Karol Silva

Initiation into prescription opioid misuse amongst young injection drug users.

BACKGROUND Prescription opioids are the most frequently misused class of prescription drugs amongst young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse amongst young injection drug users (IDUs) are scarce. METHODS An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse amongst IDUs aged 16-25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. RESULTS Initiation into prescription opioid misuse was facilitated by easy access to opioids via participants own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common amongst those who progressed to sniffing and injecting opioids. CONCLUSION Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use amongst this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.

The dual systems model: Review, reappraisal, and reaffirmation.

Highlights • Evidence related to the dual systems model of adolescent risk taking is reviewed.• The review encompasses both the psychological and neuroimaging literatures.• Recent findings (since 2008) generally support the dual systems model.• Recommendations are made for future research directions.

Misuse of Prescription and Illicit Drugs Among High-risk Young Adults in Los Angeles and New York

Background Prescription drug misuse among young adults is increasingly viewed as a public health concern, yet most research has focused on student populations and excluded high-risk groups. Furthermore, research on populations who report recent prescription drug misuse is limited. This study examined patterns of prescription drug misuse among high-risk young adults in Los Angeles (LA) and New York (NY), which represent different local markets for illicit and prescription drugs. Design and Methods Between 2009 and 2011, 596 young adults (16 to 25 years old) who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. Sampling was stratified to enroll three groups of high-risk young adults: injection drug users (IDUs); homeless persons; and polydrug users. Results In both sites, lifetime history of receiving a prescription for an opioid, tranquilizer, or stimulant was high and commonly preceded misuse. Moreover, initiation of opioids occurred before heroin and initiation of prescription stimulants happened prior to illicit stimulants. NY participants more frequently misused oxycodone, heroin, and cocaine, and LA participants more frequently misused codeine, marijuana, and methamphetamine. Combining prescription and illicit drugs during drug using events was commonly reported in both sites. Opioids and tranquilizers were used as substitutes for other drugs, e.g., heroin, when these drugs were not available. Conclusion Patterns of drug use among high-risk young adults in Los Angeles and New York appear to be linked to differences in local markets in each city for illicit drugs and diverted prescription drugs.

Factors associated with history of non-fatal overdose among young nonmedical users of prescription drugs

OBJECTIVES The current study examines the prevalence and correlates of lifetime non-fatal overdose (OD) involving the nonmedical use of prescription opioids and tranquilizers among a sample of high-risk young adults in New York, NY and Los Angeles, CA. METHODS Data were derived from a cross-sectional study of 16-25 year old nonmedical users of prescription drugs (n=596). Unadjusted associations between OD history and socio-demographic and drug use variables were investigated in bivariate logistic regression models. Multivariate logistic regression models identified correlates of non-fatal OD. RESULTS Lifetime prevalence of non-fatal overdose involving prescription opioids and/or tranquilizers was 23.6%. Factors associated with increased risk of non-fatal overdose included lower social class while growing up (OR: 1.81, 95% CI: [1.15, 2.83], p<0.01), having ever received care at a psychiatric hospital (OR: 1.79, 95% CI: [1.12, 2.85], p<0.05), ever witnessing a family member OD on drugs (OR: 1.59, 95% CI: [1.02, 2.50], p<0.05), being prescribed tranquilizers (OR: 2.07, 95% CI: [1.29, 4.27], p<0.01), ever snorting or sniffing opioids (OR: 2.51, 95% CI: [1.48, 4.27], p<0.001), injecting tranquilizers (OR: 3.09, 95% CI: [1.61, 5.93], p<0.001), and past 90-day injection drug use (OR: 1.68, 95% CI: [1.03, 2.74], p<0.05). Participants who reported past 90-day stimulant misuse had lower odds of reporting OD compared to those who were not recent stimulant users (OR: 0.60, 95% CI: [0.38-0.96], p<0.05). CONCLUSIONS This study documents the high prevalence of experiencing non-fatal overdose among young nonmedical users of prescription drugs. Results could inform overdose prevention efforts throughout the U.S.

Initiation into Prescription Drug Misuse: Differences between Lesbian, Gay, Bisexual, Transgender (LGBT) and Heterosexual High-Risk Young Adults in Los Angeles and New York

OBJECTIVE Prescription drug misuse is an important public health problem in the U.S., particularly among adolescents and young adults. Few studies have examined factors contributing to initiation into prescription drug misuse, including sexual orientation and childhood abuse and neglect. The purpose of the present study is to investigate the relationship between initiation into the misuse of prescription drugs (opioids, tranquilizers, and stimulants), sexual identity, and individual and family determinants. METHOD Results are based upon data from a cross-sectional survey of 596 youth (polydrug users, homeless youth, and injection drug users) aged 16 to 25 who reported current prescription drug misuse. Participants were recruited in Los Angeles and New York City between 2009 and 2011. We compared initiation behaviors between sexual minority and heterosexual youth and examined factors modifying the relationship between sexual identity and earlier initiation into prescription drug misuse. RESULTS Sexual minority youth were more likely to report histories of initiation into misuse of prescription opioids and tranquilizers. Further, they were more likely to report various types of childhood abuse than heterosexual youth. However, multivariate analyses indicated that age of first prescribed drug was the most significant factor associated with initiation into misuse of all three categories of prescription drugs. CONCLUSIONS The correlates of initiation into prescription drug misuse are multidimensional and offer opportunities for further research. Identifying additional factors contributing to initiation into prescription drug misuse is essential towards developing interventions that may reduce future drug use among young adults.

Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults

BACKGROUND Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations. METHODS Young adults aged 16-25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N=560). RESULTS Four latent classes/groups were identified: (1) suppressors, (2) others-reliant copers, (3) self-reliant copers and (4) active copers. Distinct patterns of prescription and illicit drug misuse were found among different coping/emotion regulation profiles, including differences in age of initiation of opiates, tranquilizers, and illicit drugs, recent injection drug use, substance use-related problems, and past 90-day use of tranquilizers, heroin, and cocaine. Specifically, suppressors and others-reliant copers evidenced more problematic patterns of substance use compared to active copers. CONCLUSION This is among the first studies to show how coping and emotion regulation profiles predict distinct patterns of substance use. Results provide the groundwork for additional investigations that could have significant prevention and clinical implications for substance-using high-risk young adults.

Prescription Drug Misuse and Risk Behaviors Among Young Injection Drug Users

Abstract Prescription drug misuse among young adults, especially opioids, is a substantial public health problem in the United States. Although risks associated with injection of illicit drugs are well established, injection and sexual risks associated with misuse of prescription drugs are under-studied. Forty young injection drug users aged 16 to 25 who reported injection of a prescription drug were recruited in 2008–09 in Los Angeles and New York City. Descriptive quantitative and qualitative data were analyzed to illustrate risky injection and sexual behaviors reported in this sample. Over half of participants engaged in risky injection behavior, three-quarters engaged in risky sexual behavior, nearly half reported both risky behaviors, and five did not report either risk behavior while misusing a prescription drug. Prescription opioids, tranquilizers, and stimulants were misused in the context of risky sexual behaviors while only opioids were misused in the context of injection risk behaviors. Access to clean syringes, attitudes and beliefs regarding hepatitis C, and risk reduction through partner selection were identified as key themes that contextualized risk behaviors. Although these findings help identify areas to target educational campaigns, such as prevention of sexually transmitted infections, risk behaviors specifically associated with prescription drug misuse warrant further study.

Adolescents in Peer Groups Make More Prudent Decisions When a Slightly Older Adult Is Present

Adolescents make more reckless decisions when with peers than when alone, which poses a challenge for organizations that place adolescents in situations in which risky and myopic decision making is problematic. We asked whether the effect of peers on adolescents’ decision making is mitigated by the presence of a slightly older adult. We examined whether target subjects’ risk taking was greater when they were in groups of 4 late-adolescent males (ages 18–22) than when they were in groups that mixed 3 late-adolescent males with 1 slightly older adult (age 25–30); risk taking in both of these conditions was compared with that of adolescents tested alone. We found that adolescents took more risks and expressed stronger preference for immediate rewards when they were grouped with 3 same-age peers than when they were alone. When 1 adolescent was replaced by someone slightly older, however, adolescents’ decision making and reward processing resembled that seen when adolescents were tested alone. Adding a young adult to a work team of adolescents may improve group decision making.

Associations between prescription opioid injection and Hepatitis C virus among young injection drug users

Abstract Objective: Hepatitis C virus (HCV) incidence has been increasing among young injection drug users (IDUs). This analysis examined whether the emerging practice of prescription opioid (PO) injection is associated with self-reported HCV among young IDUs. Methods: Young IDUs (n = 162) aged 18–25-years-old who indicated recent misuse of prescription drugs were sampled in New York and Los Angeles during 2009–2011. Participants reported lifetime PO injection history and results from their most recent HCV test as well as demographic characteristics and lifetime drug use. Bivariate analyses examined relationships between covariates and both lifetime PO injection and HCV positivity. Poisson regression examined the associations between lifetime PO injection, HCV positivity, and significant covariates. Results: A majority reported lifetime PO injection (72.2%) and 30.9% self-reported being HCV positive. Lifetime PO injectors were nearly three times more likely to report being HCV positive than non-PO injectors (adjusted incidence rate ratio (AIRR): 2.69, p < 0.05) after controlling for socio-demographic and other drug use variable. Additionally, substituting POs for heroin (AIRR: 2.27, p < 0.05), growing up in a lower social class (AIRR: 1.67, p < 0.05), age (AIRR: 1.12, p < 0.05), age of injection initiation (AIRR: 0.87, p < 0.001), and history of being prescribed stimulants (AIRR: 0.64, p < 0.05) were independently associated with HCV positivity. Conclusions: Findings suggest that PO injection should be given further consideration as a contributing factor to rising HCV infection among young adults in the US.

Perceived Drug Use Functions and Risk Reduction Practices Among High-Risk Nonmedical Users of Prescription Drugs

Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug misuse was a normalized feature of their everyday lives.