Prescription Drug Misuse Is Common Gateway for Injection Drug Use among Adolescents

Initial abuse of prescription drugs such as Vicodin, oxycodone, and other opiates during adolescence has been found to be a common denominator among young injection drug users, according to a new study. Since prescription opioids are now the nation’s leading class of abused prescription drugs among adolescents and young adults, scientists have been concerned over the long-term consequences of this public health problem for younger generations. Researchers at Drexel University’s School of Public Health have discovered that young adults who inject heroin or other opiates tend to have similar histories of prescription opioid misuse during their adolescence.

The researchers’ study, recently published online in the International Journal of Drug Policy, investigated patterns of initiation into prescription drug misuse among young injection drug users. While previous studies have examined factors surrounding the initiation of prescription drug abuse among the general population, the goal of the Drexel research team was to identify common variables among this specific population of young injection drug users that has otherwise remained unknown in scientific research. Understanding variables that may influence their initiation of prescription opioid use may help researchers and clinicians establish more efficient prevention methods among adolescents.

For the study, lead researcher Dr. Stephen Lankenau and his team recruited 50 young injection drug users (ages 16–25 years) from the Los Angeles and New York areas who had also misused prescription drugs at least three times within the past three months between 2008 and 2009. Using a semi-structured interview method, the researchers gathered descriptive data on the participants including their entho-epidemiological information, family history, and history of drug use. The participants were interviewed in neutral territories such as parks, streets, or college campuses in order to establish a non-threatening, open dialogue with the researchers.

From their data, the researchers found several common variable factors among the young injection drug users. Based on the descriptive data, most participants:

  •   Were white, heterosexual males in their early 20s
  •   Were presently homeless, or had experienced homelessness in their lifetime
  •   Had dropped out of high school, were expelled, or had been held back a grade
  •   Had a family history in which prescription drug misuse, illegal drug use (including heroin injection), or alcohol abuse by family members was normal during their childhood and adolescence
  •   Had accessibility to prescription medications from their own prescriptions or through relatives or friends
  •   Considered prescription drugs to be a valued commodity that could be bought and sold in quantities, and often participated in the sale of these drugs either due to financial gain or peer pressure
  •   Had several ways to access prescription drugs, which increased their desire to experiment with prescription opioids
  •   Had been diagnosed with a psychological disorder and had a history of drug therapy

From the data, the researchers concluded that a family history of drug misuse and access to prescription medications played important roles in the study population’s initiation into prescription opioid misuse. Researchers also identified two key associations between the participants’ misuse of prescription opioids and use of injection drugs that have not conventionally been reported in other studies involving young injection drug users. On one hand, almost all participants had misused opioid medications prior to turning to injection drug use, which is unlike the usual pattern of heroin users resorting to opioid medications as an alternative high when heroin is unavailable. On the other hand, prescription opioids were the first drugs ever injected among a majority of the participants, whereas conventional drug use trends have shown that prescription opioids are not commonly associated with initiation of injection drug use. Furthermore, nearly all participants later turned to sniffing and injecting opioids or heroin after having abused prescription opioids during their adolescence. The participants showed preference for injecting opioids in order to achieve a more potent high than heroin, and since greater quantities of opioids are more readily accessible to them.

Prescription opioid misuse has severe consequences, including dependency, addiction, overdose, and death. And, according to the study, a new pattern of drug use may be occurring in which prescription opioid misuse now precedes injection drug use among younger generations. The researchers cite their findings as evidence for more prevention efforts among adolescents and education about the dangers of prescription drugs for families. The researchers also mention that further research is needed to discover more contextual preventive methods for those households in which illicit drug use is normalized or psychological disorders may be prevalent.


Lankenau, Stephen E., Michelle Teti, Karol Silva, Jennifer Jackson Bloom, Alex Harocopos, and Meghan Treese. 2011. Initiation into prescription opioid misuse amongst young injection drug users. International Journal of Drug Policy. 10.1016/j.drugpo.2011.05.014. Available online 21 June 2011: //



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