title: Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City.
abstract: BACKGROUND
  As the prevalence of opioid analgesic (OA) misuse and associated harms have increased in the United States, the prevalence of heroin use and rates of unintentional overdose have concurrently risen. Research has begun to identify connections between OA misuse and heroin use, although this relationship remains under explored. The present study explores the context of heroin initiation among persons with histories of OA misuse in New York City.
  
  
  METHODS
  In-depth interviews were conducted with 31 individuals with histories of OA misuse who initiated heroin use within the past five years. Data were collected between August 2013 and January 2015. All participants' OA misuse temporally preceded their heroin use. Interviews were coded and analyzed utilizing thematic qualitative methods.
  
  
  RESULTS
  Participants ranged in age from 18 to 44 years; 25 identified as male and 30 identified as non-Hispanic white and heterosexual. All participants had stable housing at the time of interview and all were high school graduates. Participants described several key points of transition along their trajectories from OA misuse to heroin initiation: dual- to single-entity OAs; oral to intranasal OA administration; and the development of physical opioid dependence. Participants described the breaking down of heroin-related stigma across social networks as new drug use permeated social groups.
  
  
  CONCLUSIONS
  Several points of transition were identified in participants' trajectories from OA misuse to heroin initiation. In particular the development of physical dependence was a critical factor as existing heroin stigma was rapidly overcome in the face of opioid withdrawal. The relatively short time to heroin initiation documented among new user groups serves as an added challenge to the development of interventions.
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th Street 19th Floor Queens, NY 11101, United States. Electronic address: aharocopos@health.nyc.gov.
authors.forename: Alex
authors.initials: A
authors.lastname: Harocopos
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th Street 19th Floor Queens, NY 11101, United States.
authors.forename: Bennett
authors.initials: B
authors.lastname: Allen
authors.affiliation: New York City Department of Health and Mental Hygiene, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, 42-09 28th Street 19th Floor Queens, NY 11101, United States.
authors.forename: Denise
authors.initials: D
authors.lastname: Paone
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D006556:Heroin Dependence / Q000209:etiology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009519:New York City; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Heroin; Initiation; Opioid analgesics; Qualitative; Transition