title: Initiation into prescription opioid misuse amongst young injection drug users.
abstract: BACKGROUND
  Prescription opioids are the most frequently misused class of prescription drugs amongst young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse amongst young injection drug users (IDUs) are scarce.
  
  
  METHODS
  An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse amongst IDUs aged 16-25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively.
  
  
  RESULTS
  Initiation into prescription opioid misuse was facilitated by easy access to opioids via participant's own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common amongst those who progressed to sniffing and injecting opioids.
  
  
  CONCLUSIONS
  Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use amongst this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.
authors.affiliation: Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th floor, Philadelphia, PA 19102, United States. lankenau@drexel.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Lankenau
authors.forename: Michelle
authors.initials: M
authors.lastname: Teti
authors.forename: Karol
authors.initials: K
authors.lastname: Silva
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jackson Bloom
authors.forename: Alex
authors.initials: A
authors.lastname: Harocopos
authors.forename: Meghan
authors.initials: M
authors.lastname: Treese
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D058999:Drug-Seeking Behavior; D005190:Family; D005192:Family Health; D005260:Female; D033062:Friends; D003932:Heroin / Q000008:administration & dosage; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D009519:New York City / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000503:physiopathology / Q000523:psychology*; D055553:Prescription Drugs / Q000008:administration & dosage*; D015819:Substance Abuse, Intravenous / Q000209:etiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D003932:Heroin