Initiation into prescription opioid misuse amongst young injection drug users

“Following the CAP, ethnographers sampled young IDUs using a combination of targeted sampling (Watters & Biernacki, 1989) and chain referral sampling (Biernacki & Waldorf, 1981; Penrod et al., 2003).”

“Following the CAP, ethnographers sampled young IDUs using a combination of targeted sampling (Watters & Biernacki, 1989) and chain referral sampling (Biernacki & Waldorf, 1981; Penrod et al., 2003).”

“Following the CAP, ethnographers sampled young IDUs using a combination of targeted sampling (Watters & Biernacki, 1989) and chain referral sampling (Biernacki & Waldorf, 1981; Penrod et al., 2003).”

“…aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et al., 2004; Rondinelli et al., 2009).”

“Additionally, the young people clearly regarded prescription opioids – regardless of source – as readily accessible, valued commodities that could be traded or sold (McCabe et al. 2006).”

“Young injection drugs users (IDUs) – persons aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002;…”

“Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence (SAMSHA, 2008a; Weiss et al., 2010) and fatal overdose (Paulozzi & Xi, 2008; SAMSHA, 2010b).”

“…patterns corroborate findings from recent research on broader samples, i.e., not exclusively young adults or IDUs, suggesting that opioid misuse (Siegal et al. 2003; Daniulaityte et al., 2006; Inciardi et al. 2009) or polyopioid misuse (Grau et al., 2007) may serve as a gateway to heroin.”

“Two key characteristic of initiation - the drug and the mode of administration – are often studied to understand trajectories into increasingly risky types of drug use, such as transitions to injecting heroin or cocaine (Fuller et al., 2001; Sherman et al., 2002; Roy et al., 2003).”

““Prescription drug misuse” or “non-medical use” was defined to participants as: “drugs you may have used without a prescription, in greater amounts, administered differently, more often, or longer than prescribed, or for a reason other than a doctor said you should use them” (Blanco et al. 2007”

“However, this is the first study to our knowledge, among a sample of young IDUs - amidst this recent epidemic of prescription drug misuse (c.f., Courtwright, 1982; Hernandez & Nelson, 2010) – to report a trajectory from opioid misuse to injecting heroin or injecting both opioids and heroin.”

“…patterns corroborate findings from recent research on broader samples, i.e., not exclusively young adults or IDUs, suggesting that opioid misuse (Siegal et al. 2003; Daniulaityte et al., 2006; Inciardi et al. 2009) or polyopioid misuse (Grau et al., 2007) may serve as a gateway to heroin.”

“…most widely prescribed opioid in the U.S. (Schneider et al. 2009) – to later sniffing and/or injecting OxyContin – a less commonly prescribed but more potent opioid (Schneider et al. 2009) – indicates increasingly sophisticated users with access to varied sources of opioids (Davis & Johnson, 2008).”

“In households where problematic drug use by parents and siblings became “normalised” (MacDonald & Marsh, 2002; Parker, 1998), young peoples’ misuse of opioids or other drugs was seldom discovered by adults or viewed as aberrant.”

“Understanding sources of opioids as multiple and often overlapping – rather than mutually exclusive categories - is an important distinction made in previous research on young non-IDUs (McCabe & Boyd, 2005; Schepis & Krishnan-Sarin, 2009).”

“…begins with misuse of opioids is important given the prevalence of prescription opioid misuse among adolescents (Johnston et al., 2010) and young adults (SAMSHA, 2010a) and the risks associated with transitioning into injection drug use (Fuller et al., 2002; Sherman et al., 2006; Roy et al., 2008).”

“In households where problematic drug use by parents and siblings became “normalised” (Parker, 1998; MacDonald & Marsh, 2002), young peoples’ misuse of opioids or other drugs was seldom discovered by adults or viewed as aberrant.”

