“I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids

Abstract

Background There has been a rise in the illicit use of pharmaceutical opioids (”pain pills”) in the United States. Conducted with young adult non-medical users of pharmaceutical opioids, this study uses qualitative methods and cultural consensus analysis to describe risk perceptions associated with pharmaceutical opioids and to determine patterns of cultural sharing and intra-cultural variation of these views. Methods The qualitative sub-sample (n=47) was selected from a larger sample of 396 young adults (18–23 years old), who were participating in a natural history study of illicit pharmaceutical opioid use. Qualitative life history interviews, drug ranking task, and cultural consensus analysis were used to elicit participant views about risks and harms associated with pain pills and other drugs, as well as alcohol and tobacco. Results Cultural consensus analysis revealed that the participants shared a single cultural model of drug risks, but the level of agreement decreased with the increasing range of drugs ever used. Further, those with more extensive drug use histories differed from less “experienced” users in their views about OxyContin and some other drugs. Overall, pain pills were viewed as addicting and potentially deadly substances, but these properties were linked to the patterns and methods of use, as well as characteristics of an individual user. Further, risks associated with pharmaceutical opioids were further curtailed because they “came from the doctor,” and thus had a legitimate aspect to their use. Conclusions This study highlights potential problems with universal approaches to substance use prevention and intervention among young people since such approaches ignore the fact that substance use education messages may be experienced differently depending on an individual’s drug use history and his/her perceptions of drug risks. Findings reported here may be useful in the development of prevention and intervention programs aimed at reducing the harm associated with illicit use of pain pills.

Sources of Pharmaceutical Opioids for Non-Medical Use among Young Adults

“…Our qualitative findings also suggest that individuals are more likely to receive pain pills for free if they need them for self-medication as opposed to recreational use. As our prior studies have shown, OxyContin is typically viewed as a far more expensive and risky drug than most other pharmaceutical opioids and its use is more common among those who are more frequent users of pharmaceutical opioids and other drugs (Daniulaityte, Carlson & Kenne 2006; Daniulaityte, Carlson & Kenne 2007; Daniulaityte, Falck &Carlson 2012). Prior studies have also noted more problematic patterns of use among those individuals who bought pain pills as opposed to getting them for free from friends (Ford & Lacerenza 2011) or those who received pain pills from friends as opposed to family members (McCabe et al 2007).…”

“…This paper uses baseline data collected for our longitudinal project that focused on trajectories of illicit opioid use among young adults (Carlson et al 2014; Daniulaityte et al 2012). A respondent-driven sampling plan was used to recruit participants (Heckathorn 1997; Heckathorn 2002; Wang et al 2005).…”

“…To generate a sample of 390 individuals, initial recruits (“seeds”) and subsequent participants were asked to refer up to 3 individuals and were compensated $15 for each eligible recruit. More information on the sampling methodology is available elsewhere (Daniulaityte et al 2012). The main purpose of the longitudinal study was to identify characteristics associated with transition to opioid dependence among a community-recruited sample of young adults who were non-dependent illicit pharmaceutical opioid users at baseline.…”

High risk and little knowledge: Overdose experiences and knowledge among young adult nonmedical prescription opioid users

“…Other studies have described the varying pathways to injection heroin use in light of recent increases in PO use (Mars, Bourgois, Karandinos, Montero, & Ciccarone, 2013), the use of prescription drugs including opioids, tranquilizers, and stimulants among young injection drug users (Lankenau et al, 2012a, 2012b), and the role of cultural sharing and intra-cultural variation in regards to perceptions of risk associated with pharmaceutical opioids (Daniulaityte et al, 2012). To the best of our knowledge, however, the present study is the first qualitative exploration of overdose experiences, risk factors for overdose, and overdose-related knowledge among young nonmedical PO users.…”

“…Previous research has found that many nonmedical PO users are unaware of potential overdose risks, particularly in regard to polysubstance use (Lankenau et al, 2012a), and that while PO users are concerned about overdose, most believe the risk only applies to others who “use too much” or are “not careful `enough”' (Daniulaityte, Falck, & Carlson, 2012). Yet overdose was not the focus of these studies, and, to our knowledge, there are no studies examining nonmedical PO users' overdose knowledge and experience (apart from studies evaluating the effectiveness of naloxone distribution programs; see, for example, Strang et al, 2008; Williams, Strang, & Marsden, 2013).…”