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Initiation into prescription opioid misuse amongst young injection drug users
Open accessAbstract
Background Prescription opioids are the most frequently misused class of prescription drugs amongst young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse amongst young injection drug users (IDUs) are scarce.Methods An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse amongst IDUs aged 16-25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively.Results Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant's own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common amongst those who progressed to sniffing and injecting opioids.Conclusion Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use amongst this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.
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“Non medical use of pharmaceutical opioids leading to injection heroin use and concomitant use of heroin and pharmaceuticals opioids have been reported (Siegal et al., 1994; Lankenau et al., 2012; Nielsen et al., 2011; Wilkins et al., 2011).”
From National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. (2013) · cites this paper as Lankenau et al., 2012
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BackgroundGaps in HCV Knowledge and Risk Behaviors among Young Suburban People Who Inject Drugs
Jost, J. J., Tempalski, B. J., Vera, T., Akiyama, M. J., Mangalonzo, A. P., & Litwin, A. H. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16111958 · Cited by 25
Yedinak, J. L., Kinnard, E. N., Hadland, S. E., Green, T. C., Clark, M. A., & Marshall, B. D. L. (2016) · American Journal on Addictions · doi:10.1111/ajad.12466 · Cited by 24
“Results from this study support this literature by highlighting key factors shaping risk among young adults (eg, easy access to prescription opioids), but also suggest opportunities for reducing drug-related harms within the context of the risk environment (eg, partying).(27,28) Structural interventions specific to yo…”
BackgroundMethodResultGonzález, R., & Schuster (2012) · Neurobehavioral HIV Medicine · doi:10.2147/nbhiv.s17408 · Cited by 23
“25 By far, opioids (specifically, heroin) is the class of drugs most commonly used among IDUs; 26 however, it is important to note that injection of other sub-stances including cocaine and methamphetamine (alone or in combination with heroin) is also common.”
Syvertsen, J. L., Paquette, C. E., & Pollini, R. A. (2017) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2017.03.003 · Cited by 24
Persistent Opioid Use Among Patients with Urolithiasis: A Population based Study
Hosier, G. W., McGregor, T. B., Beiko, D. T., Jaeger, M. T., Booth, C. M., Whitehead, M., & Siemens, D. R. (2019) · European Urology Focus · doi:10.1016/j.euf.2019.08.011 · Cited by 23
Opioid initiation and injection transition in rural northern New England: A mixed-methods approach
Nolte, K., Drew, A., Friedmann, P. D., Romo, E., Kinney, L., & Stopka, T. J. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108256 · Cited by 23
“Previous research on opioid initiation and transition to injection has primarily been conducted in urban settings (Lankenau et al., 2012; Mars et al., 2014), and has implicated experiences with trauma and family history of substance use as causative factors (Lawson et al.”
BackgroundPassias, B. J., Johnson, D. B., Schuette, H. B., Secic, M., Heilbronner, B., Hyland, S. J., & Sager, A. (2022) · Archives of Orthopaedic and Trauma Surgery · doi:10.1007/s00402-022-04450-0 · Cited by 27
“a previous opioid prescription started their addiction [12].”
BackgroundReid, M. C., Oliphant-Wells, T., Moreno, C., Ketchum, J., Fitzpatrick, T., McMahan, V., & Glick, S. N. (2023) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2023.100163 · Cited by 22
“The NHBS-PWID sampling strategy is described in detail elsewhere (Lansky et al., 2007; Burt et al., 2017).”
MethodAn overview of abuse-deterrent opioids and recommendations for practical patient care
Adler, J. A., & Mallick‐Searle, T. (2018) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s166915 · Cited by 24
“Therefore, manipulations and routes of administration that facilitate dose dumping are associated with greater abuse potential.(15,16) This is particularly important because abusers may start with the oral route of abuse and then transition to non-oral routes as duration of abuse increases; in addition to concerns abo…”
BackgroundDenial of Prescription Opioids Among Young Adults with Histories of Opioid Misuse
Fibbi, M., Silva, K., Johnson, K. M., Langer, D., & Lankenau, S. E. (2012) · Pain Medicine · doi:10.1111/j.1526-4637.2012.01439.x · Cited by 23
Self-citationEstimates of Illicit Opioid Use in the US
Powell, D., & Jacobson, M. (2025) · JAMA Health Forum · doi:10.1001/jamahealthforum.2025.0809 · Cited by 23
Narcotic Free Cervical Endocrine Surgery
Ruffolo, L. I., Jackson, K. M., Juviler, P. G., Kaur, R., Chennell, T., Glover, D., Linehan, D. C., & Moalem, J. (2019) · Annals of Surgery · doi:10.1097/sla.0000000000003443 · Cited by 22
“Abuse of prescription opioids is known to lead to heroin abuse, as 86% of heroin addicts reported their first exposure to opioids was through prescription narcotic medications.(5,6) At 50,000 deaths annually, opiate abuse accounts for a 3,4 death toll larger than motor vehicle crashes or gun violence.”
