CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125th Street, New York, NY, 10027, USA.
RTI International, 2987 Clairmont Road, Century Plaza 1, Suite 400, Atlanta, GA, 30329-4434, USA.
Harm Reduct J. 2020 Mar 30;17(1):22. doi: 10.1186/s12954-020-00367-2.
Evidence is emerging that prescription opioid (PO) injection is associated with increased health risks. This mixed-methods study compares the mechanics of PO and heroin injection and examines the demographic and drug-related correlates of lifetime PO injection in a sample of young people who inject drugs (PWID) in New York City (NYC).
Qualitative analysis of 46 semi-structured interviews with young adult opioid users ages 18-32. Interview segments describing PO injection were analyzed for common themes. Quantitative analysis of structured interviews with 539 young adult opioid users ages 18-29 recruited via respondent-driven sampling (RDS). Analyses are based on the subsample of 353 participants (65%) who reported having ever injected drugs. All variables were assessed via self-report, except hepatitis C virus status, which was established via rapid antibody testing.
Participants described injecting POs and reported that preparing abuse-deterrent pills for injection is especially cumbersome, requiring extended manipulation and large amounts of water. Injecting POs, in contrast to injecting heroin, requires repeated injections per injection episode. Among RDS-recruited participants, the majority of injectors reported injecting POs, sporadically (33%) or regularly (26%), but often infrequently (≤ 7 days/month). In separate multivariable analyses controlling for syringe- and cooker-sharing, ever injecting POs was a significant predictor of testing HCV antibody-positive (AOR = 2.97) and lifetime experience of non-fatal overdose (AOR = 2.51). Ever injecting POs was independently associated with lifetime homelessness (AOR = 2.93) and having grown up in a middle-income ($51,000-100,000/year vs. ≤ $50,000/year; AOR = 1.86) or a high-income household (> $100,000/year vs. ≤ $50,000/year; AOR = 2.54).
Even in an urban environment like NYC with widespread heroin access, most young PWID have injected POs, although less frequently than heroin. PO injection involves practices that are known to increase risk for blood-borne viral infection (e.g., repeated injections) and predicted testing HCV-positive, as well as overdose. PO injection may also serve as a marker for a subgroup of PWID at elevated risk for multiple drug use-related comorbidities. Programs that provide prevention services to PWID need to tailor harm reduction measures and messaging to the specific practices and harms associated with the injection of POs.
有证据表明，处方类阿片（PO）注射与健康风险增加有关。本混合方法研究比较了 PO 和海洛因注射的机制，并在纽约市（NYC）的年轻吸毒者（PWID）样本中，调查了终生 PO 注射的人口统计学和药物相关相关性。
对 46 名 18-32 岁的成年阿片类药物使用者的半结构化访谈进行定性分析。对描述 PO 注射的访谈片段进行了分析，以找出常见主题。对通过应答者驱动抽样（RDS）招募的 539 名 18-29 岁的年轻成年阿片类药物使用者进行了结构化访谈的定量分析。分析基于报告曾经注射过药物的 353 名参与者（65%）的亚样本。所有变量均通过自我报告进行评估，丙型肝炎病毒状态除外，该状态通过快速抗体检测确定。
参与者描述了注射 PO 并报告说，准备用于注射的滥用药物抑制药丸特别麻烦，需要长时间的操作和大量的水。与注射海洛因不同，注射 PO 需要每注射一次进行多次注射。在 RDS 招募的参与者中，大多数注射者报告说他们偶尔（33%）或经常（26%）注射 PO，但通常频率较低（≤7 天/月）。在单独的多变量分析中，控制注射器和炊具共享，曾经注射过 PO 是丙型肝炎病毒抗体阳性（AOR=2.97）和非致命性过量的终生经历（AOR=2.51）的显著预测因子。曾经注射过 PO 与终生无家可归（AOR=2.93）以及在中等收入家庭（51,000-100,000 美元/年与≤50,000 美元/年；AOR=1.86）或高收入家庭（>100,000 美元/年与≤50,000 美元/年；AOR=2.54）之间存在独立关联。
即使在像 NYC 这样的城市环境中，海洛因广泛存在，大多数年轻的 PWID 也注射过 PO，但频率低于海洛因。PO 注射涉及已知会增加血源性病毒感染风险的做法（例如，重复注射），并预测 HCV 呈阳性，以及过量。PO 注射也可能是 PWID 中一组处于多重药物使用相关合并症风险增加的亚组的标志物。向 PWID 提供预防服务的计划需要根据与 PO 注射相关的特定做法和危害，调整减少伤害措施和信息传递。
