Transitions Among Opiate Users

Introduction: While preliminary research has demonstrated a connection between transitioning from prescription opiates to heroin, this is the first study revealing a connection to transitioning from heroin to prescription opiates.  Understanding different access points for opiates and triggering processes for transitioning users can assist in developing prevention and intervention strategies.

 Methods: A quantitative cross-sectional design was employed in Los Angeles. Convenience sampling was used to recruit a total of 100 individuals for the pilot study. Individuals over the age of 18 self-reporting using a prescription opiate in the past year were eligible to participate. Data was collection through a self-administered computer survey at a local harm reduction clinic. Descriptive statistics, chi-square and T-tests analyses were conducted.

Results: Of the 100 participants 45% transitioned to prescription opiates from heroin, 36% transitioned to heroin from prescriptions opiates and 19% never used heroin. The majority (86%) of individuals that used prescription opiates prior to heroin reported swallowing as the first method of use. Changes in methods of use occurred during the substance use trajectory. Prior to transitioning to heroin individuals reported injecting (23%) prescription opiates. Individuals first use of heroin after transitioning from prescription opiates was primarily via intranasal inhalation (43%), while the last reported usage method of heroin for those transitioning from prescription opiates was injection (86%).  The majority of individuals that transitioned from heroin to prescription opiates reported intranasal inhalation (42%) and injection (45%) for the first method of use for heroin. The last time individuals used heroin prior to using prescription opiates the majority were injecting (77%). Individuals that tried prescription opiates after using heroin reporting first using prescription opiates by swallowing (88%) with 24% reporting intravenous injection as the last method of use. Reasons for transitioning from one opiate to another differed. Individuals reported transitioning from prescription opiates to heroin because heroin was cheaper (37%), needing a better high (51%), to decrease pain (31%), lack of availability of pills (31%) and curiosity (43%). Individuals reporting transitioning from heroin to prescription opiates because they needed a better high (26%), pills were safer (23%), curiosity (28%) and for pain management (54%).

Conclusions: Findings from this pilot study signify the need for additional research on transitions among the opiate using population in order to inform prevention and intervention efforts. Opiate users transitioning from prescription opiates to heroin have different usage trajectories and motivations, compared to individuals that transition from heroin to prescription opiates.