Drug use generations and patterns of injection drug use: Birth cohort differences among people who inject drugs in Los Angeles and San Francisco, California

Abstract

Objectives A robust literature documents generational trends in drug use. We examined the implications of changing national drug use patterns on drug injection histories of diverse people who inject drugs (PWID). Methods Drug use histories were collected from 776 active PWID in 2011–13. Using descriptive statistics, we examine drug use initiation by year and birth cohort (BC) differences in drug first injected. A multivariate linear regression model of time to injection initiation ([TTII] (year of first injection minus year of first illicit drug use) was developed to explore BC differences. Results The first drug injected by BC changed in tandem with national drug use trends with heroin declining from 77% for the pre-1960’s BC to 58% for the 1960’s BC before increasing to 71% for the 1990’s BC. Multivariate linear regression modeling found that shorter TTII was associated with the 1980’s/1990’s BC (−3.50 years; 95% Confidence Interval [CI]=−0.79, −6.21) as compared to the 1970’s BC. Longer TTII was associated with being female (1.65 years; 95% CI=0.40, 2.90), African American (1.69 years; 95% CI=0.43, 2.95), any substance use treatment prior to injection (4.22 years; 95% CI=2.65, 5.79), and prior non-injection use of drug that was first injected (3.29 years; 95% CI=2.19, 4.40). Conclusion National drug trends appear to influence injection drug use patterns. The prescription opiate drug era is associated with shorter TTII. Culturally competent, demographically and generationally-targeted prevention strategies to combat transitions to drug injection are needed to prevent or shorten upstream increases in risky practices on a national level.

Intravenous opioid drug abuse as an independent risk factor for supraglottic squamous cell carcinoma—A case‐control study

“…According to our data, intravenous opioid drug abuse is an independent risk factor for supraglottic SCC, and this is of clinical significance for several reasons. First, the ongoing epidemic of prescribed opioid abuse may result in long‐lasting opioid addiction driving the addicts towards early intravenous opioid abuse . Additionally, the life expectancy of this specific population should be longer than the life expectancy of classic intravenous opioid abusers.…”

“…First, the ongoing epidemic of prescribed opioid abuse may result in longlasting opioid addiction 11 driving the addicts towards early intravenous opioid abuse. 35 Additionally, the life expectancy of this specific population should be longer than the life expectancy of classic intravenous opioid abusers. Furthermore, government encouraged rehabilitation and maintenance programs can potentially increase the life expectancy of opioid addicts in general.…”

Trends in opioid initiation among people who use opioids in three US cities

“…Changes in these populations and their trajectories from initiation to high‐risk use aligned with national drug trends impacting both licit and illicit drug markets . In the 1990s, a rise in prescribing of opioids for pain management vastly increased their circulation , a consequence of which was the arrival and gradual entrenchment of diverted prescription opioids for non‐medical use in the illicit drug market .…”

“…Changes in these populations and their trajectories from initiation to high‐risk use aligned with national drug trends impacting both licit and illicit drug markets . In the 1990s, a rise in prescribing of opioids for pain management vastly increased their circulation , a consequence of which was the arrival and gradual entrenchment of diverted prescription opioids for non‐medical use in the illicit drug market . The result was an unprecedented rise in non‐medical use of prescription opioids (NMPO), which refers to the use of prescription opioids not as directed by the prescribing clinician , and related overdose deaths .…”

“…The result was an unprecedented rise in non‐medical use of prescription opioids (NMPO), which refers to the use of prescription opioids not as directed by the prescribing clinician , and related overdose deaths . Use of PO and NMPO, and subsequent efforts to curb their supply , also increased likelihood of transitioning to heroin use and successive adoption of higher risk practices, such as injection . This trend occurred amid changes to the illicit drug supply resulting in increased availability of pure, low‐cost heroin and emergence of highly potent IMFA and analogues to street drug markets.…”