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The natural history of prescription opioid abuse: A pilot study exploring change in routes of administration and motivation for changes

Stacey McCaffrey, PhD, Kelly A. Manser, BA, Kimberlee J. Trudeau, PhD, Gwendolyn Niebler, DO, Colville Brown, MD, Donna Zarycranski, MS, Simon H Budman, PhD


Objective: The purpose of this retrospective, observational pilot study was to explore change in route of administration (RoA) and motivation for changing RoA during the course of opioid abuse.

Design: This retrospective pilot study involved collecting and analyzing semistructured interview data.

Setting: Interviews were conducted with patients undergoing outpatient substance abuse treatment at a buprenorphine clinic.

Participants: Twenty adult patients (50 percent male) participated in the interviews.

Main outcome measures: Interview data were qualitatively and quantitatively analyzed to evaluate trends and motivations for changing RoA.

Results: In this sample, RoA varied over time. Most patients (75.0 percent) began abusing prescription opioids by swallowing intact pills, and 53.3 percent of patients eventually progressed to chewing. All patients who initiated abuse through chewing or insufflation (ie, intranasal use) progressed to injection. However, several patients (20.0 percent) did not exhibit a linear progression from RoAs with lesser to greater risk for serious adverse events. Of the eight motivations for changing RoA identified in the current study, the most frequently cited (38.2 percent) motivation was to achieve a desired effect (eg, euphoria).

Conclusions: This pilot study is one of the first to investigate natural history of RoA in prescription opioid abuse and motivations for changing RoA. Results suggest that a defined pathway of RoA progression may not exist, and that achieving a desired effect is a common motivation for changing RoA. Although these findings need to be replicated in a larger sample, this research may help support the development of opioid risk mitigation strategies.


opioid abuse, intravenous injection, insufflation, route of administration, motivation, substance abuse, opioids

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