Non-medical use of opioid analgesics (OAs) has increased in the United States over the past decade, yet there has been little in-depth exploration into the circumstances of initiation of OA misuse. This study is based on qualitative data from five focus groups conducted with individuals who misused OAs in New York City. Participants (n = 19) were aged between 20 and 47 years. The majority were male (n = 14) and non-Hispanic White (n = 12). Three initiate groups were identified: recreational initiates, who typically began misusing OAs in their teens through non-medical sources; medical initiates, who initiated OA use through medical treatment; and experienced opioid users, who initiated OA use through both recreational and medical channels but whose entry into misuse followed a history of heroin use. Findings show heterogeneous patterns of initiation, indicating the need for prevention and intervention strategies to be tailored to particular groups.
AndersonD.WangS.SlativaI. (2012). Comprehensive assessment of chronic pain management in primary care: A first phase of a quality improvement initiative at a multisite Community Health Center. Quality in Primary Care, 20, 421-433.
2.
AroraS.ThorntonK.KomaromyM.KalishmanS.KatzmanJ.DuhiggD. (2014). Demonopolizing medical knowledge. Academic Medicine, 89, 30-32.
3.
AtluriS.SudarshanG.ManchikantiL. (2014). Assessment of the trends in medical use and misuse of opioid analgesics from 2004 to 2011. Pain Physician, 17, E199-E128.
4.
BenotschE. G.KoesterS.LuckmanD.MartinA. M.CejkaA. (2011). Non-medical use of prescription drugs and sexual risk behavior in young adults. Addictive Behaviors, 36, 152-155.
5.
BrennanF.CarrD. B.CousinsM. (2007). The role of opioids in pain management. Anesthesia & Analgesia, 105(1), 1865-1866.
6.
BurgessF. W. (2006). Pain treatment, drug diversion, and the casualties of war. Pain Medicine, 7, 474-475.
7.
BurgessF. W.PawasauskasJ. (2008). Opioid therapy and prescription drug diversion. Medicine and Health, Rhode Island, 91268-270.
8.
CanadaR. E.DiRoccoD.DayS. (2014). A better approach to opioid prescribing in primary care. Journal of Family Practice, 63(6), E1-E8.
ChouR.HuffmanL. (2009). Use of chronic opioid therapy in chronic non-cancer pain: Evidence review. Glenview, IL: American Pain Society.
11.
CiceroT. J.SurrattH. L.KurtzS.EllisM. S.InciardiJ. A. (2012). Patterns of prescription opioid abuse and comorbidity in an aging treatment population. Journal of Substance Abuse Treatment, 42, 87-94.
12.
ComptonW.VolkowN. (2006). Abuse of prescription drugs and the risk of addiction. Drug and Alcohol Dependence, 83(Suppl. 1), S4-S7.
13.
DaniulaityteR.CarlsonR. G.KenneD. R. (2006). Initiation to pharmaceutical opioids and patterns of misuse: Preliminary qualitative findings obtained by the Ohio Substance Abuse Monitoring Network. Journal of Drug Issues, 36, 787-808.
14.
DaniulaityteR.FalckR.CarlsonR. G. (2012). “I’m not afraid of those ones just ’cause they’ve been prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids. International Journal of Drug Policy, 23, 374-384.
15.
DaniulaityteR.FalckR.WangJ.CarlsonR. (2009). Illicit use of pharmaceutical opioids among young poly-drug users in Ohio. Addictive Behaviors, 34, 649-653.
16.
DarkeS. (1998). Self-report among injecting drug users: A review. Drug and Alcohol Dependence, 51(3), 253-263.
17.
DowlingK.StorrC. L.ChilcoatH. D. (2006). Potential influences on initiation and persistence of extramedical prescription pain reliever use in the US population. Clinical Journal of Pain, 22, 776-783.
18.
