Injection drug use and overdose among young adults who use prescription opioids non-medically

•Over one-quarter of participants had ever injected drugs.•Over three-quarters of participants who ever injected drugs first injected heroin.•White race, older age, homelessness associated with likelihood of injecting drugs.•Past overdose or seeing an overdose associated with likelihood of injecting drugs.

IntroductionNon-medical prescription opioid (NMPO) use is a critical public health problem in the United States, with 2.1 million new initiates annually. Young adult NMPO users are at high risk for initiating injection drug use. We assessed correlates of injection drug use among young adult NMPO users in Rhode Island, a state heavily impacted by opioid overdose.MethodsWe used data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which recruited 199 residents aged 18-29 who reported past-30-day NMPO use (65.3% male). We compared individuals who reported ever having injected with individuals who reported never injecting, using logistic regression to identify independent correlates of injection.ResultsAmong eligible participants, the mean age was 24.6 years and 61.3% were white. Over one-quarter (n = 59, 29.6%) of the sample had ever injected drugs. The majority (n = 46, 78.0%) of participants who had ever injected drugs reported injecting heroin as her/his first drug; the majority also reported previously snorting her/his first drug that was injected (n = 46, 78.0%). In multivariable analyses, white race, older age, lifetime homelessness, and ever having overdosed or seen someone overdose were independently associated with an increased likelihood of ever injecting drugs.ConclusionsThese findings demonstrate a high prevalence of lifetime injection drug use among young adults who use prescription opioids non-medically. Given the observed associations between injection drug use and witnessing as well as experiencing overdose, interventions are urgently needed to improve overdose education and naloxone distribution to young adult NMPO users who inject drugs.