Pollini Robin A, Banta-Green Caleb J, Cuevas-Mota Jazmine, Metzner Mitcheal, Teshale Eyasu, Garfein Richard S
Pacific Institute for Research and Evaluation, Calverton, MD.
Subst Abuse Rehabil. 2011 Oct;2(1):173-180. doi: 10.2147/SAR.S24800.
Misuse of prescription-type opioids and related adverse health effects are increasing, but little is known about the role of these drugs as a precursor to heroin use. We conducted an exploratory study to determine the proportion of young heroin injectors reporting problematic use of prescription-type opioids prior to using heroin, and to describe the factors associated with prior problematic prescription-type opioid use. METHODS: Between March 2009 and June 2010, we recruited injection drug users (IDUs) for a cross-sectional study of hepatitis C virus infection risk. Participants were aged 18-40 years and had injected illicit drugs within the previous six months. A computerized self-administered survey assessed sociodemographics, drug use history, human immunodeficiency virus (HIV)/hepatitis C virus risk behaviors and perceptions, and medical history. We added questions on prescription-type opioid use to the parent study in March 2010; heroin injectors who subsequently enrolled and reported problematic prescription-type opioid use prior to heroin initiation were compared with other heroin IDUs using univariate and multivariate regression methods. RESULTS: Among 123 heroin IDUs, 49 (39.8%) reported problematic prescription-type opioid use prior to heroin initiation ("prescription-type opioid first injection drug users" [PTO-First IDUs]). PTO-First IDUs had higher odds of injecting with friends (adjusted odds ratio [AOR] 6.01; 95% confidence interval [CI] 1.90-19.07), getting new syringes from a spouse/family member/sex partner (AOR 23.0; 95% CI 2.33-226.0), knowing about the local syringe exchange program (AOR 7.28; 95% CI 1.17-45.05), using powder cocaine (AOR 3.75; 95% CI 1.43-9.86), and perceiving themselves as less likely than other IDUs to get HIV (AOR 4.32; 95% CI 1.26-14.77). They had lower odds of ever being tested for HIV (AOR 0.25; 95% CI 0.08-0.80). CONCLUSION: A high proportion of young heroin IDUs reported problematic prescription-type opioid use prior to initiating heroin use. Our study provides several avenues for future investigation to help further characterize this subset of IDUs and their risks and perceptions related to HIV and other blood-borne pathogens.
处方类阿片药物的滥用及相关不良健康影响日益增加，但对于这些药物作为海洛因使用的前驱因素所起的作用知之甚少。我们开展了一项探索性研究，以确定在开始使用海洛因之前报告有处方类阿片药物问题性使用情况的年轻海洛因注射者的比例，并描述与先前处方类阿片药物问题性使用相关的因素。方法：在2009年3月至2010年6月期间，我们招募注射吸毒者（IDU）进行丙型肝炎病毒感染风险的横断面研究。参与者年龄在18 - 40岁之间，且在过去六个月内注射过非法药物。一项计算机化的自我管理调查评估了社会人口统计学、吸毒史、人类免疫缺陷病毒（HIV）/丙型肝炎病毒风险行为与认知以及病史。我们在2010年3月向母研究中添加了关于处方类阿片药物使用的问题；将随后入组并报告在开始使用海洛因之前有处方类阿片药物问题性使用情况的海洛因注射者与其他海洛因IDU使用单变量和多变量回归方法进行比较。结果：在123名海洛因IDU中，49名（39.8%）报告在开始使用海洛因之前有处方类阿片药物问题性使用情况（“处方类阿片药物首次注射吸毒者”[PTO - 首次IDU]）。PTO - 首次IDU与朋友一起注射的几率更高（调整后的优势比[AOR] 6.01；95%置信区间[CI] 1.90 - 19.07），从配偶/家庭成员/性伴侣处获得新注射器的几率更高（AOR 23.0；95% CI 2.33 - 226.0），知晓当地注射器交换项目的几率更高（AOR 7.28；95% CI 1.17 - 45.05），使用粉末可卡因的几率更高（AOR 3.75；95% CI 1.43 - 9.86），且认为自己感染HIV的可能性低于其他IDU的几率更高（AOR 4.32；% CI 1.26 - 14.77）。他们接受HIV检测的几率更低（AOR 0.25；95% CI 0.08 - 0.80）。结论：很大比例的年轻海洛因IDU报告在开始使用海洛因之前有处方类阿片药物问题性使用情况。我们的研究为未来的调查提供了几个途径，以帮助进一步描述这一IDU亚组及其与HIV和其他血源性病原体相关的风险及认知。
