Prescription Opioid Misuse and Injection Initiation Among Persons Who Inject Drugs

Introduction:In the United States, an estimated 2.1 million people suffer from substance use disorders related to prescription opioids. The number of overdose deaths from prescription opioids has more than quadrupled since 1999. Concurrently, over the past decade, heroin use has more than doubled among young adults suggesting increasingly intertwining prescription opioid and heroin epidemics. We describe the characteristics of prescription opioid misuse and injection initiation in a sample of persons who inject drugs (PWID).

Methods: Between July and October 2015 (data collection ongoing with anticipated end to data collection in December), PWID were recruited using respondent-driven sampling as part of the National HIV Behavioral Surveillance system in Denver, Colorado. Persons were eligible if they were 18 years or older and reported injection drug use in the preceding 12 months. Participants completed a behavioral survey in addition to testing for HIV and hepatitis C virus (HCV).

Results: Approximately 24% of the preliminary sample was under the age of 30 and 70% were male. Nearly 73% of respondents were currently homeless. Of the 351 eligible participants, 122 (35%) reported being hooked on prescription opioids before they injected for the very first time. Of the 122 participants who reported being hooked on prescription opioids, 67 (55%) reported heroin as the first drug they injected, 19 (16%) reported injecting a prescription opioid, and 17 (14%) reported methamphetamine as their first injected drug. Nearly a quarter of those who reported being hooked on prescription opioids before they started injecting reported their first misuse of prescription opioids at 14 years or younger and 28% reported that their first injection was before the age of 18. Among those 30 and younger, 25% reported that they had overdosed at least once in the past 12 months. Of the 332 participants who tested for HCV, 214 (64%) were antibody positive.

Conclusions: Results of this analysis highlight the critical need to identify factors that accelerate or inhibit the transition from prescription drug misuse to injection drug use to develop effective interventions. Prevention efforts that target youth who misuse prescription drugs before they have transitioned to injection drug use are urgently needed.