Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

Abstract

Extra-medical prescription opioid (EMPO) use—intentional use without a prescription or outside of prescribed parameters—is a public health crisis in the United States and around the world. Epidemiological evidence suggests that the prevalence of EMPO use and adverse sequelae, including opioid overdose and hepatitis C infection, are elevated among people aged 18 to 25. Despite these preventable health risks, many harm reduction interventions are underutilized by, or inaccessible to, EMPO-using youth. In this commentary, we describe key harm reduction strategies for young people who use prescription opioids. We examine individual, social, and policy-level barriers to the implementation of evidence-based approaches that address EMPO use and related harms among young people. We highlight the need for expanded services and new interventions to engage this diverse and heterogeneous at-risk population. A combination of medical, social, and structural harm reduction interventions are recommended. Furthermore, research to inform strategies that mitigate particularly high-risk practices (e.g., polysubstance use) is warranted. Finally, we discuss how the meaningful involvement of youth in the implementation of harm reduction strategies is a critical component of the public health response to the prescription opioid epidemic.

Hospitalizations for Endocarditis and Associated Health Care Costs Among Persons with Diagnosed Drug Dependence — North Carolina, 2010–2015

“…These findings suggest a need to focus preventive interventions on harm reduction strategies such as syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies ( 10 ). …”

The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

“…In populations with escalating incidence of PWID, a failure to integrate harm reduction strategies into any proposed healthcare intervention can have a significant impact on HCV transmission, as evidenced by the recent “opioid crisis” in parts of North America 37, 38. In Tanzania, there are an estimated 50 000 PWID, with only 3000 engaging in a local OST programme 10.…”

Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

“…Campaigns to encourage young adults to call 911 in the event that they witness an overdose are needed. Programs to increase naloxone distribution and training to young adults who use prescription opioids non-medically are also needed (Marshall, Green, Yedinak, & Hadland, 2016). …”