Nonmedical Use of Prescription Drugs and Injection Drug Use Among Runaway and Homeless Youth

Introduction: The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, resulting in a higher case fatality than heroin and cocaine combined. Opioid pain relievers are the most commonly misused prescription drug and young people misuse them at alarming rates. Furthermore, at initiation of illicit drug use, prescription opioids are the most frequent drug used, second only to marijuana, and may represent a new pathway into injection drug use (IDU). Residential instability may also play an important role in this newly emerging drug abuse pattern. We examined the association between current nonmedical use of prescription drugs and IDU among runaway and homeless youth.

Methods: As part of the YouthNet study, we collected baseline data from 386 runaway and homeless youth between October 2011 and February 2012. Youth were recruited from two drop-in agencies in California. Study eligibility included: at least 13 years of age, able speak English or Spanish, and have attended the agency at which they were recruited at least three times in the prior month. Participants completed an Audio-Computer Assisted Self-Interview survey which assessed sexual history and risk behaviors, drug and alcohol behaviors, mental health, and living situation. We used generalized linear models with log link and binomial error distribution to estimate risk ratios (RRs) and associated 95% confidence intervals (CI).

Results: Approximately 71% of participants were male and 36% were white. Mean age was 21.5 (SD=2.1). Of the 380 participants who reported current drug use, a total of 85 (22%) reported misusing a prescription drug and 48 (13%) reported IDU during the past 30 days. Youth who reported current misuse of a prescription drug were more likely to report current IDU (unadjusted RR: 7.4, 95% CI: 4.4, 13.4). Using the internet to find drugs and reporting personal alcohol and drug use as the reason for becoming homeless were identified as potential confounding variables of the main association between prescription drug misuse and IDU. Adjusting for race, gender, internet to find drugs, and personal alcohol and drug use as a reason for homelessness the association between current prescription drug misuse and IDU remained strong (adjusted RR: 5.6, 95% CI: 2.9, 10.9).

Conclusions: Results of this analysis highlight the strong association between prescription drug misuse and IDU. Identifying factors that accelerate or inhibit the transition to IDU from prescription drug use is critical given the risk for acquiring HIV and viral hepatitis associated with IDU. Prevention efforts that target youth who misuse prescription drugs before they have transitioned to IDU are urgently needed.