By Tasha Perdue a, Robert Carlson b, Raminta Daniulaityte c, Sydney M. Silverstein b, Ricky N. Bluthenthal d, Avelardo Valdez e, Alice Cepeda

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. 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.

Social Science & Medicine Volume 340. January 2024, 11pg