Exploring transitions to injecting among young adult non-medical opioid users

非医疗处方阿片类药物（NMPO）的使用是美国一个严重的公共卫生问题。尽管与nmpo相关的健康和社会危害，包括阿片类药物依赖、生产力损失和过量使用，是发病率和死亡率的主要原因，但对注射吸毒的开始和传染病具体后果，包括艾滋病毒和丙型肝炎病毒（HCV）感染的研究至关重要。该项目的目的是研究注射毒品使用的背景和流行病学，以及年轻成人NMPO使用者中与艾滋病毒和丙型肝炎相关的危险行为。这项初步研究的最终目标是利用这些数据为前瞻性队列研究的发展提供信息，以确定该人群中开始注射药物使用的多层次危险因素。具体而言，本研究的目的如下：(1)比较和评估两种新型抽样方法招募年轻成年NMPO用户的可行性；(2)探讨与年轻NMPO吸毒者HIV风险行为和向注射吸毒过渡相关的社会、宏观社会和药物相关因素。为了实现这些目标，我们将对居住在罗德岛州（RI）的200名年龄在18至25岁的NMPO用户进行一项试点研究，罗德岛州是年轻人中NMPO使用率最高的州之一。为了实现目标1，我们将比较两种新型招聘策略的效率、成本和样本组成，包括有针对性的游说和受访者驱动的抽样相结合，以及从药物信息和社交媒体网站混合的基于互联网的招聘。为了实现目标2，我们将评估非注射者对开始注射风险的认知。我们还将研究社会，宏观社会和药物相关风险因素（例如，从家庭成员转移，社会网络特征，拒绝阿片类药物控制疼痛，在滥用威慑重新配方后发展到海洛因使用）与艾滋病毒风险行为和过渡到注射吸毒之间的关系。最后，为了评估从多个医生那里收到阿片类药物处方作为注射开始的风险因素，我们将通过与RI处方监测项目进行确定性的机密数据链接，获得过去一年的阿片类药物配药历史。这项研究对改进处方阿片类药物暴露评估以及开发新的抽样方法具有重要意义，因为NMPO使用的隐藏性和无定形性一直具有挑战性，因此可以访问人群成员。这项研究将解决美国处方阿片类药物的非医疗使用者面临的紧迫公共卫生挑战的几个核心问题，特别是在进化的背景下

DESCRIPTION: Non-medical prescription opioid (NMPO) use is a serious public health problem in the United States. Although NMPO-related health and social harms, including opioid dependence, lost productivity, and overdose are major causes of morbidity and mortality, initiation of injection drug use and infectious disease specific consequences, including HIV and hepatitis C virus (HCV) infection, are crucially understudied. The objective of this project is to examine the context and epidemiology of injection drug use as well as HIV- and HCV-related risk behaviors among young adult NMPO users. The ultimate goal of this pilot study is to use these data to inform the development of a prospective cohort study to determine the multi-level risk factors for initiation of injection drug use in this population. Specifically, the proposed stdy has the following aims: (1) to compare and evaluate the feasibility of two novel sampling methods to recruit young adult NMPO users; and (2), to explore social, macro-social, and drug-related factors associated with HIV risk behavior and transitions to injection drug use among young adult NMPO users. To achieve these aims, we will conduct a pilot study of 200 NMPO users aged 18 to 25 who reside in Rhode Island (RI), a state that is among the highest in the prevalence of NMPO use among young adults. To achieve Aim 1, we will compare the efficiency, cost, and sample composition of two novel recruitment strategies, including a combination of targeted canvassing and respondent-driven sampling, as well as mixed internet-based recruitment from drug information and social media websites. To achieve Aim 2, we will assess non-injectors' perceptions of risk for initiating injection. We will also examine the relationship between social, macro-social, and drug-related risk factors (e.g., diversion from family members, social network characteristics, denial of opioids for pain control, progression to heroin use following abuse-deterrent reformulations) and HIV risk behaviors and transitions to injection drug use. Finally, to assess receipt of opioid prescriptions from multiple physicians as risk factor for injecting initiation, we will obtain past-year opioid dispensation histories by conducting a deterministic, confidential data linkage to the RI prescription monitoring program. This study has important implications for improved prescription opioid exposure assessments as well as the development of novel sampling methodologies to access members of a population that, due to the hidden and amorphous nature of NMPO use, has been challenging to study. This research will address several questions central to the urgent public health challenges facing non-medical users of prescription opioids in the US, particularly in the context of evolving technologies and abuse-deterrent formulations to prevent injecting and opioid abuse. Taken together, the results of this work will inform the development of interventions to prevent injectin initiation and reduce HIV transmission in NMPO-using populations, and avert unintended adverse consequences of ongoing prescription opioid prescribing and policy changes.