HIV/HCV Risk Among Young Adults Who Use Prescription Opioids Nonmedically: Implications for Disease Prevention

Introduction  While rates of nonmedical prescription opioid (PO) use have dramatically increased among young people in the US in recent years, to date, relatively little attention has been paid to the behaviors that may put these youth at risk for infection with blood-borne viruses.

Methods  Forty-one New York City-area young adults (aged 18-32) who reported using POs within the past 30 days were recruited, via targeted referrals and chain-referral sampling, for a qualitative study of PO use patterns and associated risk behavior. Digitally audiotaped, semi-structured interviews (~90 minutes) probed participants’:  drug use trajectories; sexual and drug-use practices; and the size and characteristics of their sexual and drug-use networks. Interview data were transcribed and content analyzed for key themes.

Results  Seventy-one percent (29/41) reported ever injecting any drug and the same number reported lifetime use of heroin; most of these participants initiated PO use via the oral route and later experimented with or transitioned to injection heroin use. All participants reported interacting with networks (consisting of 5-100 members) of young adult PO users; these networks were a common source of drug-use, injection and sexual partners. Injectors reported sporadic instances of syringe-sharing and frequently shared cookers and cottons. Although almost all participants were aware of the HIV/HCV risks associated with sharing syringes, many reported feeling protected dint of their close relationships with the friends and/or sex partners with whom they shared. Several MSM, and some heterosexual male participants, reported using POs to enhance sexual experience, noting that POs help them maintain an erection. MSM participants also reported using POs in the context of both paid sexual encounters and group sex events to lessen the discomfort associated with rough (often unprotected) anal sex. Self-reported condom use was low among all participants. Both males and females reported that women are often perceived within PO-using networks as legitimate targets for unsolicited sexual advances, and even sexual assault, when high or passed out. A significant proportion of middle/upper-class participants reported not using syringe exchange programs or related harm reduction services due to a lack of awareness of such services and/or a disinclination to identify as “junkies” whom they perceived to be the typical clients of these services.

Conclusions  Findings suggest that young adult PO users may be exposed to blood-borne viruses via multiple pathways, and that these pathways may differ for different subgroups, such as women, MSM, and drug injectors. Although most participants were at risk for exposure to HIV or HCV through their injection and/or sexual behavior, disconnection from traditional prevention services targeting drug users was a pervasive theme, underscoring the urgent need for innovative, new prevention strategies to be targeted to PO users and tailored to their specific needs, perceptions and risk contexts. Critically, since newly-initiated drug injectors are particularly vulnerable to HCV infection, such efforts should be directed to youth early in their substance use careers, before they transition to heroin use/injection.