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

7.项目摘要 与毒品有关的过量死亡现在是美国伤害死亡的最大原因， 2011年汽车事故死亡人数。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，阿片类药物滥用者在人口统计学上与前几代人不同。他们是 农村和郊区多于城市，启蒙年龄范围更广。以往的研究 从非注射吸毒过渡到注射吸毒主要是在高度城市化的环境中进行的， 在美国，对注射毒品使用者的艾滋病毒风险行为的研究也主要是 在城市环境中进行。令人惊讶的是，人们对郊区的处方阿片类药物使用者知之甚少， 远郊环境，或与从处方类阿片使用或滥用过渡到注射有关的因素 或使用海洛因。 南加州有三个县，主要由郊区/远郊和农村社区组成， 艾滋病毒感染率和对注射毒品者的有限服务：文图拉县、橙子县和圣地亚哥县。 这三个县的处方阿片类药物处方率高于州中位数， 说明意外阿片类药物相关过量死亡的中位率。我们建议利用我们独特的访问权限， 大量郊区和远郊吸毒者招募使用处方阿片类药物的个人 未按规定，或最近（<6个月）过渡到注射阿片类药物和/或海洛因使用， 对a）处方阿片类药物的开始，B）相关因素进行定性和定量探索 （c）在获得药物辅助治疗、艾滋病毒/艾滋病和艾滋病方面的障碍 HCV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 确定与开始滥用类阿片以及过渡到注射有关的因素的方法， 和（或）过渡到海洛因使用;定量调查和分析， 处方阿片类药物滥用者更大样本中的预测因素和结果;以及定性访谈， 使第一阶段的定性结果与定量结果相一致。 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 高风险人群中的止痛药滥用、海洛因开始、注射开始和过量 地理上分散的郊区和远郊社区，这一群体至今仍是很少有人关注的问题。 research.

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.