'how Much Heroin Is Too Much Heroin?' Youth Inquires Regarding Opioids

Background and Purpose

Primary prevention initiatives aimed at youth are an important strategy to combat the opioid crisis in the United States. Adolescents with a history of opioid use have elevated rates of adult substance use and polysubstance disorders, school dropout, risky sexual practices, and other problems across psychosocial domains. Considering the impact that early opioid use has on later outcomes for youth, the ability to engage youth in effective substance misuse prevention is vitally important. Prevention education efforts have been slow to respond to the need for more effective prevention efforts for youth, despite teens being marked as the population most susceptible to opioid initiation.

The current study analyzes questions asked by youth about opioids in an online forum to identify the type of information they are seeking. Understanding the information youth are seeking about opioids will inform prevention education efforts aimed at providing youth relevant substance use education to prevent misuse. Prevention education that incorporates the voices of youth in the delivery of content or as peer educators has potential to deliver developmentally appropriate messaging that considers the current depth of understanding of opioids.

Methods

This study is a content analysis of opioid related questions posed by youth to substance use experts during the National Institute on Drug Abuse’s Chat Day program, an anonymous online forum where middle and high school students pose questions to substance use experts. Opioid related questions were extracted from the 55,882 questions asked from 2008-2019. Prescription opioid brand and chemical names were used along with common street names for non-medical opioids (e.g., lean, cheese, etc.) to identify opioid-related questions.

The research team used a general inductive approach to identifying the codes used in analysis. This process used a random sample of 200 questions to develop a coding scheme where themes emerged from the review of sample questions until saturation was reached. One pair of coders analyzed the questions and interrater reliability was calculated using Cohen’s kappa (.9, very strong agreement).

Results

The top concern of youth were the effects of opioids (38.9%) and how the use of opioids impacted body systems in the short and long term. Other top concerns included the comparison of opioids to other substances (19.3%), overdose and death (12.4%), general information on opioids (10.2%), and the nature of dependence (9.1%).

Conclusions

Findings indicate youth could benefit from definitional information about opioids, the relative risk of opioid use, and the development and outcomes of dependence. Providing youth with relevant information to guide decisions around initiation of drug use may reduce the most serious opioid related harms. The ability to engage youth curiosity about opioids in the context of harm reduction may be a path to ensuring youth receive the messages on substance misuse prevention as they consider their own substance use behavior. Opioid education for youth may also be an opportunity to provide youth who witness opioid use, at home or by their peers, valuable information on how to prevent the most serious opioid related harms.