Characterising opportunity to use heroin reveals new avenues for intervention: context, outcomes, and latency to initiation

Abstract

Preceding initiation, opportunity to use heroin is the earliest necessary condition for heroin-related outcomes to occur. This study aimed to characterise first heroin use opportunity (prior to initiation) and to identify heroin-related outcomes associated with earlier age at first opportunity. Structured interviews were conducted with 93 opiate substitution treatment clients in UK drug and alcohol treatment clinics. The majority of participants (64.8%) reported initiating heroin use on the same day as being first presented with the opportunity to use heroin. Of those who reported early age at opportunity to use heroin, 77.4% reported this came from friends/partner/family compared with 59.3% of those who reported later opportunities. After adjustment, overdose was found to be more than twice as likely amongst those who reported first opportunity to use heroin at age 17 or under (AOR 2.82 95% CI 1.57–5.05). Findings indicate the early drug use environment is linked to later risk of overdose. Greater consideration of context surrounding heroin use opportunity may indicate mechanisms to disrupt or prevent initiation of heroin use and later drug-related harms. Given short latency to initiation, focus should be placed on preventing initiation of heroin use through injecting.

Keywords:

• Heroin
• overdose
• drug transitions
• opportunity
• injection drug use

Acknowledgements

The authors would like to thank the Addictions Service User Research Group (SURG), hosted by the Aurora Project Lambeth, for their feedback during the study design stage.

Disclosure statement

John Strang is a researcher and clinician and has worked with a range of types of treatment and rehabilitation service-providers. John Strang has also worked with pharmaceutical companies to seek to identify new or improved treatments, and also with a range of governmental and non-governmental organisations. John Strang’s employer King’s College London has registered intellectual property on an innovative medication development with which John Strang is involved, and John Strang has been named as inventor in a patent registration by a Pharma company for a new medication. A fuller account of Jonh Strang’s interests is at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx. John Strang is also supported by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London.

There are no other declarations of interest from authors of this paper.

Additional information

Funding

This study was supported by Medical Research Council.