Initiation into prescription opioid misuse amongst young injection drug users (original) (raw)
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Increased use of heroin as an initiating opioid of abuse
Addictive Behaviors, 2017
Introduction. Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics. Methods. Individuals entering substance abuse treatment for an opioid use disorder in the period 2010-2016 (N=5,885) were asked about the specific opioid they first regularly used to get high. To limit longterm recall and survival bias, analyses was restricted to opioid initiation that occurred in the past ten years (2005-2015). Results. In 2005, only 8.7% of opioid initiators started with heroin, but this sharply increased to 33.3% (p<.001) in 2015, with no evidence of stabilization. The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that heroin as an initiating opioid was now more frequently endorsed than prescription opioid analgesics. Conclusions. Our data document that, as the most commonly prescribed opioidshydrocodone and oxycodonebecame less accessible due to supply-side interventions, the use of heroin as an initiating opioid has grown at an alarming rate. Given that opioid novices have limited tolerance to opioids, a slight imprecision in dosing inherent in heroin use is likely to be an important factor contributing to the growth in heroin-related over dose fatalities in recent years.
Addictive Behaviors, 2018
Introduction. Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics. Methods. Individuals entering substance abuse treatment for an opioid use disorder in the period 2010-2016 (N=5,885) were asked about the specific opioid they first regularly used to get high. To limit longterm recall and survival bias, analyses was restricted to opioid initiation that occurred in the past ten years (2005-2015). Results. In 2005, only 8.7% of opioid initiators started with heroin, but this sharply increased to 33.3% (p<.001) in 2015, with no evidence of stabilization. The use of commonly prescribed opioids, oxycodone and hydrocodone, dropped from 42.4% and 42.3% of opioid initiators, respectively, to 24.1% and 27.8% in 2015, such that heroin as an initiating opioid was now more frequently endorsed than prescription opioid analgesics. Conclusions. Our data document that, as the most commonly prescribed opioidshydrocodone and oxycodonebecame less accessible due to supply-side interventions, the use of heroin as an initiating opioid has grown at an alarming rate. Given that opioid novices have limited tolerance to opioids, a slight imprecision in dosing inherent in heroin use is likely to be an important factor contributing to the growth in heroin-related over dose fatalities in recent years.
Prescription opioids prior to injection drug use: Comparisons and public health implications
Addictive Behaviors, 2017
Background-The intertwining prescription opioid and heroin epidemic is a major public health problem in the United States, with increasing morbidity and mortality among persons who use these substances. We examined differences between persons who reported being hooked on prescription opioids prior to injecting for the first time and those who did not by demographics, injection and non-injection characteristics, and overdose. Methods-Between June and December 2015, persons who inject drugs were recruited using respondent-driven sampling as part of the National HIV Behavioral Surveillance system in Denver, Colorado. Results-Of 599 participants (median age, 40: IQR, 19-69; 71% male; 58% white, non-Hispanic), 192 (32%) reported being hooked on prescription opioids before they injected for the very first time. Compared to participants who were not hooked before they injected, participants who reported being hooked were significantly more likely to be younger, more recent injectors, report a slightly older age at first injection, and report heroin as the first drug injected as well as the drug most frequently injected. Those who reported being hooked were also more likely to be more frequent users of benzodiazepines, non-injection prescription opioids, and non-injection heroin as well as report injecting on a daily or more than daily basis. Being hooked on prescription opioids prior to injection drug use was associated with a 1.55 (95% CI: 1.14, 2.10) fold increase in the risk of at least one overdose in the past 12 months.
Initiation of Heroin and Prescription Opioid Pain Relievers by Birth Cohort
American journal of public health, 2015
We examined initiation patterns among different birth cohorts of people who used prescription opioids and heroin because of historical differences in drug use availability. We examined data from a community-based study of persons who inject drugs (n = 483) in California and a general population survey from the National Survey on Drug Use and Health (n = 1264) and found that individuals born after 1980 were more likely than were individuals born before 1980 to initiate opioids through nonmedical use of prescription opioids than heroin. (Am J Public Health. Published online ahead of print December 21, 2015: e1-e3. doi:10.2105/AJPH.2015.302972).
Patterns of Prescription Drug Misuse among Young Injection Drug Users
Journal of Urban Health, 2012
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.