BackgroundKecojević, A., Silva, K., Sell, R. L., & Lankenau, S. E. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0898-5 · Cited by 21
“dysfunctions [8], and multiple risk practices [9, 10].”
BackgroundSelf-citationPharmacologically Assisted Treatment of Opioid-Dependent Youth
Pecoraro, A., Fishman, M. J., Ma, M., Piralishvili, G., & WOODY, G. E. (2013) · Pediatric Drugs · doi:10.1007/s40272-013-0041-5 · Cited by 21
“Among injection drug users aged 16–25 years in Los Angeles and New York, over 90 % of those who began using prescription opioids later used heroin, and many of them started by injecting prescription opioids before transitioning to intravenous heroin [11] with the associated risks of contracting hepatitis B and C, and…”
BackgroundHearne, E., Grund, J., Hout, M. C. V., & McVeigh, J. (2016) · Harm Reduction Journal · doi:10.1186/s12954-016-0105-2 · Cited by 21
“[75] suggest that formulation tampering with these drugs allows for dispensing higher doses and therefore is cost effective.”
BackgroundCheng, T., Small, W., Dong, H., Nosova, E., Hayashi, K., & DeBeck, K. (2018) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-018-0180-3 · Cited by 21
Do Prescription Drug Monitoring Programs Encourage Prescription – or Illicit – Opioid Abuse?
Meadowcroft, D., & Whitacre, B. E. (2019) · Substance Abuse · doi:10.1080/08897077.2019.1695707 · Cited by 22
Opioid Craving in Human Laboratory Settings: a Review of the Challenges and Limitations
Goodyear, K., & Haass‐Koffler, C. L. (2019) · Neurotherapeutics · doi:10.1007/s13311-019-00791-8 · Cited by 20
“One study showed that participants misused opioids primarily in households [17]; however, there are limited studies on location or environmental contexts for opioid use.”
BackgroundHepatitis C Surveillance among Youth and Young Adults in New York City, 2009–2013
Prussing, C., Bornschlegel, K., & Balter, S. (2014) · Journal of Urban Health · doi:10.1007/s11524-014-9920-5 · Cited by 20
Correlates and Consequences of Opioid Misuse among High-Risk Young Adults
Schrager, S. M., Kecojević, A., Silva, K., Bloom, J. J., Iverson, E., & Lankenau, S. E. (2014) · Journal of Addiction · doi:10.1155/2014/156954 · Cited by 20
“Prescription opioid misusers transition to alternate modes of administration for a range of reasons, including an increased tolerance to opioids [8], increasing frequency of opioidmisuse [17], and availability of specific opioid formulations [14, 15].”
BackgroundInfluentialSelf-citationYoung, S. G., Hayes, C. J., Aram, J., & Tait, M. A. (2019) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4838 · Cited by 19
“Furthermore, a qualitative study with young, intravenous drug users found that almost all (86%) heroin users had used prescription opioids prior to their heroin use, and in most cases, opioids were obtained from family, friends, or personal prescriptions.(4) It is, therefore, imperative that detection of nonmedical us…”
BackgroundHigh Prevalence of Illicit Drug Use in Men Who Have Sex with Men with HIV-1 Infection in Japan
Nishijima, T., Gatanaga, H., Komatsu, H., Takano, M., Ogane, M., Ikeda, K., & Oka, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0081960 · Cited by 19
“drugs are at high risk for HIV and sexual transmitted infections due to close associations between risky sexual behaviors and illicit drug use [27,28] Furthermore, illicit drug use, especially opioid use, can be a trajectory into injection drug use [29,30].”
BackgroundConversations about analgesics in the emergency department: A qualitative study
McCarthy, D. M., Engel, K. G., & Cameron, K. A. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.01.011 · Cited by 19
Lake, S., Milloy, M., Dong, H., Hayashi, K., Wood, E., Kerr, T. H., & DeBeck, K. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.10.017 · Cited by 18
“…initiators are heroin users that initiate PO injecting in parallel with increasing opioid dependence, perhaps due to better market availability of POs versus heroin at time of initiation - another common narrative emerging from qualitative work (Firestone and Fischer, 2008; Lankenau et al., 2012a).”
