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J Addict Dis. 2019 May 14:1-12. doi: 10.1080/10550887.2019.1609336. [Epub ahead of print]

Opioid misuse initiation: Implications for intervention.

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a Department of Mental Health Law and Policy , College of Behavioral and Community Sciences, University of South Florida , Tampa , FL , USA.
b Administration of Justice , Penn State Greater Allegheny , McKeesport , PA , USA.
c Lerner Center for Public Health Promotion and Department of Sociology, Maxwell School of Citizenship and Public Affairs , Syracuse University , Syracuse , NY , USA.
d The Justice Center for Research , The Pennsylvania State University , University Park , PA , USA.
e Department of Sociology and Criminology , The Pennsylvania State University , University Park , PA , USA.


The nonmedical use of opioids (e.g., prescription painkillers and heroin) has drastically increased over the past two decades. Despite the popular media narrative suggesting initiation often begins with misused personal prescriptions, there has been surprisingly little investigation into how persons initiate their misuse of opioids. Inattention to initiation patterns is an important limitation because understandings of onset directly inform prevention and treatment interventions. The primary goals of this study, therefore, were to: (1) describe the age patterns of opioid misuse initiation, (2) identify the opioid most commonly used at initiation and the source of the initial opioids, and (3) explore the narrative accounts of the circumstances surrounding opioid misuse onset. Surveys (nā€‰=ā€‰125) and in-depth interviews (nā€‰=ā€‰30) were conducted with nonmedical opioid users currently residing in southwest Pennsylvania between July 2017 and July 2018. Survey results show that initiation of opioid misuse (both heroin and prescription opioids) tends to occur prior to age 25, peaking between the ages of 18-25, with most (81%) initiating with prescription opioids. Qualitative findings provided additional context regarding the timing of initiation, acquiring opioids at initiation, and motivations for initiating. This study adds to the limited research on opioid misuse initiation and provides insights to drug treatment providers, prescribers, and public health professionals in identifying who is at risk for opioid misuse initiation, and more importantly, when and how to intervene most effectively.


Heroin; drug use initiation; opioids; pain management; prescription painkillers

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