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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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“Additionally, transition to heroin use is correlated with transition to injection drug use (13, 17), a route of administration that has been associated with increased risk of overdose (15)—a finding our bivariable results confirm.”
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“Previous research conducted in Los Angles and New York has also shown the link between injection of opioids and prescription opioid use (49).”
BackgroundDertadian, G. C., Dixon, T. C., Iversen, J., & Maher, L. (2017) · Drug and Alcohol Review · doi:10.1111/dar.12474 · Cited by 7
The Role of Family in Youth Opioid Misuse: A Literature Review
Kaur, L., Tadros, E., & Patton, R. (2019) · The Family Journal · doi:10.1177/1066480719868705 · Cited by 7
“Family structure was described in a total of 10 studies (Donaldson, Nakawaki, & Crano, 2015; Lankenau et al., 2012; Monnat & Rigg, 2016; Nakawaki & Crano, 2012; Pugatch, Knight, McGuiness, Sherritt, & Levy, 2014; Silva et al., 2013; Spoth et al., 2013; Sussman et al., 2012; Walker et al., 2014;…”
BackgroundInfluentialYouth Perspectives of Prescription Pain Medication in the Opioid Crisis
Harbaugh, C. M., Vu, J. V.-T., DeJonckheere, M. J., Kim, N., Nichols, L. P., & Chang, T. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.02.003 · Cited by 7
Baillif‐Couniou, V., Kintz, P., Sastre, C., Rop, P. P., Chèze, M., Pépin, G., Léonetti, G., & Pélissier‐Alicot, A. (2015) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2015.08.014 · Cited by 7
Epidemiology of Opioid Use, Misuse, and Overdoses
Draghmeh, K., Gold, M. S., & Fuehrlein, B. (2025) · Current Addiction Reports · doi:10.1007/s40429-025-00649-4 · Cited by 6
“The use of opioids typically follows a pattern of oral use, then snorting, and finally injection, with injection being the historically predominant route of heroin use in the United States [33–36].”
Huo, Y., Wang, X., Lin, X., Yu, J., Li, B., Liu, Z., Guo, S., Wang, Y., Tang, R.-C., Li, B., et al. (2025) · Neuron · doi:10.1016/j.neuron.2025.08.012 · Cited by 7
Paniccia, J. E., Weckstein, T. N., Lebonville, C. L., & Lysle, D. T. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.10.009 · Cited by 5
“, 2018), which is often a precursor for heroin use (Lankenau et al., 2012).”
BackgroundStader, D. E., Wald, H. L., MacKay, D. R., Mannerings, A., Valuck, R. J., Kuljis, D., & Brady, M. F. (2020) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12263 · Cited by 5
Opioids and Injury Deaths: A population-based analysis of the United States from 2006 to 2017
Truong, E. I., Kishawi, S. K., Ho, V. P., Tadi, R. S., Warner, D. F., Claridge, J. A., & Tseng, E. S. (2021) · Injury · doi:10.1016/j.injury.2021.03.018 · Cited by 6
Lei, M., Rintoul, K., Stubbs, J. L., Kim, D. D., Jones, A. A., Hamzah, Y., Procyshyn, R. M., Gicas, K. M., Cho, L. L., Panenka, W. J., et al. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1958865 · Cited by 6
“…typically develops an increased tolerance to opioids (Raith & Hochhaus, 2004), and will continue to rely primarily on non-prescribed opioids, due their higher pharmacological potency and more efficient routes of administration, to maintain their patterns of opioid abuse (Lankenau et al., 2012).”
BackgroundRintoul, K., Song, E., McLellan-Carich, R., Schjelderup, E. N. R., & Barr, A. M. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1020038 · Cited by 6
“Attempts to selfmedicate pain or other health problems due to the barriers mentioned above can lead some to use illicit drugs (17, 19, 60, 69), which then puts them in situations where they face even more challenges, potentially resulting in greater social withdrawal (49).”
BackgroundAn Integrated Structural Equation Model of eHealth Behavioral Intention
Prybutok, G. T., Ta, A., Liu, X., & Prybutok, V. R. (2019) · International Journal of Healthcare Information Systems and Informatics · doi:10.4018/ijhisi.2020010102 · Cited by 6
Probst, C., Elton‐Marshall, T., Imtiaz, S., Patte, K. A., Rehm, J. T., Sornpaisarn, B., & Leatherdale, S. T. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01518-3 · Cited by 6
Pediatric Urologic Surgery: Reducing Opioid Use
Nelson, R., Shimon, T., & Grimsby, G. M. (2021) · Pediatric Drugs · doi:10.1007/s40272-021-00462-2 · Cited by 6
“Of adolescents and young adults who used intravenous opioids, 75% reported initiating opioid misuse with prescription opioids [33].”