" Every 'Never' I Ever Said Came True " : Transitions from opioid pills to heroin injecting
This qualitative study documents the pathways to injecting heroin by users in Philadelphia and San Francisco before and during a pharmaceutical opioid pill epidemic. Data was collected through in-depth, semi-structured interviews (conducted between 2010 and 2012) that were, conducted against a background of longer-term participant-observation, ethnographic studies of street-based drug users and dealers in Philadelphia (2007–12) and San Francisco (1994–2007, 2012). Philadelphia and San Francisco were selected for their contrasting political economies, immigration patterns and source type of heroin. In Philadelphia the ethnographers found heroin injectors, usually white users, who had started their opiate using careers with prescription opioids rather than transitioning from other drugs. In both Philadelphia and San Francisco, most of the young heroin injectors interviewed began, their drug-use trajectories with opioid pills – usually Percocet (oxycodone and acetaminophen), generic short acting oxycodone or, OxyContin (long-acting oxycodone) – before transitioning to heroin, usually by nasal inhalation (sniffing) or smoking at first, followed by injecting. While most of the Philadelphia users were born in the city or its suburbs and had started using both opioid pills and heroin there, many of the San Francisco users had initiated their pill and sometimes heroin use elsewhere and had migrated to the city from around the country. Nevertheless, patterns of transition of younger injectors were similar in both cities suggesting an evolving national pattern. In contrast, older users in both Philadelphia and San Francisco were more likely to have graduated to heroin injection from non-opiate drugs such as cannabis, metham-phetamine and cocaine. Pharmaceutical opioid initiates typically reported switching to heroin for reasons of cost and ease-of-access to supply after becoming physically and emotionally dependent on opioid pills. Many expressed surprise and dismay at their progression to sniffing and subsequently to injecting heroin. Historically and structurally these users found themselves caught at the intersection of two major developments in the opiate supply: (1) an over 500% increase in opiate pill prescription from 1997 to 2005 resulting in easy access to diverted supplies of less stigmatized opiates than heroin and (2) a heroin supply glut, following the US entry of Colombian-sourced, heroin in the early 1990s, that decreased cost and increased purity at the retail level. A nationwide up-cycle of heroin use may be occurring among young inner city, suburban and rural youth fueled by widespread prescription opioid pill use.
Addictive Behaviors, 2007
Objectives-The main objectives of this study were to assess the motives, diversion sources and routes of administration associated with the nonmedical use of prescription opioids as well as to examine substance use related problems associated with the nonmedical use of prescription opioids. Method-A self-administered, cross-sectional Web survey was conducted in 2005 at a large public Midwestern 4-year university in the U.S. using a probability-based sampling approach. The final sample included 4580 full-time undergraduate students. Results-The three most common motives associated with the nonmedical use of prescription opioids were to relieve pain, get high, and experiment. The leading sources of prescription opioids were friends and parents although there were gender differences in reports of primary sources. More than 1 in every 10 nonmedical users reported intranasal administration. Multivariate analyses indicated nonmedical users of prescription opioids who used for motives other than to relieve pain, obtained these drugs from non-parental sources, or used these drugs via non-oral routes of administration were significantly more likely to experience substance use related problems. Conclusions-These results indicate that nonmedical use of prescription opioids represents a considerable problem for particular subgroups of college students. While additional research is needed, the present study offers important new directions for policy and research regarding prescription opioid misuse.
JAMA Network Open, 2021
IMPORTANCE Although prescription opioids are the most common way adolescents and young adults initiate opioid use, many studies examine population-level risks following the first opioid prescription. There is currently a lack of understanding regarding how patterns of opioid prescribing following the first opioid exposure may be associated with long-term risks. OBJECTIVE To identify distinct patterns of opioid prescribing following the first prescription using group-based trajectory modeling and examine the patient-, clinician-, and prescription-level factors that may be associated with trajectory membership during the first year. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined Pennsylvania Medicaid enrollees' claims data from 2010 through 2016. Participants were aged 10 to 21 years at time of first opioid prescription. Data analysis was performed in March 2020. MAIN OUTCOMES AND MEASURES This study used group-based trajectory modeling and defined trajectory status by opioid fill. RESULTS Among the 189 477 youths who received an initial opioid prescription, 107 562 were female (56.8%), 81 915 were non-Latinx White (59.6%), and the median age was 16.9 (interquartile range [IQR], 14.6-18.8) years. During the subsequent year, 47 477 (25.1%) received at least one additional prescription. Among the models considered, the 2-group trajectory model had the best fit. Of those in the high-risk trajectory, 65.3% (n = 901) filled opioid prescriptions at month 12, in contrast to 13.1% (n = 6031) in the low-risk trajectory. Median age among the high-risk trajectory was 19.0 years (IQR, 17.1-20.0 years) compared with the low-risk trajectory (17.8 years [IQR, 15.8-19.4 years]). The high-risk trajectory received more potent prescriptions compared with the low-risk trajectory (median dosage of the index month for high-risk trajectory group: 10.0 MME/d [IQR, 5.0-21.2 MME/d] vs the low-risk trajectory group: 4.7 MME/d [IQR, 2.5-7.8 MME/d]; P < .001). The trajectories showed persistent differences with more youths in the high-risk trajectory going on to receive a diagnosis of opioid use disorder (30.0%; n = 412) compared with the low-risk group (10.1%; n = 4638) (P < .001). CONCLUSIONS AND RELEVANCE This study's results identified 2 trajectories associated with elevated risk for persistent opioid receipt within 12 months following first opioid prescription. The high-risk trajectory was characterized by older age at time of first prescription, and longer and more potent first prescriptions. These findings suggest even short and low-dose opioid prescriptions can be associated with risks of persistent use for youths.
Correlates and Consequences of Opioid Misuse among High-Risk Young Adults
Journal of Addiction, 2014
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...