childhood abuse and neglect. The purpose of the present study is to investigate the relationship between initiation into the misuse of prescription drugs (opioids, tranquilizers, and stimulants), sexual identity, and individual and family determinants. Method-Results are based upon data from a cross-sectional survey of 596 youth (polydrug users, homeless youth, and injection drug users) aged 16 to 25 who reported current prescription drug misuse. Participants were recruited in Los Angeles and New York City between 2009 and 2011. We compared initiation behaviors between sexual minority and heterosexual youth and examined factors modifying the relationship between sexual identity and earlier initiation into prescription drug misuse.
Background: Nonmedical prescription drug misuse among young adults is a significant public health... more Background: Nonmedical prescription drug misuse among young adults is a significant public health concern. Research has shown great heterogeneity in the types of motivations/factors behind different patterns of prescription drug misuse among young adults and adolescents. Understanding individual-level risk factors (e.g., personalities and predispositions) can help inform the type of prevention or intervention efforts to be targeted for different groups. Moreover, they can assist in delineating appropriate prevention or intervention approaches to be used (e.g., building on specific strengths/characteristics of the individual). Method: Young adults (aged 16 to 25 years) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive groups of nonmedical prescription drug users based on participants' coping and emotion regulation tendencies (N=560). After controlling fo...
Background. Incidence of hepatitis C virus (HCV) has increased among young adults over the past 1... more Background. Incidence of hepatitis C virus (HCV) has increased among young adults over the past 10 years. During this same period, misuse of prescription opioids (PO) has risen among young adults. This analysis compares young injection drug users (IDUs) who have ever injected PO with young IDUs who have not to determine negative health outcomes associated with injecting PO, including HCV. Methodology. Young IDUs were recruited in New York and Los Angeles between 2009-11. Eligible participants had misused any prescription drug at least three times in the past three months. A total of 253 young adults who had ever injected drugs qualified for study enrollment. Multivariate analysis focused on factors associated with ever injecting PO, including patterns of drugs use, syringe sharing, and HCV. Results. A greater proportion of the sample had ever injected PO (60.9%) compared to those who had not (39.1%). Key factors associated with PO injection included: current IDU; ever incarcerated; ...
Introduction: Research has demonstrated associations between substance use and unsafe sexual beha... more Introduction: Research has demonstrated associations between substance use and unsafe sexual behavior. This study examined whether recent substance use predicts unsafe sex among high-risk youth. Methods: Between October 2009 and March 2011, 596 high risk youth (polydrug users, homeless, and injection drug users) aged 16 to 25, were interviewed in Los Angeles and New York City. Use of prescription and illicit drugs, and condoms in the last 90 days, and current psychosocial correlates were assessed. Multivariate logistic regression analysis was conducted with recent unprotected sex regressed on most significant bivariate predictors. Results: 75% of participants reported unsafe sex in the past 90 days. Significant demographic correlates of unsafe sex include a gender (p<0.001), and current injection drug use (p<0.05). Participants reporting unsafe sex exhibited more anxiety and stress symptoms (p<0.05). Use of prescription opioids (p<0.01), heroin (p<0.01), cocaine (p<...
Introduction: The purpose of this study was to examine the relationship between prior physician-p... more Introduction: The purpose of this study was to examine the relationship between prior physician-prescribed medication and initiation and subsequent patterns of misuse of prescription, licit, and illicit drugs among young adults. Methods: A cross-sectional survey design sampled a total of 562 high-risk youth aged 18 to 25 reporting recent prescription drug misuse in LA and NY in 2009-2010. The sample was stratified into four mutually-exclusive groups based on type of medication ever prescribed: pain pills only (group 1); pain pills and tranquilizers or stimulants (group 2); tranquilizers or stimulants only (group 3); and no history of prescription medications (group 4). Groups were analyzed to compare trajectories of drug use and health indicators. Results: Young adults who were prescribed pain pills and tranquilizers or stimulants (group 2) initiated misuse of tranquilizers significantly earlier, had higher rates of recent misuse of pain pills and tranquilizers, and had higher preva...
Introduction: Prevention Point Philadelphia (PPP) has offered overdose prevention program (ODPP) ... more Introduction: Prevention Point Philadelphia (PPP) has offered overdose prevention program (ODPP) since 2006, which teaches intravenous drug users (IDUs) how to respond to an overdose, including administering naloxone. The first aim of this ongoing study is to evaluate knowledge of overdose prevention and to describe response behaviors among trained and untrained IDUs in Philadelphia. Methods: A total of 21 IDUs (6 trained and 16 untrained) were recruited from PPP between October-December 2010. During semi-structured interviews, participants described their responses to recently witnessed overdose. Qualitative and quantitative data were compared. Findings: Several preliminary findings have emerged. 75% of all participants have heard of ODPP, but only 38% know someone who has been trained and/or has naloxone. While 66% of untrained subjects correctly identified naloxone as effective at reversing a opioid overdose, only 10% expressed an interest in receiving training. Participants witn...