FunkM. D.HobbsC. E.Camero GarciaM. A.GwinS. H.AyersM. D.AlshuwaiyerG. I.CheneyM. K. (2015). Non-medical use of prescription medications among middle school students: A qualitative analysis. Journal of Substance Use, 20, 247-253.
19.
GreenT. C.BlackR.Grimes SerranoJ. M.BudmanS. H.ButlerS. F. (2011). Typologies of prescription opioid use in a large sample of adults assessed for substance abuse treatment. PLoS ONE, 6(11), e27244.
20.
GreenT. C.Grimes SerranoJ. M.LicariA.BudmanS. H.ButlerS. F. (2009). Women who abuse prescription opioids: Findings from the Addiction Severity Index-Multimedia Version Connect prescription opioid database. Drug and Alcohol Dependence, 103, 65-73.
21.
GuestG.MacQueenK. M.NameyE. E. (2012). Applied thematic analysis. Los Angeles, CA: SAGE.
22.
GurewichD.ProttasJ.SirkinJ. T. (2014). Managing care for patients with substance abuse disorders at community health centers. Journal of Substance Abuse Treatment, 46, 227-231.
23.
HarocoposA.GoldsamtL. A.KobrakP.JostJ. J.ClattsM. C. (2009). New injectors and the social context of injection initiation. International Journal of Drug Policy, 20, 317-323.
24.
JohnsonS. D.PhelpsD. L.CottlerL. B. (2004). The association of sexual dysfunction and substance use among a community epidemiological sample. Archives of Sexual Behavior, 33, 55-63.
25.
JohnstonL. D.O’MalleyP. M.MiechR. A.BachmanJ. G.SchulenbergJ. E. (2013). Monitoring the future national survey results on drug use, 1975-2012. Volume 1: Secondary school students. Ann Arbor: Institute for Social Research, University of Michigan.
26.
JuurlinkD. N.DhallaI. A. (2012). Dependence and addiction during chronic opioid therapy. Journal of Medical Toxicology, 8, 393-399.
27.
LankenauS. E.SchragerS. M.SilvaK.KecojevicA.BloomJ.WongC.IversonE. (2012). Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York. Journal of Public Health Research, 1422-30.
28.
LarsonK.LevyJ.RomeM. G.MatteT. D.SilverL. D.FriedenT. R. (2006). Public health detailing: A strategy to improve the delivery of clinical preventative services in New York City. Public Health Reports, 121, 228-234.
29.
LiebschutzJ. M.SaitzR.WeissR. D.AverbuchT.SchwartzS.MeltzerE. C.. . .SametJ. H. (2010). Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. The Journal of Pain, 11, 1047-1055.
30.
McCabeS. E.BoydC. J.TeterC. J. (2009). Subtypes of nonmedical prescription drug misuse. Drug and Alcohol Dependence, 102, 63-70.
31.
McCabeS. E.WestB. T.BoydC. J. (2013). Motives for medical misuse of prescription opioids among adolescents. Journal of Pain, 14, 1208-1216.
32.
MillerN. S.SheppardL. M.ColendaC. C.MagenJ. (2001). Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Academic Medicine, 76, 410-418.
33.
MuhuriP. K.GfroererJ. C.DaviesM. C. (2013). Associations of nonmedical pain reliever use and initiation of heroin use in the United States. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Retrieved from http://www.samhsa.gov/data/
34.
MuiH. Z.SalesP.MurphyS. (2014). Everybody’s doing it: Initiation into prescription drug misuse. Journal of Drug Issues, 44, 236-253.
35.
PadwaH.UradaD.AntoniniV. P.OberA.Crevecoeur-MacPhailD. A.RawsonR. (2012). Integrating substance use disorder services with primary care: The experience in California. Journal of Psychoactive Drugs, 44, 299-306.
36.
PaoneD.Bradley O’BrienD.ShahS.HellerD. (2011). Opioid analgesics in New York City: Misuse, morbidity, and mortality update. New York: New York City Department of Health and Mental Hygiene.
37.
