Characterizing prescription opioid, heroin, and fentanyl initiation trajectories: A qualitative study.

We understand the current crisis of overdose deaths to be driven by widespread opioid use, characterized by distinct 'waves' of drug use. The first wave was driven by prescription opioids, the second by heroin, and the third by illicit, non-pharmaceutical fentanyl and fentanyl analogues (henceforth, fentanyl). The purpose of this study is to describe opioid initiation within each of the three waves from the perspective of people who use illicit opioids, with a focus on emerging pathways into fentanyl use. The authors recruited sixty people reporting past-30-day illicit opioid use in Dayton, Ohio. Participants completed a brief survey and a semi-structured in-depth qualitative interview, conducted from March to November 2020 with a total of 13 in-person and 47 virtual interviews. The qualitative interviews were transcribed in their entirety and analyzed thematically using NVivo 12. We noted supply-side changes as influencing trajectories in all three waves. However, we also noted differences in the experiences of prescription opioid and heroin initiation, with these trajectories influenced by pharmacological effects, pain management, curiosity, intergenerational use, pricing, and peers. In comparison, most participants were unaware that they were initiating fentanyl, and many reported overdosing with their first use of fentanyl. We identified a trajectory into fentanyl with limited to no prior heroin use among a few participants. The increased risk of overdose with initiation into fentanyl use further emphasizes the need for an expansion of naloxone distribution and the implementation of more comprehensive measures, such as overdose prevention centers, drug testing, and a safer supply. Further research on the dynamics of the ongoing overdose death crisis in the era of fentanyl and the 4th wave of the overdose crisis is critical in developing responsive prevention and intervention strategies.

Examination of multilevel domains of minority stress: Implications for drug use and mental and physical health among Latina women who have sex with women and men.

There has recently been growing attention and concern in the U.S. on the detrimental drug use and related health conditions impacting diverse sexual minority populations. While some evidence indicates that bisexual women are at increased risk of substance use, little attention has been given to disadvantaged and racial/ethnic minority bisexual women, who are particularly vulnerable to a complexity of stressors and risk. Using data from a 15-year longitudinal study in San Antonio, Texas, the current study examines drug use, incarceration histories, stressful life events, and infections among 206 young adult Mexican-American women who report engaging in sex with both men and women (WSWM) (n = 61) and those indicating having exclusively male sex partners (WSM) (n = 145). A bivariate analysis finds that WSWM experienced more frequent (p = 0.001) and longer total time incarcerated (p = 0.001), as well as exposure to more stressful life events (p = 0.003). WSWM also have higher rates of past 30 day injection drug use (p = 0.026) and related Hepatitis C Virus (HCV) infection (p = 0.001), as well as greater symptomatology associated with depression (p = 0.014), PTSD (p = 0.005), and suicidal ideation (p = 0.036). Findings indicate a significantly elevated risk profile for socio-economically marginalized WSWM. This knowledge is timely and central to policy discourse to develop interventions and health campaigns aimed at reducing and/or preventing further health disparities among this highly susceptible population of minority women.

Risk Factors for Domestic Child Sex Trafficking in the United States.

Despite increased effort to respond to human trafficking at national and state levels, very little empirical research has been conducted on domestic child sex trafficking. This study retrospectively examines associations between multiple risk factors and domestic child sex trafficking (i.e., entry into the commercial sex industry under the age of 18) in a sample of individuals aged 16 and older currently involved in the commercial sex industry ( N = 273). Two primary research questions are addressed: (1) What set of risk factors, prior to entering the commercial sex industry, are associated with domestic child sex trafficking and (2) what group differences, if any, exist in risk factors between current or former domestic child sex-trafficking victims and non-trafficked adults engaged in the commercial sex industry? A cross-sectional survey was administered using Respondent-Driven Sampling (RDS) in five cities in one Midwestern state. Overall, 115 participants (48.3%) were identified as current or former domestic child sex-trafficking victims. Bivariate results suggest that childhood emotional and sexual abuse, rape, ever running away from home, having family members in sex work, and having friends who purchased sex were significantly associated with domestic child sex trafficking. Multivariate results indicate that domestic child sex trafficking victims were significantly more likely to have ever run away and to be a racial/ethnic minority than non-trafficked adults engaged in the commercial sex industry. Findings can inform state-level policies on human trafficking and assist child protection and juvenile justice agencies in developing prevention and intervention responses to commercial sexual exploitation.

An Ecological Analysis of Risk Factors for Runaway Behavior among Individuals Exposed to Commercial Sexual Exploitation.

