title: Pharmaceutical opioid use among oral and intravenous users in Australia: A qualitative comparative study.
abstract: Between 1992 and 2012 dispensing episodes for pharmaceutical opioids (PO) in Australia increased from 500000 to 7500000. In the US, increases in the prescription of PO have been linked to increases in opioid-related morbidity and mortality and transitions to heroin injection. However, Australian data indicate that morbidity and mortality related to PO are relatively low, particularly when compared to heroin and other drugs. This paper explores the characteristics and patterns of non-medical pharmaceutical opioid (NMPO) use among a sample of young people in Sydney, Australia.
  
  
  
  During 2015, we conducted in-depth qualitative interviews with 34 young people who use PO non-medically by oral (n=22) and intravenous (n=12) routes of administration.
  
  
  
  Oral NMPO users were a more affluent group who clustered around the Northern, Inner and Eastern suburbs of Sydney, while the intravenous users came from a range of locations including rural/regional areas of NSW and socioeconomically disadvantaged suburbs of South Western Sydney. Oral users were characterised by intermittent and largely self-limiting NMPO use and reported few health and social consequences. Intravenous users reported heavy and frequent drug, including NMPO, use and a range of adverse health and social consequences including overdose, injecting risk behaviour, hepatitis C virus (HCV) infection and residential instability.
  
  
  
  Results highlight the significance of social and structural factors in trajectories of opioid use and related harms. Factors such as stable housing and family relationships, disposable income and close social networks observed in young oral NMPO users may help to explain differences in patterns of NMPO use and related outcomes between the two groups.
authors.affiliation: Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia; School of Social Sciences and Psychology, Western Sydney University, Australia. Electronic address: g.dertadian@westernsydney.edu.au.
authors.forename: George
authors.initials: G
authors.lastname: Dertadian
authors.affiliation: Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Iversen
authors.affiliation: Faculty of Law, University of Sydney, Sydney, Australia.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Dixon
authors.affiliation: Faculty of Law, University of Technology, Sydney, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Sotiropoulos
authors.affiliation: Kirby Institute for Infection and Immunity, Faculty of Medicine, UNSW, Australia, Sydney, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001315:Australia / Q000453:epidemiology; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000191:economics / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Harms; Injecting; Nonmedical use; Pharmaceutical opioids; Young people