SAN DIEGO – Youth and young adults who have transitioned from prescription drug misuse to injection drug use tend to reside in dense social networks, results from a novel study suggest.

“A lot of what we know about the transition from prescription opioids to drug use is from populations that have already transitioned to injection drug use, and we’re asking them retrospectively to tell us about their use,” lead study author Alia Al-Tayyib, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.

“About 80% of people who are injecting drugs started with prescription drug misuse, but we don’t have a lot of information about people who just used prescription opioids but didn’t transition to injection drug use.”

In an effort to examine the transition from prescription opioid misuse to injection drug use from a social network perspective, Dr. Al-Tayyib and her associates recruited Denver area residents aged 15-24 years to participate in the Social Networks of Abused Prescription Pills in Youth study between October 2015 and April 2017. Participants were recruited via direct outreach and respondent-driven sampling, which is a peer-referral sampling methodology. Individuals were eligible to participate if they were currently misusing prescription opioids or were currently using heroin after a period of prescription opioid misuse.

Study participants completed interviewer-administered behavioral and social network surveys. People from whom data were collected were referred to as “egos,” and they provided information on people in their social networks called “alters.” As a social network prompt, for example, study participants were asked to “think about people you have contact with who have been involved in your life in a significant way during the past month.”

Participants also were asked about places of aggregation with the prompt, “Where does [this person] hang out?” The egos, alters, and locations are all considered “nodes” in the social network. To examine implications on transition, the researchers examined k-plexes, or subgroups of connected nodes.

Dr. Al-Tayyib, an associate research scientist at Denver Public Health, presented results from 80 ego participants and 489 alters. The mean age of ego participants was 21.4 years, 73% were male, 68% were non-Hispanic white, and 60% reported being homeless in the past 12 months. More than three-quarters of ego participants (80%) reported injection drug use, 14% reported misusing prescription opioids, and 6% reported using heroin without injecting. Of the 489 alters, 45.2% reportedly injected, 5.9% used heroin, and 8.6% misused prescription opioids with at least one of the ego participants.

The researchers observed that study participants who transitioned to injection drug use resided in denser social network regions. “It was really hard to capture people who had not already transitioned to injection drug use, partly because that’s not a behavior that’s easily identifiable,” Dr. Al-Tayyib said. “This study is a one look in time, so it’s hard to know which came first: the chicken or the egg. If I’m injecting drugs, do I start hanging out with other people who inject drugs, or is it because I started hanging out with people who inject drugs, and then I started injecting? The take-home message is that prevention efforts need to target teens as early as possible. From a prevention standpoint, it’s engaging youth in positive networks to prevent the transition.”

The study was supported by funding from the National Institute on Drug Abuse. Dr. Al-Tayyib reported having no disclosures.

dbrunk@mdedge.com

Social networks may influence youth who transition to injection drug use