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Objective: This study examined the means of obtainment, indication, and prescriber of an index opioid in self-reporting heroin users.Design: Cross-sectional, observational study.Setting: A survey was submitted by participants in the United States with current or past heroin use.Participants: Three hundred twenty-three participants greater than 18 years of age completed the survey.Main outcome measure: Participants were surveyed regarding prescription opioid use prior to heroin initiation and specifically how they were obtained. Surveys were comprehensive in nature, divulging information including which opioid(s) was/were used, how they were obtained, by which prescriber (if prescribed), and if there was a diagnosis for chronic pain.Results: Roughly 47 percent of participants reported using prescription opioids prior to heroin. The most commonly used prescription opioid prior to heroin initiation was oxycodone (92.5 percent). The most common acquisition of opioids was through the prescribing of a physician, which occurred in roughly 63 percent of cases. These prescriptions were obtained most often from primary care physicians and emergency departments. Only 34 percent of participants reported being diagnosed with a chronic pain condition prior to using heroin.Conclusions: This study further supports the role that prescription opioids play in the transition to heroin use. It suggests that oxycodone is the most common prescription opioid used prior to heroin initiation. Additionally, it reports descriptive information as to how and where prescription opioids are obtained.

Background: Inadequate or inappropriate medication disposal is a public health concern that may lead to increased community risk of accidental poisonings, substance misuse, and environmental pollution.           Objective: The study’s primary objective was to assess medication disposal knowledge and practices of Michigan residents living in rural, underserved areas. Secondary objectives included determining baseline perceptions of at-home drug disposal kits and examining the impact of an educational video intervention on at-home drug disposal kit perceptions. Methods: To measure the objectives, an online 15-question survey was deployed to the general public via convenience sampling from local organizations working with drug disposal. The survey questions assessed medication disposal knowledge and practices in underserved, rural Michigan. Participant responses were assessed categorically and numerically. Results: Inclusion criteria were met by 97 survey participants. Results indicated that Michigan rural residents, regardless of various demographic factors, would benefit from increased drug disposal education. Specifically, at-home drug disposal kits and medication drop boxes have the highest need for additional education. Perceptions related to home disposal safety and ease of use improved significantly with an educational video intervention. Conclusion: All rural residents, regardless of demographics, would benefit from increased drug disposal education. A short, educational video can impact thoughts and attitudes related to at-home drug disposal kits. Similar interventions may be successful in other rural, underserved areas.