OPR mis/use and transitions to heroin and injecting in suburban and exurban Southern California

7.项目总结 与药物有关的过量死亡现在是美国最大的伤害死亡原因，已经超过 2011年与机动车相关的死亡人数。有证据表明，开始滥用处方阿片类药物的个人 在过去10年中，吸毒者在人口统计上与前几代阿片类药物滥用者不同。他们是 更多的是农村和郊区，而不是城市，并且有更广泛的开始年龄范围。以前的研究 从非注射吸毒到注射吸毒的转变在很大程度上是在高度城市化的环境中进行的， 对美国注射吸毒者中艾滋病毒危险行为的研究也主要是 在城市环境中进行了这项研究。令人惊讶的是，对郊区和郊区的处方阿片类药物使用者知之甚少 郊区环境，或与从处方阿片类药物使用或滥用过渡到注射有关的因素 或者使用海洛因。 南加州有三个县，主要由郊区/郊区和农村社区组成， 艾滋病毒感染率和为注射吸毒者提供的有限服务：文图拉县、奥兰治县和圣地亚哥县。 这三个县的处方阿片类药物处方率高于州中位数，高于 该州意外阿片类药物相关过量死亡的中位数。我们建议利用我们独特的访问权限 大量郊区和郊区吸毒者招募使用处方阿片类药物的个人 未按规定，或最近(&lt；6个月)按顺序转为注射阿片类药物和/或海洛因使用 对a)处方阿片类药物的启动，b)相关因素进行定性和定量的探索 过渡到注射和/或海洛因使用，以及c)获得药物辅助治疗的障碍，艾滋病毒 以及丙型肝炎病毒检测、预防过量用药和清洁针头。 我们将通过三个阶段的混合方法来实现这些目标。我们将使用定性的 确定与阿片类药物滥用以及过渡到注射有关因素的办法， 和/或向海洛因使用的转变；确定统计关系的定量调查和分析 在处方阿片类药物滥用者中的更大样本中的预测因素和结果；定性访谈 使第一阶段的定性结果与定量结果保持一致。 这项研究的结果将在设计预防阿片类药物的有针对性的干预措施方面具有独特的价值 年高危人群止痛药滥用、海洛因使用、注射开始和过量使用情况 地理上分散的郊区和郊区社区，这一群体今天几乎没有 研究。

7. Project Summary Drug-related overdose deaths are now the largest cause of injury death in the United States, having eclipsed motor vehicle-related deaths in 2011. Evidence suggests that individuals initiating prescription opioid abuse within the last 10 years are demographically different from opioid abusers of previous generations. They are more rural and suburban than urban, and have a broader range of age of initiation. Previous studies of transition from non-injecting to injecting drug use has largely been conducted in highly urban environments, and studies of HIV risk behaviors among injecting drug users in the United States have also predominantly been conducted in urban settings. Surprisingly little is known about prescription opioid users in suburban and exurban settings, or about factors associated with transition from prescription opioid use or misuse to injecting or to use of heroin. Southern California has three counties largely comprised of suburban/exurban and rural communities, high rates of HIV, and limited services for people who inject drugs: Ventura, Orange, and San Diego Counties. These three counties have higher than state median rates of prescription opioid prescribing, and higher than state median rates of accidental opioid-related overdose death. We propose to utilize our unique access to a large population of suburban and exurban drug users to recruit individuals who are using prescription opioids not as prescribed, or who have recently (<6 months) transitioned to injecting opioids and/or heroin use, in order to conduct qualitative and quantitative exploration of a) initiation of prescription opioids, b) factors associated with transition to injecting and/or heroin use, and c) barriers to accessing medication assisted treatment, HIV and HCV testing, overdose prevention, and clean needles. We will achieve these aims through a three-stage mixed methods approach. We will use qualitative approaches to determine factors associated with initiation of opioid misuse, as well as transition to injecting, and/or transition to heroin use; quantitative surveys and analysis to determine statistical relationships between predictor factors and outcomes in a larger sample of prescription opioid misusers; and qualitative interviews to reconcile first-stage qualitative findings with quantitative findings. Findings from this study will be uniquely valuable in designing targeted interventions for preventing opioid pain reliever misuse, heroin initiation, injection initiation and overdose among high risk populations in geographically dispersed suburban and exurban communities, a group that to day has been the subject of little research.