International Journal of Drug Policy, 2012
Background-Prescription opioids are the most frequently misused class of prescription drugs among... more Background-Prescription opioids are the most frequently misused class of prescription drugs among young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse among young injection drug users (IDUs) are scarce. Methods-An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse among IDUs aged 16 to 25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. Results-Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant's own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common among those who progressed to sniffing and injecting opioids. Conclusion-Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use among this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.
AIDS and Behavior, 2014
This study examined the relationship between prescription drug misuse and sexual risk behaviors (... more This study examined the relationship between prescription drug misuse and sexual risk behaviors (i.e. unprotected sex, increased number of sex partners) in a sample of young men who have sex with men (YMSM) in Philadelphia. Data come from a cross-sectional study of 18-29 year old YMSM (N=191) who misused prescription drugs in the past 6 months. Associations were investigated in two regression models: logistic models for unprotected anal intercourse (UAI) and zero-truncated Poisson regression model for number of sex partners. Of 177 participants engaging in anal intercourse in the past 6 months, 57.6% engaged in UAI. After adjusting for sociodemographic variables and illicit drug use, misuse of prescription pain pills and muscle relaxants remained significantly associated with engaging in receptive UAI. No prescription drug class was associated with a high number of sex partners. This study provides additional evidence that some prescription drugs are associated with sexual risk behaviors among YMSM.
Journal of Addiction, 2014
Background. Prescription opioids are the most frequently misused class of prescription drug among... more Background. Prescription opioids are the most frequently misused class of prescription drug among young adults aged 18–25, yet trajectories of opioid misuse and escalation are understudied. We sought to model opioid misuse patterns and relationships between opioid misuse, sociodemographic factors, and other substance uses.Methods. Participants were 575 young adults age 16–25 who had misused opioids in the last 90 days. Latent class analysis was performed with models based on years of misuse, recency of misuse, and alternate modes of administration within the past 12 months, 3 months, and 30 days.Results. Four latent classes emerged that were differentially associated with heroin, cocaine, and methamphetamine use, tranquilizer misuse, daily opioid misuse, and opioid withdrawal. Alternate modes of administering opioids were associated with increased risk for these outcomes. Sociodemographic factors, homelessness, prescription history, and history of parental drug use were significantl...
Journal of Public Health Research, 2012
Background Prescription drug misuse among young adults is increasingly viewed as a public health ... more Background Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurre...
Drugs: Education, Prevention and Policy, 2014
Objective-Hepatitis C virus (HCV) incidence has been increasing among young injection drug users ... more Objective-Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. Methods-Young IDUs (n = 162) aged 18-25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009-2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. Results-A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p<0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p<0.05), growing up in a lower social class (AIRR: 1.67, p<0.05), age (AIRR: 1.12, p<0.05), age of injection initiation (AIRR: 0.87, p<0.001), and history of being prescribed stimulants (AIRR: 0.64, p<0.05) were independently associated with HCV positivity. Conclusions-Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US.
Pain Medicine, 2012
Objectives. An exploratory study was undertaken to examine how being denied prescription opioids ... more Objectives. An exploratory study was undertaken to examine how being denied prescription opioids to treat pain impacted the drug-using careers of young adults with a history of misuse of prescription drugs. Design. Ethno-epidemiological methodology utilizing a cross-sectional design, semi-structured interviews, and qualitative/quantitative data analysis. Settings. Non-clinical participants were recruited from natural settings, such as streets, parks, beaches, and college campuses, in New York City and Los Angeles during 2008 and 2009. Participants. One hundred fifty participants aged 16 to 25 who had misused a prescription opioid, tranquilizer, or stimulant in the past 90 days. Outcome Measures. Analyses focused on denial of opioids and associated consequences, including self-medication with prescription opioids and heroin. Results. Thirty-four participants (22.7%) described being denied prescription opioids for the treatment of a painful condition. Current opioid misuse and current pain problems were higher in this group compared to those who had never been denied prescription opioids. Reasons for denial included being identified as a drug user by a physician, lack of health insurance, and having medication withheld by a parent or authority figure. Approximately half reported self-medicating pain with either illegally obtained prescription opioids or heroin. Selfmedication often coincided with initiation of new risk behaviors and more intensive drug use. Conclusion. Being denied prescription opioids was an important moment in the drug using careers of many study participants. Results suggest that effective pain management techniques are needed to prevent high-risk young adults with pain problems from engaging in escalated opioid misuse and risk behaviors.
