Dr. Stephen Lankenau, associate professor at the Drexel University School of Public Health, was lead author and principal investigator on a newly published study that explores factors surrounding young injection drug users’ initiation into prescription opioid misuse. The article appeared in the International Journal of Drug Policy.
Opioids, a very common classification of prescription drugs that includes codeine and oxycodone, are the most frequently misused class of prescription drugs amongst young adults. Initiation into prescription opioid misuse is an important public health concern due to the increasing association of opioids with drug dependence and fatal overdose. However, descriptive data about initiation into prescription opioid misuse amongst young injection drug users (IDUs) are scarce.
To fill this gap, the researchers interviewed 50 young IDUs aged 16 and 25 years old in New York and Los Angeles, who had misused a prescription drug at least three times in the past three months, to study contextual factors leading to opioid initiation. Participants were recruited in natural settings, such as parks, streets, and college campuses, during 2008 and 2009. A mixed-methods research design was utilized that collected both quantitative and qualitative data.
Of the survey participants:
Most were white, heterosexual males in their early 20s
Many did not complete high school, were expelled from school, or held back a grade
Nearly all were homeless at some point, most were currently homeless, and most regarded themselves as “travelers,” (i.e., moving from city to city in search of work, housing, or adventure)
Most had received a psychological diagnosis, such as depression, anxiety, or Attention Deficit Hyperactivity Disorder (ADHD), and many had a history of drug treatment
Most generally regarded prescription opioids as readily accessible, valued commodities that could be traded or sold
Nearly three-quarters had been prescribed an opioid in their lifetime, which occurred on average at 14.6 years old, often for common ailments such as dental procedures or sports injuries
Most witnessed family members misuse one or more substances during childhood and adolescence, ranging from alcoholism to injecting heroin
“Participants were commonly raised in household where misuse of prescription drugs, illegal drugs, or alcohol, was normalized,” explains Dr. Lankenau. “Access to prescription medications – either from a participant’s own source, a family member, or a friend – was a key feature of initiation into prescription drug misuse.”
In numerous cases, the desire to experiment with a prescription opioid combined with financial incentives or pressures from friends to sell available quantities, resulted in escalated patterns of opioid misuse.
The authors describe two key findings as evidence of an emerging dynamic amongst opioid and heroin misuse and injection drug use. First, four of five IDUs misused an opioid before injecting heroin, which is in contrast to more conventional patterns of using opioids as a substitute drug after initiating heroin use. Second, nearly one out of four young IDUs initiated injection drug use with a prescription opioid, a substance infrequently reported at initiation into injection drug use amongst young IDUs. All but two of these IDUs later transitioned into injecting heroin.
The authors conclude that prevention efforts, especially during adolescence, are needed, and that parents and guardians need to carefully monitor and safeguard all prescription medications, particularly opioids, within the household. Although households where drug use is normalized or where broader social or psychological problems exist are more difficult to remedy with prevention efforts or policy changes, future research examining prescription opioid misuse amongst a range of adolescents and young adults to better understand the contextual and environmental factors of drug use may yield additional solutions.
The article was co-authored by Karol Silva (Drexel University); Michelle Teti (University of Missouri); Alex Harocopos (National Development and Research Institutes); and Jennifer Jackson Bloom and Meghan Treese (Children’s Hospital Los Angeles).
Dr. Lankenau is also principal investigator of two studies evaluating the effectives of overdose prevention programs in Los Angeles and Philadelphia.
Dr. Lankenau is an associate professor in the Department of Community Health & Prevention at the Drexel University School of Public Health. He received his PhD and MA degrees in Sociology from the University of Maryland. He earned his BA in Sociology at the University of Vermont.
For additional media coverage of this story: WHYY-FM/Newsworks.org | UPI | PsychCentral | MyHealthNewsDaily