BackgroundResultInfluentialHeroin use onset among nonmedical prescription opioid users in the club scene
Surratt, H. L., Kurtz, S. P., Buttram, M. E., Levi‐Minzi, M. A., Pagano, M. E., & Cicero, T. J. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.06.034 · Cited by 18
“In line with other emerging research, our findings indicate that route of administration is a key factor in opioid transitions (Carlson et al., 2016; Lankenau et al., 2012), and may represent an important target for prevention and intervention efforts.”
BackgroundMethodResultTrends in Adolescent Heroin and Injection Drug Use in Nine Urban Centers in the U.S., 1999–2017
Brighthaupt, S.-C., Schneider, K. E., Johnson, J. K., Jones, A. A., & Johnson, R. M. (2019) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2019.03.026 · Cited by 18
Buttram, M. E., Kurtz, S. P., Surratt, H. L., & Levi‐Minzi, M. A. (2013) · Substance Use & Misuse · doi:10.3109/10826084.2013.828754 · Cited by 18
Cepeda, J., Astemborski, J. A., Kirk, G. D., Celentano, D. D., Thomas, D. L., & Mehta, S. H. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213357 · Cited by 18
The opioid crisis and the infrastructure of social capital
Sered, S. S. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.05.017 · Cited by 17
Barranco, M. A., Rosenberg, E. S., Flanigan, C. A., Shufelt, S., Bruce, E. M., Wilberschied, L. A., Parker, M. M., Duncan, E., & Udo, T. (2022) · Journal of Viral Hepatitis · doi:10.1111/jvh.13735 · Cited by 17
“Study eligibility criteria included (1) Residing in counties served by participating SSPs; (2) Age 18 or older; (3) History of IDU in the past year; (4) Able to read and write in English; (5) Willing to provide contact information and be re- contacted (e.”
BackgroundLatent class analysis of non-opioid dependent illegal pharmaceutical opioid users in Ohio
Carlson, R. G., Nahhas, R. W., Daniulaityte, R., Martins, S. S., Li, L., & Falck, R. S. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.10.004 · Cited by 17
“…characteristics, such as sources of opioid diversion (Inciardi et al., 2009), initiation into non-medical opioid use (Daniulaityte et al., 2006; Lankenau et al., 2012), motivations for opioid use (Boyd et al., 2006; McCabe et al., 2009), gender differences in non-medical opioid use…”
Jordan, A. E., Jarlais, D. D., & Hagan, H. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-95 · Cited by 17
“As the epidemic of misuse of prescription opioids matures, it will likely serve as a persistent source of new PWID, a group characterized by high rates of HCV seroconversion of 40 per 100 person years or higher [30,31].”
BackgroundInfluentialThe Poly-Drug User: Examining Associations between Drugs Used by Adolescents
Biggar, R., Forsyth, C., Chen, J., & Burstein, K. (2017) · Deviant Behavior · doi:10.1080/01639625.2016.1246022 · Cited by 17
“…addiction and the rising heroin epidemic occurring in many communities, the research supporting the possibility of prescription pain medication as a gateway drug to heroin use and/or addiction is becoming more plausible (Compton and Volkow 2006; Kelly et al. 2013a, 2013b; Lankenau et al. 2012).”
Background
Metadata
- Authors
- Lankenau, S. E., Teti, M., Silva, K., Bloom, J. J., Harocopos, A., & Treese, M.
- Affiliations
- Drexel University (US)
- University of Missouri (US)
- Children's Hospital Los Angeles (US)
- National Development and Research Institutes (US)
- Corresponding author
- Lankenau, Stephen E.
- Venue
- International Journal of Drug Policy
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 23
- Issue
- 1
- Pages
- 37-44
- ISSN
- 0955-3959 (ISSN-L)
- PMC
- PMC3196821
- OpenAlex
- W2128960742
- Cited by
- 440
- References
- 71
- Citations by year
- 2026: 5 · 2025: 17 · 2024: 13 · 2023: 19 · 2022: 22 · 2021: 30 · 2020: 84 · 2019: 46 · 2018: 35 · 2017: 34 · 2016: 33 · 2015: 35 · 2014: 27 · 2013: 27 · 2012: 11
- FWCI
- 20.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Drug Policy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (DA021299)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- prescription opioid misuse, intravenous drug use, young adults, opioid initiation, heroin use, substance use trajectories, opioid access, drug addiction, opioid overdose, illicit drug use
- MeSH terms
- Adolescent, Adolescent Behavior, Adult, Age Factors, Analgesics, Opioid, Heroin, Family, Family Health, Female, Humans, Male, Opioid-Related Disorders, New York City, Surveys and Questionnaires, Los Angeles, Substance Abuse, Intravenous, Friends, Prescription Drugs, Young Adult, Drug-Seeking Behavior
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