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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA035146-05
Application #
9182877
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Lambert, Elizabeth
Project Start
2013-02-15
Project End
2018-11-30
Budget Start
2016-12-01
Budget End
2018-11-30
Support Year
5
Fiscal Year
2017
Total Cost
Indirect Cost
Name
National Development & Research Institutes
Department
Type
DUNS #
080481880
City
New York
State
NY
Country
United States
Zip Code
10010
Guarino, Honoria; Mateu-Gelabert, Pedro; Teubl, Jennifer et al. (2018) Young adults' opioid use trajectories: From nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose. Addict Behav 86:118-123
Friedman, Samuel R; Williams, Leslie; Young, April M et al. (2018) Network Research Experiences in New York and Eastern Europe: Lessons for the Southern US in Understanding HIV Transmission Dynamics. Curr HIV/AIDS Rep 15:283-292
Mateu-Gelabert, Pedro; Guarino, Honoria (2018) The opioid epidemic and injection drug use: MIPIE and health harms related to the injection of prescription opioids. Int J Drug Policy 57:130-132
Mateu-Gelabert, Pedro; Guarino, H; Quinn, K et al. (2018) Young Drug Users: a Vulnerable Population and an Underutilized Resource in HIV/HCV Prevention. Curr HIV/AIDS Rep :
Rajan, Sonali; Ruggles, Kelly V; Guarino, Honoria et al. (2018) Heroin Use and Drug Injection among Youth Also Misusing Prescription Drugs. Am J Health Behav 42:144-155
Toro-Tobón, David; Berbesi-Fernandez, Dedsy; Mateu-Gelabert, Pedro et al. (2018) Prevalence of hepatitis C virus in young people who inject drugs in four Colombian cities: A cross-sectional study using Respondent Driven Sampling. Int J Drug Policy 60:56-64
Palamar, Joseph J; Le, Austin; Mateu-Gelabert, Pedro (2018) Not just heroin: Extensive polysubstance use among US high school seniors who currently use heroin. Drug Alcohol Depend 188:377-384
Jessell, Lauren; Mateu-Gelabert, Pedro; Guarino, Honoria et al. (2017) Sexual Violence in the Context of Drug Use Among Young Adult Opioid Users in New York City. J Interpers Violence 32:2929-2954
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; 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

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