(228) Natural history of prescription opioid misuse/abuse: a qualitative investigation

      There is significant interest in understanding factors associated with the growing opioid epidemic so that meaningful prevention efforts can be implemented. We conducted a qualitative study to explore the natural history of opioid misuse and abuse, looking specifically at changes in route of administration (ROA) over time. 20 adult outpatients from a buprenorphine naloxone clinic in Kentucky participated in one-hour, semi-structured interviews about their opioid abuse history. Interviewers created timelines to track the sequence of “progression events” in a participant’s ROA, preferred product, and/or dosage. The sample was 90% white and 50% female with a mean age of 36.2 years; 12 participants had a history of pain. On average, there were 11 years between the first opioid misuse/abuse event and the current treatment episode. 70% of participants reported illicit use of non-opioid substances prior to opioid misuse/abuse. 85% of participants reported manipulating opioids prior to administration (oral, intranasal, or intravenous). A majority (n=11) engaged in chewing at some point when using the oral ROA. Participants who manipulated prescription opioids at first use tended to employ alternative ROAs over time (intranasal or intravenous). Several participants (n=6) went back and forth between ROAs. Less than half of patients injected (n=7) or snorted (n=5). This study provides preliminary evidence that there may not be a “typical” pattern of ROA progression for opioid misuse and abuse. Many participants alternated between ROAs over time and others did not progress from oral to intranasal or intravenous use. In this study, manipulation (including chewing) of opioids was common prior to opioid misuse and abuse. Confirmation of the findings from this small study is warranted. Funded by Egalet Corporation.