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Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose.
Harm Reduct J. 2020 03 30; 17(1):22.HR

Abstract

AIM

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).

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

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. pedro.mateu-gelabert@sph.cuny.edu.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.National Development Research Institutes, Inc., 71 West 23rd St, New York, NY, 10010, USA.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.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.Independent Consultant, New York, NY, USA.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.NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32228700

Citation

Mateu-Gelabert, Pedro, et al. "Prescription Opioid Injection Among Young People Who Inject Drugs in New York City: a Mixed-methods Description and Associations With Hepatitis C Virus Infection and Overdose." Harm Reduction Journal, vol. 17, no. 1, 2020, p. 22.
Mateu-Gelabert P, Guarino H, Zibbell JE, et al. Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose. Harm Reduct J. 2020;17(1):22.
Mateu-Gelabert, P., Guarino, H., Zibbell, J. E., Teubl, J., Fong, C., Goodbody, E., Edlin, B., Salvati, C., & Friedman, S. R. (2020). Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose. Harm Reduction Journal, 17(1), 22. https://doi.org/10.1186/s12954-020-00367-2
Mateu-Gelabert P, et al. Prescription Opioid Injection Among Young People Who Inject Drugs in New York City: a Mixed-methods Description and Associations With Hepatitis C Virus Infection and Overdose. Harm Reduct J. 2020 03 30;17(1):22. PubMed PMID: 32228700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescription opioid injection among young people who inject drugs in New York City: a mixed-methods description and associations with hepatitis C virus infection and overdose. AU - Mateu-Gelabert,Pedro, AU - Guarino,Honoria, AU - Zibbell,Jon E, AU - Teubl,Jennifer, AU - Fong,Chunki, AU - Goodbody,Elizabeth, AU - Edlin,Brian, AU - Salvati,Carli, AU - Friedman,Samuel R, Y1 - 2020/03/30/ PY - 2020/01/10/received PY - 2020/03/13/accepted PY - 2020/4/2/entrez PY - 2020/4/2/pubmed PY - 2021/7/7/medline KW - Drug overdose KW - Hepatitis C virus (HCV) infection KW - Heroin KW - Prescription opioid injection KW - Prescription opioid misuse KW - Young PWID SP - 22 EP - 22 JF - Harm reduction journal JO - Harm Reduct J VL - 17 IS - 1 N2 - AIM: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1477-7517 UR - https://www.unboundmedicine.com/medline/citation/32228700/Prescription_opioid_injection_among_young_people_who_inject_drugs_in_New_York_City:_a_mixed_methods_description_and_associations_with_hepatitis_C_virus_infection_and_overdose_ L2 - https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-020-00367-2 DB - PRIME DP - Unbound Medicine ER -