International Journal of Drug Policy Volume: 28 Dated: February 2016 Pages: 106-112
This study examined the context of heroin initiation among persons with histories of opioid analgesic (OA) misuse in New York City.
As the prevalence of (OA) misuse and associated harms have increased in the United States, the prevalence of heroin use and rates of unintentional overdose have concurrently risen. Research has begun to identify connections between OA misuse and heroin use, although this relationship remains under explored. For the current study in-depth interviews were conducted with 31 individuals with histories of OA misuse who initiated heroin use within the past 5 years. Data were collected between August 2013 and January 2015. All participants' OA misuse temporally preceded their heroin use. Interviews were coded and analyzed using thematic qualitative methods. Participants ranged in age from 18 to 44 years; 25 identified as male and 30 identified as non-Hispanic White and heterosexual. All participants had stable housing at the time of interviews and all were high school graduates. Participants described several key points of transition along their trajectories from OA misuse to heroin initiation: dual- to single-entity OAs; oral to intranasal OA administration; and the development of physical opioid dependence. Participants described the breaking down of heroin-related stigma across social networks as new drug use permeated social groups. Several points of transition were identified in participants' trajectories from OA misuse to heroin initiation. In particular, the development of physical dependence was a critical factor as existing heroin stigma was rapidly overcome in the face of opioid withdrawal. The relatively short time to heroin initiation documented among new user groups is an added challenge to the development of interventions. (Publisher abstract modified)
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