Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users.
ABSTRACT The purpose of this study was to examine the prevalence and correlates of opioid analgesic injection (OAI) in a cohort of rural opioid analgesic users.
Cross-sectional study of 184 participants from rural Appalachian Kentucky.
The majority of participants were male (54.9%), white (98.4%) and the median age was 30 years (interquartile range: 24-37). The self-reported lifetime prevalence of injection drug use (IDU) was 44.3%, with 35.3% of respondents reporting injection of oral opioid analgesic formulations. The prevalence of self-reported hepatitis C (HCV) was 14.8%, significantly greater than those not injecting opioid analgesics (1.7%) (p<0.001). Receptive needle sharing, distributive needle sharing and sharing of other injection paraphernalia was reported by 10.5%, 26.3%, and 42.1% of those currently injecting, respectively.
Opioid analgesic injection was more prevalent in this rural population than has been found in previous reports. This study suggests a rising problem with injecting among rural opioid users, a problem more typically associated with urban drug users. Educating injectors of opioid analgesics on safe needle practices is necessary in order to curb the transmission of HIV, HCV, and other infectious diseases. Further study on the longitudinal course of opioid analgesic injection in this population appears warranted.
- SourceAvailable from: Stacey Sigmon
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- "Similarly, the above studies took place in predominantly urban areas (i.e., New York City; Baltimore, Maryland; Oslo, Norway). It is important to examine the efficacy of interim treatment in the rural and suburban areas where access to maintenance can be especially limited (Fortney and Booth, 2001; Havens et al., 2007; Lenardson and Gale, 2007; Rosenblum et al., 2011; Rounsaville and Kosten, 2000; Sigmon, 2014). Finally, we must learn more about the baseline characteristics that may predict a patient's response to interim opioid treatment. "
ABSTRACT: Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication+emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20years since the approval of interim opioid treatment. A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. . Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity. Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response. Copyright © 2015. Published by Elsevier Inc.Preventive Medicine 04/2015; DOI:10.1016/j.ypmed.2015.04.017 · 2.93 Impact Factor
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- "Since 1999, intentional overdose deaths related to PO have quadrupled and now account for more overdose deaths than heroin and cocaine combined . Young non-medical users of POs are often unaware of the risks associated with their use , tending to view prescribed drugs as safer, less stigmatised and less subject to legal penalties than illicit street drugs  . Although most non-medical PO use begins with oral ingestion, recent research indicates that a significant minority may transition to the use of heroin and/or administration of opioids by injection, typically within 2–3 years of initiating use . "
ABSTRACT: The non-medical use of pharmaceutical opioids is associated with a range of negative health consequences, including the development of dependence, emergency room presentations and overdose deaths. Drawing on life history data from a broader qualitative study of the non-medical use of painkillers, this brief report presents two cases of transitions from recreational or non-medical pharmaceutical opioid use to intravenous heroin use by young adults in Australia. Although our study was not designed to assess whether recreational oxycodone use is causally linked to transitions to intravenous use, polyopioid use places individuals at high risk for progression to heroin and injecting. Our first case, Jake, used a range of analgesics before he transitioned to intravenous use, and the first drug he injected was methadone. Our second case, Emma, engaged in a broad spectrum of polydrug use, involving a range of opioid preparations, as well as benzodiazepines, cannabis and alcohol. Both cases transitioned from oral to intravenous pharmaceutical opioids use and subsequent intravenous heroin use. These cases represent the first documented reports of transitions from the non-medical or recreational use of oxycodone to intravenous heroin use in Australia. As such, they represent an important starting point for the examination of pharmaceutical opioids as a pathway to injecting drug use among young Australians and highlight the need for further research designed to identify pharmaceutical opioids users at risk of transitions to injecting and to develop interventions designed to prevent or delay these transitions. [Dertadian G, Maher L. From oxycodone to heroin: Two cases of transitioning opioid use in young Australians. Drug Alcohol Rev 2013].Drug and Alcohol Review 11/2013; 33(1). DOI:10.1111/dar.12093 · 1.55 Impact Factor
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- "Unfortunately, previous research demonstrates that cocaine injection may not be influenced by increasing access to opioid substitution therapy (Condelli, Fairbank, Dennis, & Rachal, 1991; Grella, Anglin, & Wugalter, 1997) or syringe exchange. In this cohort, however, in contrast to prescription opioid injection, the prevalence of cocaine injection did not rise significantly over the study period of 2001 to 2004 (Havens et al., 2007b). Therefore the influence of cocaine injection on HIV risk among rural Appalachian drug users appears to be constant. "
ABSTRACT: The purpose of this study was to examine injection drug use (IDU) among a cohort of felony probationers from rural Appalachian Kentucky. An interviewer-administered questionnaire given to 800 rural felony probationers ascertained data regarding demographics, drug use, criminal behavior, psychological distress, and HIV-risk behaviors. The sample was primarily white (95.1%) and male (66.5%) and the median age was 32.3 years (interquartile range: 25.2, 40.5). There were no cases of HIV in the sample. Of the 800 rural probationers, 179 (22.4%) reported lifetime IDU. Receptive syringe sharing (RSS) and distributive syringe sharing (DSS) were reported by 34.5% and 97.1% of the IDUs, respectively. Independent correlates of risky injection behaviors included cocaine injection (adjusted odds ratio (AOR): 14.9, 95% confidence interval (CI): 8.0, 27.7) and prescription opioid injection (AOR: 14.7, 95% CI: 7.7, 28.1). Although HIV was not prevalent, data suggest that the rural felony probationers in this sample were engaging in risky injection practices that could facilitate transmission of HIV. This is especially problematic since those involved in the criminal justice system may be more likely to be exposed to HIV. Therefore, prevention aimed at reducing HIV-risk behaviors among rural, criminally involved individuals is warranted.AIDS Care 02/2011; 23(5):638-45. DOI:10.1080/09540121.2010.516346 · 1.60 Impact Factor