Young Heroin Users in Baltimore: A Qualitative Study

Abstract

This study describes the characteristics of 67 young heroin users, interviewed using a semistructured qualitative questionnaire (QQ) as part of a larger study of 18- to 25-year-old heroin users seeking detoxification with buprenorphine at a drug treatment center in Baltimore. This new generation of heroin users has a different demographic profile compared to older heroin users in this area. Our data, supported by data from another clinic and from the Maryland State Alcohol and Drug Abuse Administration, seem to indicate that the younger heroin users in treatment settings are predominantly White, with a high proportion of women, often living in the suburbs. Based on responses to the QQ, all subjects initiated heroin use intranasally, usually in a group setting; 75% had subsequently gone on to use intravenously. The typical young heroin user in Baltimore Metropolitan area appears to be a young White man or woman from a middle/working-class background, with exposure to drug use among close contacts while growing up, experimenting with gateway drugs with peers before proceeding first to intranasal, and then intravenous heroin use, engaging in criminal activities to support the habit, repeatedly seeking help with assistance from family, but failing to sustain abstinence due to continued exposure to drug using peers and a poorly implemented plan of aftercare. Further research should focus on efforts to engage peer groups and families in order to improve treatment outcomes in young heroin users.

Opioid Use Disorders

“…Typically, inhaled (smoked or snorted) heroin is a precursor to injection heroin use xlii .There are varying estimates of the proportion of adolescents with any form of opioid addiction who transition to injection heroin use, ranging from 40-90% ii,xxxv Almost 70% of young heroin users (age 18-25) eventually transition from nasal to injection heroin xliii ,and almost half of adolescents with current heroin addiction are injection heroin users xviii,xliv . Among patients seeking treatment for heroin addiction, the percentage of injection heroin use is even higher (62-83%) xvi,xxxiii,xxxvi .…”

The social production of substance abuse and HIV/HCV risk: an exploratory study of opioid-using immigrants from the former Soviet Union living in New York City

“…Recent research has shown that most young heroin users now initiate use of the drug via the intranasal route, with a proportion later transitioning to injection [12,48]. Of the three participants in this sample who either initiated heroin use via injection or progressed to injection almost immediately, two began their use of the drug in the FSU (the same two women cited above).…”

“…Interview data demonstrate that participants were typically initiated into opioid use and injection within social settings in the company of fellow Russian-speaking peers. While the peer context has been documented to play an important role in opioid use and injection initiation among a variety of substance-using groups, especially youth, [42,43,48], this micro-level social context may be particularly salient and have distinctive dynamics among FSU immigrant substance users. Participant testimony supports published evidence that communal opioid use within friendship networks has historical antecedents within Russian culture extending back to the Soviet-era.tradition of home-based opium preparation in which a group of individuals commonly pooled resources and gathered together to cook and consume the liquid product [27].…”

“…First, the majority of interviewees did not initiate substance use with opioids, as has been reported to be characteristic of FSU immigrant addicts in NYC [17] but rather experimented with a succession of illicit substances prior to using heroin - a pattern documented with other groups of adolescent and young adult heroin users in the U.S. [48,50]. Interestingly, the two participants whose substance use trajectories began in the FSU pre-immigration are the only exceptions to this pattern within the sample; these two women used heroin either before using any other illicit drug or very shortly after initiating the use of illicit substances.…”

A Model of School Problems, Academic Failure, Alcohol Initiation, and the Relationship to Adult Heroin Injection

“…In addition, compared with high-school graduates, dropouts are significantly more likely to have injected drugs, both recently (Obot & Anthony, 1999; Obot, Hubbard, & Anthony, 1999) and in their lifetime (Obot & Anthony, 2000). Also, adults with opioid use disorders often report low academic achievement (Gandhi, Kavanagh, & Jaffe, 2006). Studies of this nature frequently quantify academic achievement as high-school graduation.…”