Running away from home is a known risk factor for commercial sexual exploitation among youth; however, research has not fully investigated the process by which multiple factors at individual, familial, and extra-familial levels increase youths' risk for runaway behavior. This study applies an ecological risk factor framework to assess risk for runaway behavior among individuals exposed to commercial sexual exploitation and examines mediating relationships between salient risk factors (i.e. substance abuse, insufficient basic needs, having a much older boyfriend/girlfriend) and runaway behavior. A cross-sectional, retrospective survey was administered to individuals involved in the commercial sex industry using Respondent Driven Sampling methods (N = 273). Bivariate results suggested associations between runaway behavior and childhood emotional and physical abuse, having friends who sold sex, having a much older boyfriend/girlfriend, dropping out of school, being worried about where to eat/sleep, homelessness, and frequent alcohol and drug use prior to entering the commercial sex industry. Hierarchical logistic regression revealed that individuals with runaway behavior histories were more likely to have frequently used alcohol and/or drugs and to have insufficient basic needs compared to those did not run away; however, these factors were no longer significant after accounting for having a much older boyfriend/girlfriend. Having an older boyfriend/girlfriend fully mediated the relationship between frequent alcohol and/or drug use and runaway behavior. Findings support the need for community and school-based prevention programs that target these risk factors with a specific focus on healthy dating relationships, which may reduce risk for runaway behavior and subsequent commercial sexual exploitation.

Mental health of heroin users with differing injection drug use histories: A non-treatment sample of Mexican American young adult men.

BACKGROUND: While the comorbidity of mental health and injecting heroin has been documented, current research is limited by describing the mental health of people who inject drugs without a comparison group and by the lack of research on nontreatment samples in the United States, particularly among Hispanics. The purpose of this study was to examine the association of injecting history (never, former, occasional, and daily) and multiple outcomes of global and mental health using a sample of U.S.-based Latinos not currently in treatment. METHODS: Data are from a sample of street-recruited Mexican American young adult men (n=275) in San Antonio, TX. Multiple logistic regression and structural equation modeling were used. RESULTS: Overall 54% of men reported lifetime injecting drug use (20.7% former users, 11.1% occasional users, and 21.9% daily users). We found varying prevalence rates of global and mental health status among different histories of injecting. After covariate adjustment, daily injecting remained strongly associated with all four outcomes: perceived poor health status (AOR=4.39; p≤0.001), psychological distress (AOR=2.78; p≤0.05), depression (AOR=4.37; p≤0.001), and suicidal ideation (OR=4.75; p≤0.001). Acculturation, gang membership, and incarceration history also emerged as important factors. CONCLUSION: This study provides new information about the relationship between mental health and injecting heroin use. FINDINGS: Support the need to consider mental health states among people who inject drugs, and to examine varying histories of injecting with socially and culturally relevant factors.

Risk Environments and Substance Use Among Mexican Female Sex Work on the U.S.-Mexico Border.

We use a risk environment framework to qualitatively examine pathways into substance use and abuse among Mexican female sex workers on the U.S.-Mexico border. Life history interviews and ethnographic observations were conducted with female sex workers to uncover how the border context shapes patterns of substance use. The findings illustrate that, for many women, initiation into sex work is contextualized within immigration, the global economy, and demands and desire for financial autonomy. Paradoxically, many find autonomy within sex work as they increase their ability to support their families and themselves. As women become more entrenched in sex work, however, they are put on a path toward substance abuse beginning with alcohol then cocaine and heroin. This identification of specific substance use pathways and trajectories has important implications for the development of prevention and intervention programs that can help curtail problematic drug use that can lead to negative health consequences.

Offenders who are mothers with and without experience in prostitution: differences in historical trauma, current stressors, and physical and mental health differences.

BACKGROUND: Women offenders are a growing population in the criminal justice system; most are mothers. A subset of these women have a history of prostitution. Despite more recent research identifying the needs of women offenders who are mothers, those with and without experience in prostitution are still generally represented in the literature as a homogenous group. METHODS: This study examined the differences between mothers who indicated that they had engaged in prostitution with those who had not. The data were from a survey of offending mothers in a Midwestern city and was based on 889 respondents. Approximately 20% of the women indicated that they had engaged in prostitution at some point in their lives. FINDINGS: Mothers with histories of prostitution reported more exposure to violence, witnessing crime, living in areas with high drug activity, and having a higher rate of physical and mental health problems. CONCLUSIONS: Health care professionals who interact with mothers in the criminal justice system who have histories of prostitution should be careful to assess for a history of trauma and its psychological consequences. Along with increased health care needs, interventions are needed to help these women obtain basic needs such as stable housing outside of high crime and high drug-use areas and to receive targeted psychological services that respond to the unique trauma suffered by this subpopulation of offenders.