TY - JOUR
T1 - Trends in opioid initiation among people who use opioids in three US cities
AU - Rouhani, Saba
AU - Park, Ju Nyeong
AU - Morales, Kenneth B.
AU - Green, Traci C.
AU - Sherman, Susan G.
N1 - Funding Information:
We would like to recognise and thank the participants of this study for the time they committed to this research. We are grateful to the FORECAST study team and collaborators. The study was approved by the Johns Hopkins School of Public Health (00000287) and the Rhode Island Hospital Institutional Review Boards (1062206). This work was supported by the Bloomberg American Health Initiative. SR is a National Institutes of Health Drug Dependency Epidemiology Fellow, supported by the National Institute for Drug Abuse/National Institute of Health (T32DA007292). TCG is supported through the Center of Biomedical Research Excellence on Opioids and Overdose (P20GM125507). SGS is supported by the Johns Hopkins University Center for AIDS Research (1P30AI094189). The funding sources had neither impact nor involvement in the preparation of this report. SGS is an expert witness for plaintiffs in opioid litigation. Remaining authors report no conflict of interest nor financial disclosures.
Funding Information:
We would like to recognise and thank the participants of this study for the time they committed to this research. We are grateful to the FORECAST study team and collaborators. The study was approved by the Johns Hopkins School of Public Health (00000287) and the Rhode Island Hospital Institutional Review Boards (1062206). This work was supported by the Bloomberg American Health Initiative. SR is a Drug Dependency Epidemiology Fellow, supported by the National Institute for Drug Abuse/National Institute of Health (T32DA007292). TCG is supported through the Center of Biomedical Research Excellence on Opioids and Overdose (P20GM125507). SGS is supported by the Johns Hopkins University Center for AIDS Research (1P30AI094189). The funding sources had neither impact nor involvement in the preparation of this report. SGS is an expert witness for plaintiffs in opioid litigation. Remaining authors report no conflict of interest nor financial disclosures. National Institutes of Health
Publisher Copyright:
© 2020 Australasian Professional Society on Alcohol and other Drugs
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Introduction and Aims: The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk. Design and Methods: We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each. Results: Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%). Discussion and Conclusions: Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment.
AB - Introduction and Aims: The increased availability of prescription opioids (PO) and non-medical prescription opioids (NMPO) has fundamentally altered drug markets and typical trajectories from initiation to high-risk use among people who use opioids (PWUO). This multi-site study explores trends in opioid initiation in three US cities and associations with sociodemographic factors, current drug use and overdose risk. Design and Methods: We analysed survey data from a cross-sectional study of PWUO in Baltimore, Maryland (n = 173), Boston, Massachusetts (n = 80) and Providence, Rhode Island (n = 75). Age of first exposure to PO, NMPO and heroin was used to calculate opioid of initiation, and multinomial regression was employed to explore correlates of initiating with each. Results: Thirty-three percent of PWUO initiated with heroin, 24% with PO, 18% with NMPO and 24% with multiple opioids in their first year of use. We observed a reduction in heroin initiation and gradual replacement with PO/NMPO over time. Women were more likely to initiate with NMPO [relative risk ratio (RRR) 2.4; 95% confidence interval (CI) 1.1, 5.0], PO (RRR 2.2, 95% CI 1.1, 4.4) or multiple opioids (RRR 2.1, 95% CI 1.1, 4.2), than heroin. PWUO initiating with NMPO had significantly higher current benzodiazepine use, relative to those initiating with heroin (RRR 3.2, 95% CI 1.4, 7.4), and a high prevalence of current fentanyl use (30%). Discussion and Conclusions: Our study highlights women and PWUO initiating with NMPO as key risk groups amid the changing landscape of opioid use and overdose, and discusses implications for targeted prevention and treatment.
KW - drug use
KW - opioid initiation
KW - women
UR - http://www.scopus.com/inward/record.url?scp=85083199209&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083199209&partnerID=8YFLogxK
U2 - 10.1111/dar.13060
DO - 10.1111/dar.13060
M3 - Article
C2 - 32249463
AN - SCOPUS:85083199209
VL - 39
SP - 375
EP - 383
JO - Drug and Alcohol Review
JF - Drug and Alcohol Review
SN - 0959-5236
IS - 4
ER -