09 Apr Does Prescription Opioid Abuse Increase Risks For HIV Exposure?
In the U.S., prescription opioid abuse is a relatively common phenomenon. Unfortunately, for a number of reasons, people who abuse opioid medications have a significantly increased chance of initiating use of the street drug heroin and ultimately participating in heroin injection. In a study published in July 2014 in the Journal of Substance Abuse Treatment, a team of American researchers examined the impact of this drug-using progression on the odds that a young-adult prescription opioid abuser will eventually be at-risk for exposure to the human immunodeficiency virus (HIV) and/or the hepatitis C virus (HCV).
From Prescription Opioids to Heroin
Like heroin and other opioid drugs, prescription opioid medications produce both pain relief and a powerful form of pleasure called euphoria. Normally, proper prescription control limits the drug effects of these medications. However, by definition, prescription opioid abusers avoid the controls placed on the consumption of these substances by doing such things as taking more of a medication than directed and taking a medication without a prescription. In addition, some abusers seriously intensify the drug effects of opioid medications by crushing them and then snorting or injecting the resulting powder.
When taken in excessive amounts or inhaled or injected, opioid medications can produce an impact on the body that’s roughly equivalent to the impact produced by heroin. Since heroin is commonly both less costly and easier to acquire than opioid medications, significant numbers of prescription opioid abusers view heroin consumption as a “reasonable” alternative to opioid medication consumption. People who hold this point of view can easily initiate heroin use and, in some cases, eventually fall into a repeated pattern of heroin injection. According to figures compiled by the National Institute on Drug Abuse, almost 50 percent of all young-adult heroin injectors in the U.S. apparently have a prior history of prescription opioid abuse.
Drug Injection, HIV and HCV
Injection drug use is one of the known major risk factors for exposure to HIV. This risk is the result of practices among IV drug users that include sharing needles during episodes of drug injection and trading sex for drug access. The same practices that increase the odds of HIV infection also increase the odds of getting infected with the hepatitis C virus. Populations commonly viewed as at-risk for substance-related exposure to HIV and HCV include the poor, people affected by mental illness, gay men and people with a history of exposure to physical or sexual abuse. These groups don’t necessarily overlap with the groups most likely to abuse prescription opioid medications (i.e., young adults, people from middle-class backgrounds and European Americans).
Risks for Exposure
In the study published in the Journal of Substance Abuse Treatment, researchers from the National Development and Research Institutes used an assessment of 46 young adults living in New York City to investigate the connection between initiating prescription opioid abuse and ultimately being exposed to HIV and/or HCV. All of the study participants were between the ages of 18 and 32 and had a current history of opioid intake. The researchers used interviews with these participants to probe topics such as their original impressions of the dangers of prescription opioid abuse, their experiences with opioid addiction and heroin use, their level of involvement in heroin injection and their habitual practices while injecting heroin.
After completing the interviews, the researchers came to a series of conclusions. First, they concluded that the study participants frequently underestimated the addictive power of prescription opioids and subsequently developed opioid addictions. After developing an addiction, many of the participants graduated to heroin use and eventually started injecting heroin. The researchers found that, after becoming IV heroin users, the participants increased their risks for HIV/HCV exposure by occasionally sharing needle use with others they perceived as disease-free, occasionally sharing syringes with others and commonly sharing other paraphernalia used during drug injection. In addition, the IV heroin users took part in dangerous sexual practices that included having sex without condoms, having sex with multiple partners and using sex to pay for drugs. While knowledge of HIV-related risks was fairly widespread, the IV heroin users knew very little about their risks for hepatitis C exposure.
Based on their findings, the study’s authors believe that public health efforts to prevent the spread of HIV and HCV should include young adults who abuse prescription opioids (a group not necessarily included in traditional risk profiles).
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