Paper Review-Initiation into Injection Drug Use and Prescription Opioids

Lankenau SE, 2012

It’s been a few weeks since my last post. Apologies! Just finished up a big experiment and grant proposal. My goal is to release a few small posts over the next few days and here’s the first:

Numerous reported the dramatic increase in opioid addiction and death’s due to overdose over the past decade. Abuse of prescription opioid pain medication, such as oxycodone and hydrocodone, has skyrocketed. Even more disturbing is the surge in addiction to heroin, which was in decline during the 80s and 90s. I already reviewed an article that cites some of the statistics. Read it here.

Some key facts cited in today’s paper:

  • Abuse of prescription opioid drugs has been increasing dramatically over the past decade, especially amongst young people (18-26)
  • Opioids, such as hydrocodone and oxycodone, are the second most abused drug amongst young adults, after cannabis.
  • Very little data exists on initiation of drug abuse (i.e. first drugs abused) among injection drug users.

This study is a epidemiology/public health study that recruited 50 young (under 30), active injection drug users (e.g. heroin users) from New York and Los Angeles and interviewed them about their drug use. Note that this is a small study as far as epidemiology studies go, and the authors admit this and describe it as an exploratory study, but the trends they find are consistent with other studies (see the National Survey on Drug Use and Health).

The conclusions are simple: the majority of injection drug users began by abusing prescription opioids.

The average age for first use of prescription opioids was 12.6 years old and 41/50 reported swallowing (compared to 8 that snorted or 1 injecting). And 30/50 reported getting the prescription opioids from the homes of either immediate or extended family members that had a prescription.

Even more disturbing is that 36/50 injection drug users reported having a prescription for opioid pain medications during their lifetime, which occurred on average at 14.6 years of age. 8 of these 36 reported their opioid abuse began from their own prescriptions.

Several other interesting trends can be found in this study but the conclusions are pretty stark: injection of heroin began with abuse of pain pills.

Clearly tighter control of available prescriptions and careful monitoring of prescription opioids is required to help control their abuse among adolescents. However, the specific policy recommendations and medical attitude changes necessary are complex. Hopefully the more knowledge about the topic will provide an impetus for this important and necessary discussion.

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