“…injection drugs users (IDUs) – persons aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et…”

“Two key characteristic of initiation - the drug and the mode of administration – are often studied to understand trajectories into increasingly risky types of drug use, such as transitions to injecting heroin or cocaine (Fuller et al., 2001; Sherman et al., 2002; Roy et al., 2003).”

“…aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et al., 2004; Rondinelli et al., 2009).”

“This mixed method approach has been used previously to describe risk behaviours and patterns of substance misuse among smaller samples of high-risk youth (Lankenau et al., 2005; Lankenau & Sanders, 2007; Hathazi et al., 2009; Sanders et al., 2010).”

“…towards a fuller comprehension of emerging drugs (Lankenau & Clatts, 2004; Firestone & Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and…”

“Young IDUs – whose lifetime prevalence of heroin has approached 100% in some studies (Ochoa et al., 2005; Havens et al., 2006) - are at increased risk for initiation and misuse of prescription opioids (SAMSHA, 2009b).”

“…young IDUs contributes towards a fuller comprehension of emerging drugs (Lankenau & Clatts, 2004; Firestone & Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt…”

“…& Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and potential prevention and intervention strategies (Sherman et al., 2005; Miller et al. 2006”

“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 (Chein et al., 1964; Faupel, 1991; Daniulaityte et al., 2006).”

“…IDUs in North America, published since 2000 – the period covering the rapid rise in opioid misuse (SAMSHA, 2009c) - revealed only five manuscripts that reported data on prescription opioid misuse (Hagan et al., 2007; Lankenau et al., 2007a; 2007b; Firestone & Fischer, 2008; Evans et al., 2009).”

“…& Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and potential prevention and intervention strategies (Sherman et al., 2005; Miller et al. 2006”

“Two key characteristic of initiation - the drug and the mode of administration – are often studied to understand trajectories into increasingly risky types of drug use, such as transitions to injecting heroin or cocaine (Fuller et al., 2001; Sherman et al., 2002; Roy et al., 2003).”

“The study design was informed by an ethno-epidemiological methodology (Agar, 1996; Clatts et al., 2002; Pach & Gorman, 2002) that utilises both quantitative data, i.e., frequencies and percentages, to describe broader patterns found within a study sample and qualitative data, i.e., narrative…”

“…aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et al., 2004; Rondinelli et al., 2009).”

“Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence (SAMSHA, 2008a; Weiss et al., 2010) and fatal overdose (Paulozzi & Xi, 2008; SAMSHA, 2010b).”

“Understanding sources of opioids as multiple and often overlapping – rather than mutually exclusive categories - is an important distinction made in previous research on young non-IDUs (McCabe & Boyd, 2005; Schepis & Krishnan-Sarin, 2009).”

“…& Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and potential prevention and intervention strategies (Sherman et al., 2005; Miller et al. 2006”

“(Johnston, O’Malley, Bachman, & chulenberg, 2010; SAMHSA, 2009a, 2010a) and is most prevalent mongst young adults aged 18–25 years old (Boyd et al., 2009; AMHSA, 2010a).”

“…patterns corroborate findings from recent research on broader samples, i.e., not exclusively young adults or IDUs, suggesting that opioid misuse (Siegal et al. 2003; Daniulaityte et al., 2006; Inciardi et al. 2009) or polyopioid misuse (Grau et al., 2007) may serve as a gateway to heroin.”

“The study design was informed by an ethno-epidemiological methodology (Agar, 1996; Clatts et al., 2002; Pach & Gorman, 2002) that utilises both quantitative data, i.e., frequencies and percentages, to describe broader patterns found within a study sample and qualitative data, i.e., narrative…”

“…& Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and potential prevention and intervention strategies (Sherman et al., 2005; Miller et al. 2006”

“…aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002; Miller et al., 2004; Rondinelli et al., 2009).”

“Prior to sampling, trained ethnographers from each site conducted a Community Assessment Process (CAP; Clatts et al., 1995), which recorded local knowledge about prescription drug misuse and determined the locations of groups of young IDUs.”

