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Addict Behav. 2017 Feb;65:224-228. doi: 10.1016/j.addbeh.2016.08.016. Epub 2016 Aug 19.

Prescription opioids prior to injection drug use: Comparisons and public health implications.

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Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. Electronic address:
Departments of Anthropology and Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.
Division of Substance Dependence, University of Colorado School of Medicine, Aurora, CO, USA.



The intertwining prescription opioid and heroin epidemic is a major public health problem in the United States, with increasing morbidity and mortality among persons who use these substances. We examined differences between persons who reported being hooked on prescription opioids prior to injecting for the first time and those who did not by demographics, injection and non-injection characteristics, and overdose.


Between June and December 2015, persons who inject drugs were recruited using respondent-driven sampling as part of the National HIV Behavioral Surveillance system in Denver, Colorado.


Of 599 participants (median age, 40: IQR, 19-69; 71% male; 58% white, non-Hispanic), 192 (32%) reported being hooked on prescription opioids before they injected for the very first time. Compared to participants who were not hooked before they injected, participants who reported being hooked were significantly more likely to be younger, more recent injectors, report a slightly older age at first injection, and report heroin as the first drug injected as well as the drug most frequently injected. Those who reported being hooked were also more likely to be more frequent users of benzodiazepines, non-injection prescription opioids, and non-injection heroin as well as report injecting on a daily or more than daily basis. Being hooked on prescription opioids prior to injection drug use was associated with a 1.55 (95% CI: 1.14, 2.10) fold increase in the risk of at least one overdose in the past 12months.


Being hooked on prescription opioids prior to injection might result in a higher risk profile for persons who inject drugs.


Injection drug use; Overdose; Prescription opioids

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