Opioid misuse initiation: Implications for intervention

Abstract

The nonmedical use of opioids (e.g., prescription painkillers and heroin) has drastically increased over the past two decades. Despite the popular media narrative suggesting initiation often begins with misused personal prescriptions, there has been surprisingly little investigation into how persons initiate their misuse of opioids. Inattention to initiation patterns is an important limitation because understandings of onset directly inform prevention and treatment interventions. The primary goals of this study, therefore, were to: (1) describe the age patterns of opioid misuse initiation, (2) identify the opioid most commonly used at initiation and the source of the initial opioids, and (3) explore the narrative accounts of the circumstances surrounding opioid misuse onset. Surveys (n = 125) and in-depth interviews (n = 30) were conducted with nonmedical opioid users currently residing in southwest Pennsylvania between July 2017 and July 2018. Survey results show that initiation of opioid misuse (both heroin and prescription opioids) tends to occur prior to age 25, peaking between the ages of 18–25, with most (81%) initiating with prescription opioids. Qualitative findings provided additional context regarding the timing of initiation, acquiring opioids at initiation, and motivations for initiating. This study adds to the limited research on opioid misuse initiation and provides insights to drug treatment providers, prescribers, and public health professionals in identifying who is at risk for opioid misuse initiation, and more importantly, when and how to intervene most effectively.

Keywords:

• Heroin
• opioids
• prescription painkillers
• drug use initiation
• pain management

Disclosure Statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Social Science Research Institute and by the Justice Center for Research at Penn State University. Dr. Monnat acknowledges funding from the USDA National Institute of Food and Agriculture, Agricultural and Food Research Initiative Competitive Program, Agriculture Economics and Rural Communities, grant #2018-68006-27640. Dr. Verdery acknowledges funding from the Population Research Institute, which is supported by an infrastructure grant by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C-HD041025), and the Institute for CyberScience at Penn State University.