Physical Alteration of Prescription Opioids Prior to Ingestion: An Under-Recognized Risk of Prescription Opioid Nonmedical Use

Abstract

Background: To examine the role of physical alteration of prescription opioids prior to ingestion (PAPO) as part of the current opioid public health crisis, this study compared biopsychosocial characteristics and behaviors among individuals who reported prescription opioid nonmedical use (NMU) via oral IN-TACT only, PAPO, and NONORAL routes of administration. Methods: A YouGov survey of the United States (US) general adult population (n = 24,000) captured demographics, polysubstance use, motivations for NMU, source of drug, age of first use, and environmental factors that influenced route of administration. Four mutually exclusive groups based on prescription opioid NMU routes of administration were compared. Results: Of the 4,590 that reported prescription opioid NMU: 3,477 (75.8%) reported prescription opioid NMU via oral INTACT only; 438 (9.5%) PAPO; 390 (8.5%) NONORAL; and 285 (6.2%) PAPO + NONORAL. Compared to the INTACT only group, PAPO and NONORAL groups reported higher prevalence of lifetime diagnosis of behavioral/mental health comorbidities, poly-substance use, and abuse-related motivations for NMU, as well as earlier age of substance use initiation and higher likelihood of obtaining drugs through illicit channels. Conclusions: PAPO group characteristics were highly consistent with NONORAL group and significantly different than INTACT group, therefore, PAPO should be considered a high-risk behavior and a potentially critical transition in substance use trajectories. This study cannot determine causality yet suggests a greater likelihood of additional high-risk behaviors in those that engage in PAPO. These findings highlight why PAPO should be as concerning as NON-ORAL use, as both are associated with underlying behavioral/mental health issues, polysubstance use, and associated high-risk behaviors.