Journal of Urban Health, 2012
Misuse of prescription drugs and injection drug use has increased among young adults in the USA. ... more Misuse of prescription drugs and injection drug use has increased among young adults in the USA. Despite these upward trends, few studies have examined prescription drug misuse among young injection drug users (IDUs). A qualitative study was undertaken to describe current patterns of prescription drug misuse among young IDUs. Young IDUs aged 16-25 years who had misused a prescription drug, e.g., opioids, tranquilizers, or stimulants, at least three times in the past 3 months were recruited in 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analyzed both quantitatively and qualitatively. Most IDUs sampled were both homeless and transient. Heroin, prescription opioids, and prescription tranquilizers were frequently misused in the past 30 days. Qualitative results indicated that young IDUs used prescription opioids and tranquilizers: as substitutes for heroin when it was unavailable; to boost a heroin high; to self-medicate for health conditions, including untreated pain and heroin withdrawal; to curb heroin use; and to reduce risks associated with injecting heroin. Polydrug use involving heroin and prescription drugs resulted in an overdose in multiple cases. Findings point to contrasting availability of heroin in North American cities while indicating broad availability of prescription opioids among street-based drug users. The results highlight a variety of unmet service needs among this sample of young IDUs, such as overdose prevention, drug treatment programs, primary care clinics, and mental health services.
Journal of Psychoactive Drugs, 2013
Prescription drug misuse among young adults, especially opioids, is a substantial public health p... more Prescription drug misuse among young adults, especially opioids, is a substantial public health problem in the United States. Although risks associated with injection of illicit drugs are well established, injection and sexual risks associated with misuse of prescription drugs are understudied. Forty young injection drug users aged 16 to 25 who reported injection of a prescription drug were recruited in 2008-09 in Los Angeles and New York City. Descriptive quantitative and qualitative data were analyzed to illustrate risky injection and sexual behaviors reported in this sample. Over half of participants engaged in risky injection behavior, three-quarters engaged in risky sexual behavior, nearly half reported both risky behaviors, and five did not report either risk behavior while misusing a prescription drug. Prescription opioids, tranquilizers, and stimulants were misused in the context of risky sexual behaviors while only opioids were misused in the context of injection risk behaviors. Access to clean syringes, attitudes and beliefs regarding hepatitis C, and risk reduction through partner selection were identified as key themes that contextualized risk behaviors. Although these findings help identify areas to target educational campaigns, such as prevention of sexually transmitted infections, risk behaviors specifically associated with prescription drug misuse warrant further study.
Journal of Drug Issues, 2013
Nonmedical use of prescription drugs has become the fastest growing drug problem in the United St... more Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug mis...
Journal of Community Health, 2012
In response to the growing public health problem of drug overdose, community-based organizations ... more In response to the growing public health problem of drug overdose, community-based organizations have initiated overdose prevention programs (OPP), which distribute naloxone, an opioid antagonist, and teach overdose response techniques. Injection drug users (IDUs) have been targeted for this intervention due to their high risk for drug overdose. Limited research attention has focused on factors that may inhibit or prevent IDUs who have been trained by OPPs to undertake recommended response techniques when responding to a drug overdose. IDUs (n=30) trained by two OPPs in Los Angeles were interviewed in 2010-11 about responses to their most recently witnessed drug overdose using an instrument containing both open and closed-ended questions. Among the 30 witnessed overdose events, the victim recovered in 29 cases while the outcome was unknown in one case. Participants responded to overdoses using a variety of techniques taught by OPP. Injecting the victim with naloxone was the most common recommended response while other recommended responses included stimulating the victim with knuckles, calling 911, and giving rescue breathing. Barriers preventing participants from employing recommended response techniques in certain circumstances included prior successes using folk remedies to revive a victim, concerns over attracting police to the scene, and issues surrounding access to or use of naloxone. Practical solutions, such as developing booster sessions to augment OPP, are encouraged to increase the likelihood that trained participants respond to a drug overdose with the full range of recommended techniques.
Drug and Alcohol Dependence, 2013
Background-Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and b... more Background-Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations. Methods-Young adults aged 16-25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N = 560).
Addictive Behaviors, 2012
Objective-Prescription drug misuse is an important public health problem in the U.S, particularly... more Objective-Prescription drug misuse is an important public health problem in the U.S, particularly among adolescents and young adults. Few studies have examined factors contributing to initiation into prescription drug misuse, including sexual orientation and childhood abuse and neglect. The purpose of the present study is to investigate the relationship between initiation into the misuse of prescription drugs (opioids, tranquilizers, and stimulants), sexual identity, and individual and family determinants. Method-Results are based upon data from a cross-sectional survey of 596 youth (polydrug users, homeless youth, and injection drug users) aged 16 to 25 who reported current prescription drug misuse. Participants were recruited in Los Angeles and New York City between 2009 and 2011. We compared initiation behaviors between sexual minority and heterosexual youth and examined factors modifying the relationship between sexual identity and earlier initiation into prescription drug misuse.