Currently, an estimated 4.8% of the U.S. population reports past-year nonmedical use of prescription opioids (NMU-POs), an increase of over 40% from 10 years ago. Among young adults 18-25 years old, the prevalence is markedly higher (11.1%). Young NMU-POs are often naive to the serious risks associated with such use, tending to view prescription drugs as relatively safe in comparison to illicit street drugs. Although the majority of NMU-POs begin ingesting POs orally, emerging research demonstrates that a significant minority may transition to heroin use and/or injection drug use (IDU), often within 2-3 years of NMU-PO initiation. This suggests that NMU-PO may function as a new pathway into heroin use and dependence and IDU among youth. IDU and heroin use is associated with significant negative health outcomes, increased sexual risk behavior and increased susceptibility to route-specific infections. These risks are exacerbated by the fact that harm reduction services aimed at preventing HIV among IDUs typically serve older heroin injectors who have been found to differ in age, race/ethnicity and other characteristics from the emerging group of young NMU-POs. The striking increases in NMU-PO throughout the U.S. are thus alarming from a public health perspective, and may lead to increases in HCV and HIV prevalence among groups of NMU-POs. However, research on drug-use trajectories, drug and sexual risk behaviors and, most notably, HIV, HCV and STI prevalence rates, in NMU-PO populations remains scarce. Although very little research to date has examined the sexual risk behaviors of NMU-POs, the body of research on young urban drug users, as well as our team's pilot study of 18-29 year-old NMU-POs, suggests that high levels of sexual risk-taking may be common among NMU-PO young adults. The proposed mixed-methods study will assess the drug and sex-related HIV/HCV/STI risk associated with NMU-PO among young adults. Specifically, we will: characterize the drug-use patterns and sexual behaviors of a representative RDS-recruited sample of 600 NMU-POs (ages 18-29) in the New York City area; determine the proportion of this population that engages in IDU and/or heroin use; and identify individual, network and socio-structural factors that may predispose some NMU-PO young adults to engage in IDU and/or the use of heroin. In addition, key objectives of this research will be to systematically document the HIV/HCV/Chlamydia and Gonorrhea risk and preventive behaviors, knowledge, testing practices and prevalence rates of NMU-PO young adults. Foundational research that elucidates drug- and sex-related risk behaviors and HIV, HCV and other STI prevalence rates among this growing group of young NMU-POs is necessary for the development of disease prevention messages and interventions tailored to their specific characteristics, needs and drug-use and sexual practices. Furthermore, this research will help identify young NMU-POs who are likely to transition to heroin use and/or IDU, enabling interventions designed to prevent or delay these behaviors to be targeted to groups of youth who are most at-risk.

Public Health Relevance

Within the past 10 years, the nonmedical use of prescription opioids (POs) has increased 40% in the U.S. with the largest increases occurring among adolescents and young adults (SAMHSA, 2011). These trends are alarming from a public health perspective because opioid use is associated with significant risk for HIV, HCV and STIs, yet very little U.S.-based research to date has explored the risk behaviors of nonmedical PO users. The proposed mixed-methods, respondent-driven sampling (RDS)-based study will assess the drug and sex- related disease risk associated with nonmedical PO use and determine prevalence rates for HIV, HCV and STIs (Chlamydia and Gonorrhea) among young adult (ages 18-29) nonmedical PO users in New York City, an endeavor which will contribute to the development of disease prevention messages tailored to this group's distinct characteristics, needs and drug-use practices.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Lambert, Elizabeth
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National Development & Research Institutes
New York
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Mateu-Gelabert, Pedro; Jessell, Lauren; Goodbody, Elizabeth et al. (2017) High enhancer, downer, withdrawal helper: Multifunctional nonmedical benzodiazepine use among young adult opioid users in New York City. Int J Drug Policy 46:17-27
Friedman, S R; Mateu-Gelabert, P; Ruggles, K V et al. (2017) Sexual Risk and Transmission Behaviors, Partnerships and Settings Among Young Adult Nonmedical Opioid Users in New York City. AIDS Behav 21:994-1003
Mateu-Gelabert, Pedro; Harris, Shana; Berbesi, Dedsy et al. (2016) Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention. Subst Use Misuse 51:230-40
Herzberg, David; Guarino, Honoria; Mateu-Gelabert, Pedro et al. (2016) Recurring Epidemics of Pharmaceutical Drug Abuse in America: Time for an All-Drug Strategy. Am J Public Health 106:408-10
Palamar, Joseph J; Shearston, Jenni A; Dawson, Eric W et al. (2016) Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors. Drug Alcohol Depend 158:132-8
Meylakhs, Peter; Friedman, Samuel R; Mateu-Gelabert, Pedro et al. (2015) Taking care of themselves: how long-term injection drug users remain HIV and Hepatitis C free. Sociol Health Illn 37:626-41
Frank, David; Mateu-Gelabert, Pedro; Guarino, Honoria et al. (2015) High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users. Int J Drug Policy 26:84-91
Jessell, Lauren; Mateu-Gelabert, Pedro; Guarino, Honoria et al. (2015) Sexual Violence in the Context of Drug Use Among Young Adult Opioid Users in New York City. J Interpers Violence :
Mateu-Gelabert, Pedro; Guarino, Honoria; Jessell, Lauren et al. (2015) Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City. J Subst Abuse Treat 48:13-20
Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria et al. (2014) The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection. AIDS Educ Prev 26:144-57