Heroin use is associated with significant medical and social problems. In addition to HIV and other blood-borne infections there is concern about mounting heroin-related overdose (HOD) and bacterial skin and soft tissue infections (SSTI) including methicillin-resistant staphylococcus aureus (MRSA) infections. Social concerns include trafficking-related violence and societal costs of heroin use eg incarceration and healthcare utilization. US heroin and illicit opioid supply and consumption are changing: in the past 20 years, as Colombian- sourced heroin gained dominance, heroin prices have decreased and purity increased to record levels; prescription opioid pill misuse has drawn in new populations that are younger, more rural, white and female. Nationwide heroin use is increasing dramatically due to robust availability of high quality heroin and a wave of dependent opioid pill users switching to this cheaper, more reliable supply. In addition the heroin supply is in flux wit evidence of sharply increased production in Mexico and a diversity of heroin products hitting US streets. What are the health and behavioral implications of use of these novel heroin source-forms? Different source-forms of heroin are chemically distinct leading to different use patterns and medical consequences. Distribution of Colombian-sourced powder heroin (PH), a cold-water soluble heroin, is associated with greater HIV and HOD. New forms of powdered heroin are emerging regionally eg chocomil, gunpowder, fentanyl-laced heroin and cheese heroin; all are cold water soluble raising concerns about increased HIV and HOD risk. In addition, some market characteristics, eg branding, maybe associated with higher quality heroin and more negative consequences than others. How are changes in heroin supply, heroin market structure and quality affecting populations at risk and healthcare utilization and costs? The Heroin in Transition study will investigate the rapidly evolving risk environment for heroin users in the US utilizing integrated micro- to macro-level anthropological, economic and epidemiological approaches.
Specific Aim 1 : To assess, through qualitative inquiry, the micro-personal risk behaviors of heroin IDUs related to their use of specific major and variant types of heroin in 2 sentinel and 12 rapid assessment sites.
Specific Aim 2 : To examine the structure of heroin markets and retail heroin price/purity in 27 US MSAs, 1993-2014, relating them to changes in populations at risk, healthcare utilization and societal costs.
Specific Aim 3 : To develop longitudinal and agent-based models linking heroin and opioid market conditions, ie structure, availability and quality, to individuals' patterns of heroin-related medical outcomes eg HIV, HOD, SSTI and MRSA.

Public Health Relevance

The Heroin in Transition study uses multiple methods to study the rising use of novel forms of heroin, changing drug markets and the resultant medical problems and social costs. Achieving its objectives will advance understanding of drug epidemics and morbidities; help tailor public health interventions and provide community level tools for better monitoring and allocation of scarce resources.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
1R01DA037820-01A1
Application #
8845995
Study Section
Special Emphasis Panel (ZRG1-AARR-G (02))
Program Officer
Obrien, Moira
Project Start
2015-03-15
Project End
2020-01-31
Budget Start
2015-03-15
Budget End
2016-01-31
Support Year
1
Fiscal Year
2015
Total Cost
$789,811
Indirect Cost
$230,976
Name
University of California San Francisco
Department
Family Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Harris, M; Brathwaite, R; McGowan, Catherine R et al. (2018) 'Care and Prevent': rationale for investigating skin and soft tissue infections and AA amyloidosis among people who inject drugs in London. Harm Reduct J 15:23
Branas, Charles C; South, Eugenia; Kondo, Michelle C et al. (2018) Citywide cluster randomized trial to restore blighted vacant land and its effects on violence, crime, and fear. Proc Natl Acad Sci U S A 115:2946-2951
Dasgupta, Nabarun; Beletsky, Leo; Ciccarone, Daniel (2018) Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am J Public Health 108:182-186
Bluthenthal, Ricky N; Chu, Daniel; Wenger, Lynn D et al. (2018) Differences in time to injection onset by drug in California: Implications for the emerging heroin epidemic. Drug Alcohol Depend 185:253-259
Mars, Sarah G; Rosenblum, Daniel; Ciccarone, Daniel (2018) Illicit fentanyls in the opioid street market: desired or imposed? Addiction :
Mars, Sarah G; Ondocsin, Jeff; Ciccarone, Daniel (2018) Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency. Harm Reduct J 15:26
Harris, Magdalena; Brathwaite, Rachel; Scott, Jenny et al. (2018) Drawing attention to a neglected injecting-related harm: a systematic review of AA amyloidosis among people who inject drugs. Addiction 113:1790-1801
Mars, Sarah G; Ondocsin, Jeff; Ciccarone, Daniel (2018) Sold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD. J Psychoactive Drugs 50:167-176
Peiper, Nicholas C; Clarke, Sarah Duhart; Vincent, Louise B et al. (2018) Fentanyl test strips as an opioid overdose prevention strategy: Findings from a syringe services program in the Southeastern United States. Int J Drug Policy :
Bourgois, Philippe (2018) Decolonising drug studies in an era of predatory accumulation. Third World Q 39:385-398

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