The prevalence of heroin use has been rising steadily in the U.S in recent years. According to the National Survey on Drug Use and Health, the number of individuals reporting past year heroin use almost doubled between 2007 (373,000) and 2012 (669,000). Emerging evidence suggests the increase may be linked to prescription opioid (PO) users who transition from oral and/or intranasal PO use to heroin use, with POs providing the entryway to regular opioid use, and ultimately, heroin injection. This drug-use trajectory appears to have become increasingly common over the past ten years; in one study, 77.4% of participants in a 2008-2010 cohort reported using POs nonmedically prior to initiating heroin use, as compared to 66.8% in the 2002-2004 cohort.
"Despite indications that young PO misusers are at high risk of acquiring HIV and/or HCV through injection and sexual risk behaviors associated with drug use, little research has explored the social pathways by which PO misuse may lead to a heightened risk of infection," said Pedro Mateu-Gelabert, PhD, principal investigator with New York University's Center for Drug Use and HIV Research (CDUHR) and affiliated with the NYC-based National Development Research Institutes (NDRI).
The study, "Injection and Sexual HIV/HCV Risk Behaviors Associated with Nonmedical Use of Prescription Opioids Among Young Adults in New York City, published in the Journal of Substance Abuse Treatment (JSAT) explores within a social context the drug-use and sexual experiences of young adult (ages 18-32) nonmedical PO users as they relate to risk for HIV and HCV transmission.
"Young adults who use POs non-medically have many characteristics that differentiate them from other groups of drug users (more likely to be young, white and middle class)" notes Dr. Mateu-Gelabert. "Disease prevention efforts on the local and national levels have been slow to target this group, thus they comprise a population that is currently underserved by harm reduction efforts according to the HHS. Our research provides insight into the social contexts in which nonmedical PO use occurs and will hopefully provide a platform upon which intervention efforts can be built."
In their current qualitative study, the researches explored the drug-use and sexual experiences of young adult (ages 18-32) nonmedical PO users (n=46) as they relate to risk for HIV and HCV transmission. The subjects all resided in NYC and were engaged in non-medical PO use in the past 30 days.
Through in-depth, semi-structured interviews, the researchers explored patterns of escalation in opioid use, the context of PO initiation and misuse, and users' evolving perceptions of POs vs. heroin. The researchers also asked about subjects' sexual and drug-use networks and practices, with a focus on behaviors that may present risk for HIV/HCV transmission, as well as HIV/HCV knowledge and perceptions of risk.
"Our results reveal that PO misuse can lead to long-term opioid dependence, as well as transition to heroin use and drug injection," said Dr. Honoria Guarino, a co-investigator in the study. "In New York City, as in many locations in the U.S., heroin is cheaper and more readily available than POs, especially as new government restrictions on PO access are implemented."
The researchers note that nonmedical PO use is also associated with risky sexual behavior that may place participants at additional risk for HIV infection by facilitating unprotected sex with casual partners, sexual commodification (i.e., exchanges of sex for drugs between friends or acquaintances, professional sex work), group sex and sexual violence.
"This study demonstrates the importance of understanding nonmedical PO use among young adults and its role as a pathway to heroin use, injection drug use and increased vulnerability to HIV and HCV infections," said Dr. Mateu-Gelabert. "Drug treatment programs should target young nonmedical PO users so that they can address their opioid dependence prior to transitioning to heroin use.
Moving forward, Dr. Mateu-Gelabert and his colleagues are pursuing funding to implement Staying Safe, a project aimed at training this emerging group of young injectors in strategies to avoid HIV and HCV infections and overdose.