Harocopos Alex, Allen Bennett, Paone Denise
New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th Street 19th Floor Queens, NY 11101, United States.
New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th Street 19th Floor Queens, NY 11101, United States.
Int J Drug Policy. 2016 Feb;28:106-12. doi: 10.1016/j.drugpo.2015.12.021. Epub 2015 Dec 29.
As the prevalence of opioid analgesic (OA) misuse and associated harms have increased in the United States, the prevalence of heroin use and rates of unintentional overdose have concurrently risen. Research has begun to identify connections between OA misuse and heroin use, although this relationship remains under explored. The present study explores the context of heroin initiation among persons with histories of OA misuse in New York City.
In-depth interviews were conducted with 31 individuals with histories of OA misuse who initiated heroin use within the past five years. Data were collected between August 2013 and January 2015. All participants' OA misuse temporally preceded their heroin use. Interviews were coded and analyzed utilizing thematic qualitative methods.
Participants ranged in age from 18 to 44 years; 25 identified as male and 30 identified as non-Hispanic white and heterosexual. All participants had stable housing at the time of interview and all were high school graduates. Participants described several key points of transition along their trajectories from OA misuse to heroin initiation: dual- to single-entity OAs; oral to intranasal OA administration; and the development of physical opioid dependence. Participants described the breaking down of heroin-related stigma across social networks as new drug use permeated social groups.
Several points of transition were identified in participants' trajectories from OA misuse to heroin initiation. In particular the development of physical dependence was a critical factor as existing heroin stigma was rapidly overcome in the face of opioid withdrawal. The relatively short time to heroin initiation documented among new user groups serves as an added challenge to the development of interventions.
在美国，随着阿片类镇痛药（OA）滥用及相关危害的发生率上升，海洛因使用的流行率和意外过量服用率也同时增加。尽管这种关系仍有待深入研究，但已有研究开始确定OA滥用与海洛因使用之间的联系。本研究探讨了纽约市有OA滥用史者开始使用海洛因的背景情况。
对31名有OA滥用史且在过去五年内开始使用海洛因的个体进行了深入访谈。数据收集时间为2013年8月至2015年1月。所有参与者的OA滥用在时间上先于其海洛因使用。访谈采用主题定性方法进行编码和分析。
参与者年龄在18至44岁之间；25人认定为男性，30人认定为非西班牙裔白人且为异性恋。所有参与者在访谈时都有稳定住房，且均为高中毕业生。参与者描述了他们从OA滥用到开始使用海洛因的过程中的几个关键转变点：从复方到单方OA；从口服到鼻内使用OA；以及身体阿片类药物依赖的形成。随着新的药物使用渗透到社会群体中，参与者描述了海洛因相关污名在社交网络中的消解。
在参与者从OA滥用到开始使用海洛因的过程中确定了几个转变点。特别是身体依赖的形成是一个关键因素，因为面对阿片类药物戒断，现有的海洛因污名迅速被克服。新用户群体中记录到的相对较短的开始使用海洛因的时间对干预措施的制定构成了额外挑战。
