Heroin use onset among nonmedical prescription opioid users in the club scene

Abstract

Background Nonmedical prescription opioid use (NMPOU) is well documented among participants in the club scene, yet prior studies have not examined transition to heroin use. We prospectively examined heroin initiation among a sample of young adults with drug involvement associated with participation in the club scene, to understand factors that influence transition from NMPOU to heroin and to identify opportunities for intervention. Methods Data were drawn from a randomized trial that enrolled 750 Miami-based club and prescription drug users through respondent driven sampling, and tested the efficacy of assessment interventions in reducing risk. Participants reported current substance use at baseline, 3, 6, and 12 month follow-ups. We examined predictors of heroin initiation among participants reporting NMPOU at baseline, with no lifetime history of heroin use (N=323). Results The mean age was 25.0 years; 67.5% met DSM-IV criteria for substance dependence. About 1 in 13 participants (7.7%) initiated heroin use at follow-up. In univariable comparisons, frequent LSD use, history of drug overdose, high frequency NMPOU, using oral tampering methods, and endorsing a primary medical source for prescription opioids were associated with greater likelihood of heroin initiation. LSD use, oral tampering, and primary medical source were significant predictors in a Cox regression model. Conclusions Heroin initiation of 7.7% suggests a high level of vulnerability for transition among young adult NMPO users in the club scene. The importance of oral tampering methods in the trajectory of NMPOU may indicate a need to further examine the role of abuse deterrent formulations in prevention efforts.

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

“…As the influence of attachment always has to be considered in the context of other risk factors (13), exploring and integrating the clinical characteristics of individuals with PUD are of vital importance for future research on treatment approaches. For example, polydrug use can frequently be found in connection to sexual behaviors (155–158). However, few studies to date seem to have explored the role of sexual behaviors in PUD (159) and no study seems to have explored their romantic relationships.…”

Young adults' opioid use trajectories: From nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose

“…Emerging research has begun to explore risk factors associated with transitions from PO misuse to heroin use, adding to a body of earlier work on the transition from intranasal to injection use of heroin. To date, most studies conducted with young nonmedical PO users have identified a limited range of drug-related predictors of progression to heroin that are indicative of greater-severity use, such as earlier onset and higher frequency PO misuse and co-occurring use of other drugs (Carlson, Nahhas, Martins, & Daniulaityte, 2016; Cerda, Santaella, Marshall, Kim, & Martins, 2015; Palamar, Shearston, Dawson, Mateu-Gelabert, & Ompad, 2016; Surratt et al, 2017). On the social network level, having peers and sex partners who inject has long been re-cognized as a critical factor preconditioning injection initiation, through mechanisms including exposure to injection, the influence of initiators and group norms accepting of injection (Harocopoes, Goldsamt, Kobrak, Jost, & Clatts, 2009; Neaigus et al, 2006; Sherman, Smith, Laney, & Strathdee, 2002).…”

Nonmedical opioid use among electronic dance music party attendees in New York City

“…While users of other illegal drugs have been shown to be at high risk for nonmedical opioid use (Hughes et al, 2016), of specific concern is that nonmedical prescription opioid users appear to be at high risk for heroin use (Cerdá et al, 2015; Mateu-Gelabert et al, 2015; Palamar et al, 2016c). A recent longitudinal study investigating drug use among nightclub attendees in Miami found that among those reporting nonmedical prescription opioid use at baseline, 7.7% reported initiating heroin use within the next year (Surratt et al, 2017). Indeed, nonmedical use of prescription opioids has been found to be the main contributor to a resurgence of heroin use, as well as the spread of HIV and Hepatitis C (Compton et al, 2016; Murthy, 2016).…”