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.
"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. "
Available from: George (Kev) Christopher Dertadian
"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 . "
[Show abstract][Hide abstract] 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
"Although prescription opioids may be formulated for oral use, they are often taken intravenously or intranasally when abused [5,6]. As tolerance to opioid psychoactive effects increases with use over time, the user often progresses from the oral route to the intranasal or intravenous (IV) route to attain greater opioid effects and more rapid onset of action [5,7-10]. "
[Show abstract][Hide abstract] ABSTRACT: Respiratory depression, a potentially fatal side-effect of opioid-overdose, may be reversed by timely administration of an opioid antagonist, such as naloxone or naltrexone. Tampering with a formulation of morphine sulfate and sequestered naltrexone hydrochloride extended release capsules (MS-sNT) releases both the opioid morphine and the antagonist naltrexone. A study in recreational opioid-users indicated that morphine and naltrexone injected in the 25:1 ratio (duplicating the ratio of the formulation) found MS-sNT reduced morphine-induced euphoric effects vs intravenous (IV) morphine alone. In the same study, the effects of morphine + naltrexone on end-tidal carbon dioxide (EtCO2), a measure of respiratory-depression, were evaluated and these data are reported here.
Single-center, placebo-controlled, double-blind crossover study. Non-dependent male opioid users were randomized to receive single IV doses of placebo, 30 mg morphine alone, and 30 mg morphine + 1.2 mg naltrexone. EtCO2 was measured by noninvasive capnography.
Significant differences in EtCO2 least-squares means across all treatments for maximal effect (Emax) and area under the effect curve (AUE0-2, AUE0-8, AUE0-24) were detected (all p ≤ 0.0011). EtCO2 Emax values for morphine + naltrexone were significantly reduced vs morphine alone (42.9 mm Hg vs 47.1 mm Hg, p < 0.0001) and were not significantly different vs placebo (41.9 mm Hg). Median time to reach maximal effect (TEmax) was delayed for morphine + naltrexone vs morphine alone (5.0 h vs 1.0 h).
Results provide preliminary evidence that the naltrexone:morphine ratio within MS-sNT is sufficient to significantly reduce EtCO2 when administered intravenously to non-dependent male recreational opioid-users. Further studies with multiple measures of respiratory-function are warranted to determine if risk of respiratory depression is also reduced by naltrexone in the tampered formulation.
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