“These studies provided only minimal descriptive data such as lifetime prevalence (Lankenau et al. 2007a), misuse in the past three months (Hagan et al., 2007; Evans et al., 2009), or anecdotal findings on initiation (Lankenau et al., 2007b; Finestone & Fischer, 2008).”

“This mixed method approach has been used previously to describe risk behaviours and patterns of substance misuse among smaller samples of high-risk youth (Lankenau et al., 2005; Lankenau & Sanders, 2007; Hathazi et al., 2009; Sanders et al., 2010).”

“This mixed method approach has been used previously to describe risk behaviours and patterns of substance misuse among smaller samples of high-risk youth (Lankenau et al., 2005; Lankenau & Sanders, 2007; Hathazi et al., 2009; Sanders et al., 2010).”

“…IDUs in North America, published since 2000 – the period covering the rapid rise in opioid misuse (SAMSHA, 2009c) - revealed only five manuscripts that reported data on prescription opioid misuse (Hagan et al., 2007; Lankenau et al., 2007a; 2007b; Firestone & Fischer, 2008; Evans et al., 2009).”

“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 (Chein et al., 1964; Faupel, 1991; Daniulaityte et al., 2006).”

“Young injection drugs users (IDUs) – persons aged 30 and younger who currently inject drugs (e.g., Fuller et al., 2001; Roy et al., 2007; Page et al., 2009; Hagan et al., 2010) - are a particularly high-risk subgroup of adolescents and young adults (Thorpe et al., 2002; Davidson et al., 2002;…”

“…begins with misuse of opioids is important given the prevalence of prescription opioid misuse among adolescents (Johnston et al., 2010) and young adults (SAMSHA, 2010a) and the risks associated with transitioning into injection drug use (Fuller et al., 2002; Sherman et al., 2006; Roy et al., 2008).”

“Young IDUs – whose lifetime prevalence of heroin has approached 100% in some studies (Ochoa et al., 2005; Havens et al., 2006) - are at increased risk for initiation and misuse of prescription opioids (SAMSHA, 2009b).”

“These studies provided only minimal descriptive data such as lifetime prevalence (Lankenau et al. 2007a), misuse in the past three months (Hagan et al., 2007; Evans et al., 2009), or anecdotal findings on initiation (Lankenau et al., 2007b; Finestone & Fischer, 2008).”

“…IDUs in North America, published since 2000 – the period covering the rapid rise in opioid misuse (SAMSHA, 2009c) - revealed only five manuscripts that reported data on prescription opioid misuse (Hagan et al., 2007; Lankenau et al., 2007a; 2007b; Firestone & Fischer, 2008; Evans et al., 2009).”

“Prior research indicates that studying initiation events among young IDUs contributes towards a fuller comprehension of emerging drugs (Lankenau & Clatts, 2004; Firestone & Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al.,…”

“Furthermore, the progression from initiating misuse with Vicodin – amongst the most widely prescribed opioid in the U.S. (Schneider et al. 2009) – to later sniffing and/or injecting OxyContin – a less commonly prescribed but more potent opioid (Schneider et al. 2009) – indicates increasingly sophisticated users with a…”

“…(Lankenau & Clatts, 2004; Firestone & Fischer, 2008), user populations (Roy et al., 2002; Fuller et al., 2003), risk behaviours (Roy et al., 2003; Lankenau et al., 2010), social context (Harocopos et al., 2009; Goldsamt et al., 2010) and potential prevention and intervention strategies (Sherman…”

“This mixed method approach has been used previously to describe risk behaviours and patterns of substance misuse among smaller samples of high-risk youth (Lankenau et al., 2005; Lankenau & Sanders, 2007; Hathazi et al., 2009; Sanders et al., 2010).”

“…(eg US Department of Justice, 2001; OSAM, 2002) there have been very few in-depth studies of the experiences of users transitioning between these drugs, their modes of administration and the contexts in which these developments take place (see Daniulaityte et al, 2006 and Lankenau et al, 2012).”