title: Prescription opioid misuse and its relation to injection drug use and hepatitis C virus infection: protocol for a systematic review and meta-analysis.
abstract: BACKGROUND
  The production, prescription, and consumption of opioid analgesics to treat non-cancer pain have increased dramatically in the USA in the past decade. As a result, misuse of these opioids has increased; overdose and transition to riskier forms of drug use have also emerged. Research points to a trend in transition to drug injection among those misusing prescription opioids, where clusters of acute hepatitis C virus (HCV) infection are now being reported. This systematic review and meta-analysis aims to synthesize the prevalence of prescription opioid misuse in the USA and examine the rate of transition to injection drug use and incident HCV in these new people who inject drugs (PWID).
  
  
  METHODS
  Eligible studies will include quantitative, empirical data including national survey data. Scientific databases will be searched using a comprehensive search strategy; proceedings of scientific conferences, reference lists, and personal communications will also be searched. Quality ratings will be assigned to each eligible report using the Newcastle-Ottawa Scale. Pooled estimates of incidence rates and measures of association will be calculated using random effects models. Heterogeneity will be assessed at each stage of data synthesis.
  
  
  CONCLUSIONS
  A unique typology of drug use is emerging which is characterized by antecedent prescription opioid misuse among PWID. As the epidemic of prescription opioid misuse matures, this will likely serve as a persistent source of new PWID. Persons who report a recent transition to drug injection are characterized by high rates of HCV seroincidence of 40 per 100 person years or higher. Given the potential for the persistence and escalation of the consequences of prescription opioid misuse in the USA, there is a critical need for synthesis of the current state of the epidemic in order to inform future public health interventions and policy.
  
  
  BACKGROUND
  PROSPERO CRD42014008870.
authors.affiliation: New York University College of Nursing, 726 Broadway, New York NY 10003, USA. ae.jordan@nyu.edu.
authors.forename: Ashly E
authors.initials: AE
authors.lastname: Jordan
authors.forename: Don Des
authors.initials: DD
authors.lastname: Jarlais
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
mesh_terms: D000701:Analgesics, Opioid; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D063487:Prescription Drug Misuse / Q000009:adverse effects / Q000706:statistics & numerical data*; D015995:Prevalence; D012107:Research Design; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000209:etiology; D000078202:Systematic Reviews as Topic; D014481:United States / Q000453:epidemiology; D015201:Meta-Analysis as Topic
chemical_list: D000701:Analgesics, Opioid