Teens and young adults face high risk from opioid-involved overdose

The prevalence of opioid-involved overdoses has become an increasing concern to health officials both in NYC and nationally. According to the New York City Department of Health and Mental Hygiene, the number of unintentional opioid-involved overdose deaths in 2011 was nearly triple the number of such deaths in 2000. Much of the increase has been attributed to a dramatic rise in nonmedical prescription opioid (PO) use among teens and young adults, and, more recently, in heroin use among youth who transitioned from POs to heroin.

Now researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR) and the NYC-based National Development Research Institutes (NDRI) have published a study in the International Journal of Drug Policy exploring for the first time overdose-related knowledge and experiences of young adult nonmedical PO users to better understand how PO use relates to the likelihood and experience of overdose. The subjects (n=46) were between the ages of eighteen and thirty-two, all resided in NYC, and were engaged in nonmedical PO use in the past 30 days.

The study, "High Risk and Little Knowledge: Overdose Experiences and Knowledge among Young Adult Nonmedical Prescription Opioid Users," used a series of in-depth, semi-structured interviews to explore the group's overdose experiences, as well as their knowledge of and experience with opioid safety/overdose prevention services and practices. The researchers also gauged subjects' knowledge of naloxone, a specific opioid receptor antagonist used to reverse an opioid overdose.

"We found that despite significant overdose experiences, nonmedical PO users were uninformed about overdose awareness, avoidance, and response strategies, especially the use of naloxone. Prevention efforts should provide education about overdose prevention and access to naloxone to young PO misusers." said Pedro Mateu-Gelabert, PhD, principal investigator with CDUHR and NDRI.

The extent of this high risk group's lack of knowledge is troubling. In most cases, when asked about their experience with overdose, participants described utilizing various potentially ineffective folk methods, such as slapping the individual or placing them in a cold shower, to revive individuals who appeared to have experienced an overdose. Notably, multiple participants mentioned the popular film Pulp Fiction, which includes a highly fictionalized and inaccurate overdose reversal scene, highlighting the extent to which mass media depictions often function as salient sources of drug-related knowledge for this population. When asked if he or she had ever heard of naloxone, one participant responded "No. Is that like the adrenalin?"

Looking to explain this deficit, researchers looked to the educational resources, mainly harm reduction organizations and syringe exchange programs (SEPs), available to participants and why they had failed to engage in them. Researchers found their participants seemed to represent a different subpopulation from those traditionally served by such organizations.

"Many participants drew clear distinctions between nonmedical PO use and heroin use, and even those who transitioned to heroin tended to maintain identity-based distinctions between themselves and those they perceived as 'junkies,' David Frank, co-investigator in the project, explains. "Their desire to uphold this distinction affected their willingness to utilize such services, which are often stigmatized."

Furthermore, many participants were opioid dependent, yet did not engage in injection drug use; therefore, despite being at risk for overdose, they were outside of the traditional purview of SEPs/harm reduction organizations.

The researchers emphasize the need for efforts to increase overdose prevention and response education for young nonmedical PO users, especially those who initiated opioid use with POs, by expanding existing resources outside the realm of the traditional centers. This would better address the less marginalized/stigmatized group of drug users studied.

"Given that every participant in the study had attended at least some high school, with half having attended at least some college, we believe the development of high school and college education programs that offer harm reduction training and distribute naloxone could contribute to overdose prevention efforts," said Dr. Mateu-Gelabert.