Down in the valley: Trajectories of injection initiation among young injectors in California’s Central Valley

Abstract

Background Injection drug use initiation represents a critical point of public health intervention, as injection increases risk forblood borne infections including Hepatitis C and HIV. In this paper, weexplore pathways to injection initiation among youth (<=30) in the ruralcontext of California’s Central Valley, where rates of injection drug useare among the highest in the nation. Methods We draw on semi-structured qualitative interviews with 20 younginjectors to examine drug use histories, including the factors that participants associated with their transition to injection drug use. Results The average age was 24.7 years (range: 20–30), 45% were female(n=9), and 30% were Latino (n=6). Participants described a variety ofpathways to injection, culminating in a first injection that involvedeither opioids (n=12) or methamphetamine (n=8). Among the opioid group, the majority used prescription opioids before transitioning to injection, while a smaller number transitioned to opioid injection from non-opioid recreational drug use. Injectors who first used prescription opioidsoften described growing up in affluent suburban areas and transitioned toinjection with peers, owing to a combination of factors related toindividual tolerance, cost, and shifting drug markets. In contrast, methamphetamine initiates grew up in less affluent families withhistories of substance use that exposed them to drugs at an early age. Methamphetamine users transitioned from smoking and snorting toinjection, often with family members or intimate partners, within broadercontexts of social disadvantage and stress. Conclusions While much of the focus on young injectors has centered onthe current opioid epidemic, our data suggest a need to consider multiple pathways toward injection initiation of different drugs. Targetedinterventions addressing the unique injection transition contexts of bothopioids and methamphetamine are urgently needed in the Central Valley ofCalifornia.

Hepatitis C testing and treatment uptake among young people who use opioids in New York City: A cross‐sectional study

“…12 Additionally, people who misuse prescription opioids are also at increased risk of subsequently injecting drugs. [32][33][34] Data from the current study show that individuals who report injecting drugs reported initiating injection an average of 4 years after starting non-injection opioid misuse. 19 may not yet be connected to testing.…”

“…One practical consideration is that individuals may not disclose injection practices in healthcare settings as a means to avoid stigma, preventing clinicians from accurately differentiating these risk groups 12 . Additionally, people who misuse prescription opioids are also at increased risk of subsequently injecting drugs 32–34 . Data from the current study show that individuals who report injecting drugs reported initiating injection an average of 4 years after starting non‐injection opioid misuse 19 .…”

A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA

“…Research suggests that a range of influences shape the initiation of injection drug use, including age, gender, socio-economic position and structural shifts (Guise, Horyniak, Melo, McNeill, & Werb, 2017; Harocopos, Goldsamt, Kobrak, Jost, & Clatts, 2009; Syvertsen, Paquette, & Pollini, 2017). Injection drug use initiation has also been linked to a range of meanings and experiences for individuals, including cost-efficacy, pleasure and belonging (Guise et al, 2017).…”

Patient perspectives of transitioning from prescription opioids to heroin and the role of route of administration

“…Other qualitative studies have focused on the route of administration transitions of youths with opioid use disorders, finding that this group largely attributed their transition to injection use to individual tolerance, cost, and shifting drug markets – findings that are consistent with those presented in this study [ 19 ]. Additionally, quantitative studies on this population found that lifetime prescription opioid dependence, early ago of prescription opioid initiation, use not attributed to self-medication of a health issue, and predominantly using prescription opioids non-orally were all significant predictors of youths transitioning to heroin [ 20 ]. By understanding the key role of route of administration and common myths shape key transition points for opioid users, practitioners will be allowed to develop effective harm reduction and prevention materials that target individuals already using prescription opioids, or in the early stages of heroin use.…”