The Experience of Transitioning from Opioid Analgesics to Heroin: A Life Course Perspective

Background and Purpose:

The prevalence of nonmedical opiate abuse initiating heroin use continues to be well established, with an average of forty-five percent of heroin users first being addicted to nonmedical opioids. Literature on how the actual process of transitioning affects the user, rather than the associated consequences of the transition, is lacking.  The majority of existing literature seeks to further explain why and how individuals continue to use drugs, despite being presented with continued hardships and negative consequences.  Various fields of study refer to this process as an individual making a “choice,” and explanations for doing so have included the neurobiological cause for addiction, cognitive conditioning, or behavioral economics.  

Missing from existing literature is the experience of the individual and the socio-contextual factors that are a part of their story and clinical picture.  Also absent is the use of a conceptual framework to interpret the meaning that individuals make of the transition experience.

This study provides a thorough examination of the lived experience of persons who transition from opioid analgesics to heroin.  Specifically, this study focused on understanding the individuals who transition, their social influences and historical context during this process, and how their sense of agency changed as they transitioned from using opioid analgesics to heroin.

Methods:

This was a phenomenological study using purposive sampling and semi-structured interviews with participants (n=15) who were English speaking, over the age of 18 and who had a dependence on opioid analgesics prior to transitioning to heroin.  Thematic coding was used in data analysis and strategies to increase trustworthiness and transferability of findings were included.

Findings and Implications:

Results indicate that as participants’ opioid use progressed, strategic social adaptations occurred, individual agency declined and upon entering treatment individuals were lonely, disempowered and mistrusting of the medical community/providers.  Themes of exploitation and differential racialization associated with the opioid epidemic also emerged. 

Findings highlight the need to alter engagement strategies with the specific population of persons who transitioned during the height of the opioid epidemic. Specifically, clinical interventions that focus on empowerment and self-efficacy should be utilized. Narratives underscored the importance individuals placed on the neuro-physiological manifestations of opioid addiction and implies that social work education related to SUDs should incorporate a biological component and/or use of inter-professional education. Further research into whether other addicts in recovery feel that the opioid epidemic has been racialized could potentially decrease the demonizing, blaming and mistreatment of specific demographic groups, as occurred during the crack epidemic, and inform culturally competent practice.