PaoneD.TuazonE.KattanJ.NolanM. L.O’BrienD. B.DowellD.. . . KuninsH. V. (2015). Decrease in rate of opioid analgesic overdose deaths—Staten Island, New York City, 2011–2013. Morbidity and Mortality Weekly Report, 64(18), 491-494.
38.
PaulozziL. J.JonesC. M.MackK. A.RuddR. A. (2011). Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999-2008. Centers for Disease Control and Prevention Mortality and Morbidity Weekly Report, 60(43), 1487-1492.
39.
PaulozziL. J.MackK. A.HockenberryJ. M. (2014). Vital signs: Variation among states in prescribing of opioid pain relievers and benzodiazepines—United States, 2012. Centers for Disease Control and Prevention Mortality and Morbidity Weekly Report, 63(26), 563-568.
40.
RiggK. K.IbañezG. E. (2010). Motivations for non-medical prescription drug use: A mixed methods analysis. Journal of Substance Abuse Treatment, 39, 236-247.
41.
RiggK. K.MurphyJ. W. (2013). Understanding the etiology of prescription opioid abuse: Implications for prevention and treatment. Qualitative Health Research, 23, 963-975.
42.
RosenblumA.ParrinoM.SchnollS. H.FongC.MaxwellC.ClelandC. M.. . .HaddoxJ. D. (2007). Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug and Alcohol Dependence, 90, 64-71.
43.
SaitzR.HortonN. J.LarsonM. J.WinterM.SametJ. H. (2005). Primary medical care and reductions in addiction severity. A prospective cohort study. Addiction, 100, 70-78.
44.
ScottJ. D.UnruhK. T.CatlinM. C.MerrillJ. O.TaubenD. J.RosenblattR.. . .BuchwaldD. (2012). Project ECHO: A model for complex, chronic care in the Pacific Northwest region of the United States. Journal of Telemedicine and Telecare, 18, 481-484.
45.
SlobadaZ.StephensR. C.StephensP. C.GreyS. F.TeasdaleB.HawthorneR. D.. . .MarquetteJ. F. (2009). The adolescent substance abuse prevention study: A randomized field trial of a universal substance abuse prevention program. Drug and Alcohol Dependence, 102(1-3), 1-10.
46.
SpillerH.LorenzD. J.BaileyE. J.DartR. C. (2009). Epidemiological trends in abuse and misuse of prescription opioid. Journal of Addictive Disease, 28, 130-136.
47.
Substance Abuse and Mental Health Administration, U.S. Department of Health and Human Services, Office of Applied Studies. (2011). Drug Abuse Warning Network. 2011: National estimates of drug-related emergency department visits. Available from http://DAWNinfo.samhsa.gov
48.
Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 National Survey on Drug Use and Health: Volume 1. Summary of national findings. Rockville, MD: Office of Applied Studies.
49.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Treatment Episode Data Set: 2002-2012. (2014). National Admissions to Substance Abuse Treatment Services. BHSIS Series S-71, HHS Publication No. (SMA) 14-4850. Rockville, MD: Substance Abuse and Mental Health Services Administration.
50.
TrescotA. M.HelmS.HansenH.BenyaminR.GlaserS. E.AdlakaR.. . .ManchikantiL. (2008). Opioids in the management of chronic non-cancer pain: An update of American Society of the Interventional Pain Physicians’ (ASIPP) guidelines. Pain Physician, 11(Suppl. 1.), S5-S62.
51.
UnickG. J.RosenblumD.MarsS.CiccaroneD. (2013). Intertwined epidemics: National demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993–2009. PLoS ONE, 8(2), e54496.
52.
WuL. T.WoodyG. E.YangC.BlazerD. G. (2010). Subtypes of nonmedical opioid users: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence, 112, 69-80.
53.
YoungA.McCabeS. E.CranfordJ. A.Ross-DurowP.BoydC. J. (2012). Nonmedical use of prescription opioids among adolescents: Subtypes based on motivations for use. Journal of Addictive Diseases, 31, 332-341.
