Prescription Opioids Among Street Drug Users: Medical Use, Misuse & Diversion

描述（由申请人提供）：历史上，纽约市在美国拥有最多的海洛因使用者（约250,000）。有必要对处方阿片类药物的医疗使用、滥用和街头吸毒者的转移有更清晰的科学认识。通过处方获得的阿片类药物数量有所增加，滥用阿片类药物的报告也有所增加。街头吸毒者滥用和非法转移麻醉品的风险很高，尽管这一人群也可能出于适当的医疗原因使用麻醉品。目前还没有对这一重要的吸毒者群体进行广泛的纵向研究，以确定长期以来PO使用、滥用和转移的程度。2006年，一项针对纽约市700多名街头吸毒者的最新试点研究发现，近90%的人在一生中使用过POs， 60%的人在过去一个月使用过POs。奥施康定、维柯丁和街头美沙酮最常被使用、滥用和出售/转移；该研究发现，使用大麻的原因、使用方式和来源存在相当大的差异。拟议的研究旨在澄清使用大麻的各种动机（如缓解疼痛、避免戒断、兴奋）、摄入途径（如按指示口服、嗅/鼻吸、注射）、供应来源（如医生/药剂师、街头小贩、家庭）和转移/转售（如他人使用、转售、海洛因替代品）。该研究还将记录各种监管政策的影响，以防止POs的滥用和转移。社会网络理论提供了概念框架；这项研究将包括基本的网络分析，将海洛因和可卡因使用者/销售商的网络与主要使用POs的网络进行比较。人种学数据将补充转售活动的定量报告。目的A（医疗使用和非医疗滥用）：记录和分析纽约市街头吸毒者的PO消费模式。目的B：分析纽约市街头吸毒者中POs的转移途径和市场。将对500名街头吸毒者进行访谈，了解其使用、误用和转用POs的情况，并于6个月后进行随访。我们将对100名报告有系统地转用毒品的街头吸毒者就转用毒品的情况进行详细访谈。统计分析将记录其他药物使用、医疗使用和各种形式的误用之间的联系。该研究将提供系统的、纵向的证据，说明这一人群中药物使用、滥用和转移的程度，以帮助为药物滥用控制工作提供信息。

DESCRIPTION (provided by applicant): Historically, New York City has had the largest number of heroin users in the U.S. (approximately 250,000). There is a need for a much clearer scientific understanding of prescription opioid (PO) medical use, misuse, and diversion among street drug users. The number of opioids available via prescription has increased, as have reports of their misuse. Street drug users are at high risk for misusing and illegally diverting POs, though this population may also use POs for appropriate medical reasons. There has been no broad-based longitudinal research with this significant population of drug users to determine the extent of PO use, misuse and diversion over time. An updated pilot study of over 700 NYC street drug users through 2006 found that nearly 90% used POs in their lifetimes and 60% used POs in the past month. OxyContin, Vicodin, and street methadone were the most often used, misused, and sold/diverted; the study found considerable variation in reasons for use, modes of use, and sources of POs. The proposed research aims to clarify the various motivations for PO use (e.g. pain relief, withdrawal avoidance, euphoria), routes of ingestion (e.g. oral as indicated, sniff/snort, injection), sources of supply (e.g. physicians/pharmacists, street dealers, family), and diversion/resale (e.g. use by someone else, resold, heroin substitute). The study will also document the impact of various regulatory policies to prevent misuse and diversion of POs. Social network theory provides the conceptual framework; this study will include a basic network analysis, comparing heroin and cocaine users'/sellers' networks with those predominantly using POs. Ethnographic data will complement the quantitative reports of resale activity. AIM A (Medical Use and Non-medical Misuse): Document and analyze patterns of PO consumption among street drug users in NYC. AIM B: Analyze the routes of diversion and markets for POs among street drug users in NYC. 500 street drug users will be interviewed regarding their use, misuse, and diversion of POs and followed-up after 6 months. 100 street drug users who report systematic diversion of POs will be interviewed in detail regarding episodes of diversion. Statistical analyses will document associations among other drug use, medical use of POs, and various forms of PO misuse. The research will provide systematic, longitudinal evidence about the extent of medical use, misuse, and diversion of POs within this population to help inform drug abuse control efforts.