Prescription opioid use, misuse, and diversion among street drug users in New York City.
OBJECTIVE
The use of heroin, cocaine, and other drugs is well researched in New York City, but prescription opioids (POs) have been overlooked. This study documents patterns of PO use, misuse, and diversion among street drug users, and begins to indicate how drug culture practices interact with the legitimate therapeutic goals of PO prescriptions (e.g. pain management).


METHODS
Staff completed interviews inquiring about the reasons for use of POs and illicit drugs with 586 street drug users. Ethnographers wrote extensive field notes about subjects' complex patterns of PO use.


RESULTS
Methadone was used (71.9%) and sold (64.7%) at a higher level than OxyContin, Vicodin, and Percocet, used by between 34% and 38% of the users and sold by between 28% and 41% of the sellers. Recent PO use is associated with the recency of using heroin and cocaine (p<.001). Half of the heroin/cocaine sellers sold POs, and one quarter of the PO sellers only sold POs. Subjects were classified into four groups by whether they diverted POs or used POs to relieve pain or withdrawal rather than for euphoria. This classification was associated with frequency of PO use, whether POs were obtained from doctors/pharmacies or from drug dealers and family members, and those mostly likely to use POs for pain and withdrawal.


CONCLUSIONS
POs are an important component of street drug users' drug-taking regimes, especially those who are Physically Ill Chemical Abusers (PICA). Future research is needed to model PO use, misuse, and diversion among this population.
Davis
W Rees
WR
National Development and Research Institutes, Inc., 71 West 23rd Street, 14th Floor, New York, NY 10010, USA. rees@hvc.rr.com
Johnson
Bruce D
BD
D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002047:Buprenorphine; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D011307:Drug Prescriptions; D005006:Ethnicity; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009292:Narcotic Antagonists; D009294:Narcotics / Q000627:therapeutic use; D009519:New York City / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy; D018579:Patient Selection; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone