TY - JOUR
KW - Adult
KW - Analgesics, Opioid
KW - Baltimore/epidemiology
KW - Cohort Studies
KW - Female
KW - Humans
KW - Illicit drugs
KW - Injections
KW - Male
KW - Middle Aged
KW - Prescription Drugs
KW - Substance Abuse, Intravenous/epidemiology/mortality
AU - J. A. Cepeda
AU - J. Astemborski
AU - G. D. Kirk
AU - D. D. Celentano
AU - D. L. Thomas
AU - S. H. Mehta
A1 - 
AB - INTRODUCTION: Prescription drug abuse is a major public health problem in rural and suburban areas of the United States, however its emergence in large urban settings with endemic injection drug use remains understudied. We examined temporal trends in injection drug use initiation and mortality among people who inject drugs (PWID) in Baltimore, Maryland. METHODS: Data were derived from the baseline assessment of PWID enrolled in a community-based cohort study with longitudinal follow-up for mortality assessment. PWID were recruited from 2005-2008 (N = 1,008) and 2015-2018 (N = 737). We compared characteristics by birth cohort (before/after 1980) and type of drug initiated (prescription opioids, prescription non-opioids, non-injection illicit drugs, or injection drugs). We calculated standardized mortality ratios (SMR) using the US general population as the reference. RESULTS: PWID born after 1980 were more likely to initiate drug use with prescription opioids and non-opioids and had higher levels of polysubstance prior to injection initiation, compared to individuals born before 1980. Overall mortality was high: 2.59 per 100 person-years (95% CI: 2.27-2.95 per 100 person-years). Compared to the US population, the highest SMRs were observed among participants between 40-44 years of age, with especially high mortality among women in this age group (SMR:29.89, 95% CI: 15.24-44.54). CONCLUSIONS: Mirroring national trends, the profile of PWID in Baltimore has changed with increased prescription drug abuse and high levels of polysubstance use among younger PWID. Interventions need to reach those using prescription drugs early after initiation of use in order to reduce transition to injecting. Urgent attention is warranted to address premature mortality, particularly among middle-aged and female PWID.
AD - Department of Medicine, University of California San Diego, La Jolla, California, United States of America.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.; Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
BT - PloS one
C5 - Education & Workforce; Opioids & Substance Use
CP - 3
DO - 10.1371/journal.pone.0213357
IS - 3
JF - PloS one
LA - eng
M1 - Journal Article
N2 - INTRODUCTION: Prescription drug abuse is a major public health problem in rural and suburban areas of the United States, however its emergence in large urban settings with endemic injection drug use remains understudied. We examined temporal trends in injection drug use initiation and mortality among people who inject drugs (PWID) in Baltimore, Maryland. METHODS: Data were derived from the baseline assessment of PWID enrolled in a community-based cohort study with longitudinal follow-up for mortality assessment. PWID were recruited from 2005-2008 (N = 1,008) and 2015-2018 (N = 737). We compared characteristics by birth cohort (before/after 1980) and type of drug initiated (prescription opioids, prescription non-opioids, non-injection illicit drugs, or injection drugs). We calculated standardized mortality ratios (SMR) using the US general population as the reference. RESULTS: PWID born after 1980 were more likely to initiate drug use with prescription opioids and non-opioids and had higher levels of polysubstance prior to injection initiation, compared to individuals born before 1980. Overall mortality was high: 2.59 per 100 person-years (95% CI: 2.27-2.95 per 100 person-years). Compared to the US population, the highest SMRs were observed among participants between 40-44 years of age, with especially high mortality among women in this age group (SMR:29.89, 95% CI: 15.24-44.54). CONCLUSIONS: Mirroring national trends, the profile of PWID in Baltimore has changed with increased prescription drug abuse and high levels of polysubstance use among younger PWID. Interventions need to reach those using prescription drugs early after initiation of use in order to reduce transition to injecting. Urgent attention is warranted to address premature mortality, particularly among middle-aged and female PWID.
PY - 2019
SN - 1932-6203; 1932-6203
T1 - Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland
T2 - PloS one
TI - Rising role of prescription drugs as a portal to injection drug use and associated mortality in Baltimore, Maryland
U1 - Education & Workforce; Opioids & Substance Use
U2 - 30830944
U3 - 10.1371/journal.pone.0213357
VL - 14
VO - 1932-6203; 1932-6203
Y1 - 2019
Y2 - Mar 4
ER -