Transitions and Harm Reduction Strategies Among Diverse Opiate Users

Background and Purpose:The Substance Abuse and Mental Health Services reports that four out of five recent heroin initiators had prior histories of non-medical use of prescription opioids. While prescription opiate use has been described as epidemic in the United States, and has been linked with an increased risk of heroin use by the Substance Abuse and Mental Health Services, and the National Institute on Drug Abuse, not much is known about the nature and extent of the risks associated with the transitioning population. A pilot study was conducted to investigate risky behavior amongst those who engage in recreational nonmedical and medical prescription opioid abuse and heroin use, while exploring the role of a comprehensive harm reduction center on risk taking behavior.

Methods: Using convenience sampling 50 individuals were recruited for focus groups and survey data was collected from 100 individuals receiving services from a harm reduction center located in Skid Row in Los Angeles. The harm reduction is unique in that it provides a peer-based naloxone training and distribution program. Individuals over the age of 18 who reported using prescription opiates in the past year were eligible for participation. The University of Southern California Institutional Review Board approved all data collection methods.

Results: Of the 50 focus group respondents, most were male (74%) and Latino (29%), followed by African American (27%). Most reported a high school education (94%) and the majority were unemployed, disabled or not working (86%). Almost three-fourths reported an income of $9,999 and under (74%) and over half (53%) reported living on the streets. Individuals in the focus groups described their opiate use trajectories, overdose and other health risk behavior outcomes, current treatment barriers, and the role of the harm reduction center. The 100 survey respondents were primarily male (71%), African American (44%) and experiencing some form of homelessness (72%). Almost two-thirds reported an income of $9,999 and less (64%), the majority were unemployed or disabled (84%), and 71% reported a high school degree or above. Although previous research has focused on a liner transition from prescription opiates to heroin, a majority of the sample (45%) reported transitions from heroin to prescription opiates, with pain control (54%) cited as a primary reason for the transition.

Conclusions and Implications: While much attention has been placed on the current opiate epidemic, most discussions center on the impact of opiate use among the emerging adult population, with white males often comprising the majority of participants. This study highlights the need to focus on diverse groups when creating treatment approaches and interventions. In addition, the differing transition experiences demonstrate a need for more attention to the non-linear opiate use trajectory. Qualitative themes provide an understanding of the risk taking behavior of this population, but also highlights the benefits of the innovative harm reduction center in risk reduction. Neglecting subsets of the population impacted by opiate use and abuse, and focusing on linear transitions from prescription opiates to heroin will only compound health outcomes for historically marginalized and disadvantaged populations.