“Stories of starting”: Understanding the complex contexts of opioid misuse initiation

Abstract

Background: The impacts of opioid use disorder and opioid-involved overdose are known, but less is known about the contexts in which people first misuse opioids, and the motivations for continued misuse. Methods: In-depth interviews with 26 individuals in Allegheny County, Pennsylvania with current or past histories of opioid misuse were conducted. Narratives were analyzed to understand the circumstances and influences contributing to initial and continued misuse of opioids. Results: Participants described social and familial contexts that normalized or accepted opioid misuse—this often included their own use of other illicit substances prior to initiating opioids. Participants also described initial use of opioids as related to efforts to cope with physical pain. They also described recognizing and then seeking psychological/emotional benefits from opioids. All three of these themes often overlapped and intersected in these stories of starting opioid misuse. Conclusions: Opioid misuse stemmed from complex interacting influences involving coping with physical and psychological pain, perception that opioids are needed to feel “normal”, and acceptance or normalization of opioid use. This suggests a multi-pronged approach to both prevention and treatment are needed.

Keywords:

• Opioid misuse initiation
• qualitative research
• opioid crisis
• social determinants of health

Acknowledgements

We would like to acknowledge the team members who assisted in coding and analysis of the data: Shelcie Fabre, Puneet Gill, Shushma Gudla, Bhavita Jagessar, Nicole Paul, and Daly Trimble.

We would also like to acknowledge the leadership team and their respective organizations, which served to develop and advise the project:

Aaron Arnold: Prevention Point Pittsburgh

Abby Wilson, Robert Elser, and Otis Pitts: Allegheny County Health Department

Kristin Maser Michaels, JoEllen Marsh, and Lydia Morin: Congress of Neighboring Communities (CONNECT)

Eric Hulsey and Latika Davis-Jones: Allegheny County DHS

Laura Drogowski: City of Pittsburgh

JR Henry: Ross-Westview EMS.

Author contributions

The authors confirm contribution to the paper as follows: study conception and design: KH, JC; planning and supervision of work: KH, JC, ST; data collection: ST, NS; analysis and interpretation of results: ST, NS, RR, LK, JC, KH; manuscript preparation: NS, ST, RR, LK, JC, KH. All authors reviewed the results and approved the final version of the manuscript.

Additional information

Funding

This work was funded by the Hillman Foundation. The funding agency was not involved in the work reported in the manuscript or in the composition of the submission. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.