High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users

Abstract

Background Opioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Yet few studies have examined the overdose knowledge and experience of nonmedical PO users. Methods In depth, semi-structured, audio-recorded interviews were conducted with 46 New York City young adults (ages 18–32) who reported using POs nonmedically within the past 30 days. Verbatim interview transcripts were coded for key themes in an analytic process informed by grounded theory. Results Despite significant experience with overdose (including overdose deaths), either personally or within opioid-using networks, participants were relatively uninformed about overdose awareness, avoidance and response strategies, in particular the use of naloxone. Overdose experiences typically occurred when multiple pharmaceuticals were used (often in combination with alcohol) or after participants had transitioned to heroin injection. Participants tended to see themselves as distinct from traditional heroin users, and were often outside of the networks reached by traditional opioid safety/overdose prevention services. Consequently, they were unlikely to utilize harm reduction services, such as syringe exchange programs (SEPs), that address drug users' health and safety. Conclusions These findings suggest that many young adult nonmedical PO users are at high risk of both fatal and non-fatal overdose. There is a pressing need to develop innovative outreach strategies and overdose prevention programs to better reach and serve young PO users and their network contacts. Prevention efforts addressing risk for accidental overdose, including opioid safety/overdose reversal education and naloxone distribution, should be tailored for and targeted to this vulnerable group.

Sexual Violence in the Context of Drug Use Among Young Adult Opioid Users in New York City

“…Research has found that young adults frequently use POs nonmedically with peers in social settings (e.g., at parties, while hanging out with friends) and young people report using POs to reduce anxiety, facilitate social interactions, enhance sexual experiences, and intensify the effects of other substances (Mateu-Gelabert, Guarino, Jessell, & Teper, 2015; McCabe, Cranford, Boyd, & Teter, 2007; Silva, Kecojevic, & Lankenau, 2013). When taken in large doses or in combination with other substances (e.g., benzodiazepines, alcohol), the effects of POs may lead to drowsiness, impaired judgment, incapacitation, loss of consciousness, and overdose (Frank etal., 2015; Jones, Mogali, & Comer, 2012; Lipman, 2010; Mateu-Gelabert et al, 2015). …”

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“…Among people who misuse substances, several studies have noted that individuals with multiple HIV transmission risk factors tended to perceive their personal risk of contracting HIV as low 11–13 . A recent qualitative study found that people who misuse opioids other than heroin often perceive these opioids as being safe from the risk of overdose, even though most of the interviewees had experienced one or more overdoses in the past 14 .…”

A mixed-methods evaluation of the feasibility, acceptability, and preliminary efficacy of a mobile intervention for methadone maintenance clients.

“…Given the recent increase in the number of Americans reporting nonmedical use of prescription opioids (SAMHSA, 2014a) – and emerging evidence that a growing proportion of nonmedical prescription opioid users are transitioning to heroin use (Frank, Mateu-Gelabert, Guarino, Bennett, Wendel, & Teper, 2014; Jones, 2013; Mars, Bourgois, Karandinos, Montero, & Ciccarone, 2013; Mateu-Gelabert, Guarino, Jessell, & Teper, A., 2014) – the demand for effective treatment for opioid use disorders is high and likely to intensify in the near future. Yet the vast majority of those who could benefit from treatment do not receive it.…”