Prescription opioid misuse and heroin initiation by young urban and suburban non-injecting heroin users in Chicago

Objective: Assess non-prescribed legal opioid (NP-LO) use prior to heroin initiation by young non-injecting heroin users (NIHU). Methods: NIHU 16-30 years old recruited through street outreach and respondent-driven methods completed computerized self-administered interviews. A subset engaged in qualitative interviews. Results: Between 6-2002 and 1-2005 we enrolled 689 NIHU; 645 were eligible for this analysis. The sample was 64% male, 45% 16-24 years old, 31% suburban, 49% black, 23% white, and 25% Hispanic. Over half (59%) reported NP-LO use. In bivariate analysis, the 15% who initiated LO at an earlier age than they initiated heroin were significantly more likely to be white, age 16-24, suburban, ever diagnosed with a psychiatric disorder, and polydrug users. In a multivariable logistic regression model, factors associated with NP-LO use before heroin were white race (AOR=3.4, 95% CI, 2.1–5.4), polydrug use (AOR=1.9, 95% CI, 1.2–3.3) and ever diagnosed with a psychiatric disorder (AOR=2.2, 95% CI, 1.2–4.1). Age and suburban residence were associated with white race and dropped out of the model. No NIHU in qualitative interviews (n=118) reported initiating heroin as the result of LO addiction. Conclusion: Early in a period of marked increases in LO prescribing in the U.S. and in an area with robust heroin markets, few NIHU used NP-LO at an age younger than initiating heroin; addiction to LO as a motive for heroin use appeared rare. NIHU who initiated NP-LO use before heroin were more likely to be young, white, and suburban, to have mental health problems and to be polydrug users.