Transition from NMPO Sample Clauses

Transition from NMPO only use to heroin and co-use Following implementation of interventions that reduce the supply of POs, reports indicate a reduction in PO prescribing and NMPO use, but also an increase in more problematic opioid use including heroin use and injection. An analysis of national data found that prevalence of NMPO use decreased from 5.4% in 2003 to 4.9% in 2013 and from 2011 to 2013, prescriptions for POs trended downward (Dart et al., 2015; Han et al., 2015). This is in contrast to more than a decade of drastic increases in NMPO use and related outcomes. However, studies also document an increase in NMPO abuse and dependence from 2003 to 2013 and a 62.5% increase in previously stable rates of heroin from 2002 to 2013. The steepest increase in heroin use was among those who reported prior NMPO use, suggesting NMPO use as a gateway to heroin use and subsequent co-use of both opioids (Xxxxx, Logan, Gladden, & Xxxx, 2015). The literature provides additional evidence of transition from NMPO-only use to NMPO and heroin co-use. Data from national studies show that NMPO use is a robust risk factor for heroin initiation as 80% of heroin initiates from 2002 to 2011 reported previous NMPO use (Muhuri, Gfroerer, & Davies, 2013). During this period, heroin use increased among those reporting NMPO use but not among non-NMPO users (Xxxxx, 2013). Heroin abuse or dependence is 40 times more likely with PO abuse or dependence (Jones, Logan, et al., 2015). Qualitative studies provide more context as those who transition describe heroin as less expensive, more available, and a similar but more effective high (Xxxxxxxx et al., 2010; Cicero et al., 2014; Xxxxxx & Xxxxxx; Mars, Bourgois, Karandinos, Montero, & Xxxxxxxxx, 2014). Taken together, these studies outline an opioid use trajectory that begins with NMPO use, followed by abuse and dependence, initiation of heroin use in the face of dependency and limited PO availability, and continued use of both heroin and POs depending on availability (Xxxxxxxx et al., 2009; Levy, 2007; Siegal, Carlson, Kenne, & Swora, 2003). National studies underscore this trajectory as the growing norm; among opioid treatment enrollees, 75% reported initiating with POs instead of heroin in the 2000s, compared to only 20% in the 1960s (Cicero et al., 2014). Similarly, a study of drug injectors from 16 US cities showed that 49% of people who began injecting drugs between 2010-2015 reported previous PO use, compared to only 12% who began injecting before 19...