Social context and perspectives of non‐medical prescription opioid use among young adults in Rhode Island: A qualitative study

Abstract

Background and Objectives This pilot study examined the context of nonmedical prescription opioid (NMPO) use and related risk behaviors among young adults in Rhode Island, a New England region with markedly high prevalence of NMPO use and overdose mortality. Methods We conducted semi-structured interviews (n = 13) with young adults (18–29 year-olds) who reported current or recent NMPO use. We also conducted focus groups (two groups, n =14 total) with professional service providers recruited from service organizations. Data were audio-recorded, transcribed, and key themes were analyzed. Results Participants discussed high levels of access to prescription opioids for nonmedical use via prescriptions originally provided to family and friends. The contexts described by participants included social environments such as parties, in which mixing opiates with benzodiazepines, alcohol or other types of drugs, and incidents of unintentional overdose were reported. Participants attributed risk for overdose to individual-level factors (eg, users who “couldn’t handle it”), rather than contextual factors, and described negative reactions to being labeled as an “addict” or “addicted.” Professional service providers had first-hand experience with young adults in treatment settings, yet limited exposure to young adults who were treatment-naïve. Conclusions Young adult NMPO users described social settings where polysubstance use and pill use were common, and highlighted an aversion to being labeled as having a substance use disorder. Scientific Significance To reduce harms of NMPO use among young adults, interventions should address the social context in which drug use and risk behaviors occur.

Injection drug use and overdose among young adults who use prescription opioids non-medically

“…New OEND programs or extensions of existing programs should be designed for and implemented among young adults. Intervention design should consider that young adults who use prescription opioids non-medically are often not engaged by traditional community-based services and harm reduction strategies and may be better reached through their social networks (Marshall, Green, Yedinak, & Hadland, 2016; Yedinak et al, 2016). Future research should assess the impact and effectiveness of these programs, which remain understudied specifically among young adults.…”

Intersectional inequalities and the U.S. opioid crisis: challenging dominant narratives and revealing heterogeneities

“…Both pain management and substance use are complex, related phenomena influenced by a variety of social processes. In the case of POM, it is necessary to consider a variety of factors, including: (1) the likelihood of individuals becoming patients requiring pain management, (2) factors influencing physician assessment of pain in their patients (which can affect prescribing rates and dosages), (3) contextual influences in the lives of individuals relying on opioids for pain management that may determine, through stress and coping pathways (Crutchfield and Gove, 1984), their likelihood of developing POM, (4) individuals' agency and ability to negotiate with their physicians for adequate pain management, (5) micro-contextual factors such as group norms, perceptions of drug-related risks, effects and behaviours and local drug availability (Stanistreet, 2005;Yedinak et al, 2016) and 6macro-environmental factors such as state drug policy (Yedinak, et al, 2016) and interests and practices of pharmaceutical companies. Importantly, social processes such as these will operate differently across intersectional social strata.…”

Use of rapid fentanyl test strips among young adults who use drugs

“…This trend mirrors a growing national trend, as young adults are increasingly affected by the fentanyl overdose epidemic (Jones, Logan, Gladden, & Bohm, 2015; O’Donnell, Halpin, Mattson, Goldberger, & Gladden, 2017). Young adults may be most affected due to their lack of knowledge concerning harm reduction practices, lack of connection to established harm reduction services, and lower uptake of harm reduction practices (Frank et al, 2015; Yedinak et al, 2016). Suspected IMF exposure is common among people who use drugs in Rhode Island (Macmadu et al, 2017), but demand for fentanyl is low and many wish to avoid it (Carroll, Marshall, Rich, & Green, 2017).…”