BackgroundPostoperative Opioid Filling Patterns in Women Undergoing Midurethral Sling Placement
Feroz, R. T., Boyd, S. S., Schaefer, É., Swailes, A. L., & Long, J. B. (2020) · Urogynecology · doi:10.1097/spv.0000000000000919 · Cited by 6
Delorme, T. C., Sambare, S., Williams, B. R., Gamble, M. C., Carrette, L. L. G., Woods, L. C. S., Maturin, L., Palmer, A. A., George, O., & Logan, R. W. (2025) · Addiction Neuroscience · doi:10.1016/j.addicn.2025.100240 · Cited by 5
Webster, L. R., Iverson, M., Pantaleon, C., Smith, M. D., Kinzler, E. R., & Aigner, S. (2018) · Pain Medicine · doi:10.1093/pm/pny043 · Cited by 5
A prospective study of opioid use for postoperative pain management after breast operation
Limbach, K. E., Pommier, S. J., Massimino, K. P., Pommier, R. F., & Naik, A. M. (2019) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2019.07.032 · Cited by 5
Educational Intervention Changes College Students’ Attitudes toward Prescription Opioid Drug Use
Johnson, E. C., Huffman, A. E., Yoder, H. A., Bordelon, N. M., Sewczak-Claude, G., & Smith, D. T. (2019) · Substance Use & Misuse · doi:10.1080/10826084.2019.1673418 · Cited by 5
“This style of attainment and the resulting spread of POD in college students is a concern because diversion has been linked to accelerated drug use, such as injecting drugs (Lankenau et al., 2012).”
BackgroundPeer Influence in Initiation to Heroin Use
Costello, B. J., Anderson, B., & Stein, M. (2020) · Journal of Drug Issues · doi:10.1177/0022042620979628 · Cited by 8
Substance and Behavioral Addictions Assessment Instruments
Grigsby, T. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.012 · Cited by 6
Dash, G. F., Gizer, I. R., & Slutske, W. S. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.111084 · Cited by 5
Opioid-Related Disparities in Sexual Minority Youth, 2017
Wilson, J. D., Sumetsky, N., Coulter, R. W. S., Liebschutz, J. M., Miller, E., & Mair, C. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000628 · Cited by 5
“Additionally, previous iterations of the Youth Risk Behavior Survey (YRBS) grouped together all prescription misuse (eg, stimulants, opioids, tranquilizers) limiting our ability to understand opioid misuse specifically, which is the most common way youth initiate opioid use and can serve as a pathway to more severe op…”
Danagoulian, S., King, A. M., Mangan, K. C., Tarchick, J., & Dolcourt, B. A. (2021) · Pain Medicine · doi:10.1093/pm/pnab270 · Cited by 5
Maher, L., & Page, K. A. (2015) · Addiction · doi:10.1111/add.13003 · Cited by 5
Opioid use in Latin America: Chronicle of a death foretold?
León, P. J., Altermatt, F. R., Vega, E. A., Elgueta, M. F., & Léniz, J. (2024) · Journal of Global Health · doi:10.7189/jogh.14.03040 · Cited by 4
“Stories of starting”: Understanding the complex contexts of opioid misuse initiation
Spencer, N. E., Taubenberger, S. P., Roberto, R., Krishnamurti, L. S., Chang, J. C., & Hacker, K. A. (2021) · Substance Abuse · doi:10.1080/08897077.2021.1878084 · Cited by 4
Post-Procedural Opioid Prescribing in Children: A Survey of the American Academy of Pediatrics
Hedges, E. A., Livingston, M. H., Esce, A. R., Browne, M., Moriarty, K. P., Raval, M. V., Rothstein, D. H., & Wakeman, D. S. (2021) · Journal of Surgical Research · doi:10.1016/j.jss.2021.07.044 · Cited by 4
Wilton, J., Wong, S., Purssell, R. A., Abdia, Y., Chong, M., Karim, M. E., MacInnes, A. I., Bartlett, S. R., Balshaw, R., Gomes, T., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.43050 · Cited by 4
Kitson, C., Haines, M., & O’Byrne, P. (2022) · Global Qualitative Nursing Research · doi:10.1177/23333936221080935 · Cited by 4
“…our review of the literature, much of the research on PWUD includes either samples of exclusively male participants or male and female participants, with limited research samples comprising only females (see: Firestone & Fischer, 2008; Lankenau et al., 2012; Neale et al., 2007; Roy et al., 2011).”
BackgroundCushion, M. L., Johnson, M. E., & Smith, N. D. L. (2019) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2020.1735598 · Cited by 4
“Early OM initiation has been associated with transitioning from Corresponding Author: Minor L. Cushion. uthor M anuscript A uthor M anuscript A uthor M anuscript prescription opioids to injectable opioids, drug dependence and fatal overdose (Lankenau et al., 2012).”
BackgroundPrevention and Treatment of Sex Addiction
Reid, R. C., Grubbs, J. B., & Kraus, S. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.025 · Cited by 4
Johnson, M. E., & Zaidi, F. (2021) · Addiction Research & Theory · doi:10.1080/16066359.2021.1891414 · Cited by 4
Eisenschink, J., Leveille, D., Leveille, R., Mollica, A. J., & Rhodenizer, J. (2023) · The Journal of Foot & Ankle Surgery · doi:10.1053/j.jfas.2023.05.009 · Cited by 4
Opioid prescribing habits of podiatric surgeons following elective foot and ankle surgery
Sundling, R. A., Logan, D. B., Tawancy, C. H., So, E., Lee, J., & Logan, K. (2020) · The Foot · doi:10.1016/j.foot.2020.101710 · Cited by 4
A Syndemic Approach to Understanding HIV/AIDS Among People Who Inject Drugs in the U.S.
Pouget, E. R., & Bennett, A. S. (2016) · Social disparities in health and health care · doi:10.1007/978-3-319-34004-3_8 · Cited by 4
Characterizing non-heroin opioid overdoses using electronic health records
Averitt, A., Slovis, B., Tariq, A. A., Vawdrey, D., & Perotte, A. J. (2019) · JAMIA Open · doi:10.1093/jamiaopen/ooz063 · Cited by 3
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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