Prevalence and correlates of prescription opioid residue injection

Drug Alcohol Depend. 2016 Sep 1;166:69-74. doi: 10.1016/j.drugalcdep.2016.06.025. Epub 2016 Jun 29.


Background: There is growing evidence of intravenous administration of prescription opioids (POs) in several countries. Preparation of POs for injection may leave residues in containers and filters used by people who inject drugs and may lead to adverse health outcomes if they are injected.

Methods: This exploratory study used cross-sectional data from the COSMO study, a prospective cohort of out-of-treatment cocaine users carried out in Montréal (Canada) between October 2010 and August 2015. For this analysis, only one visit per participant was selected, that is, the first time the participant reported PO injection during the study. The outcome of interest, "injection of PO residues", was defined as having injected PO residues from a filter and/or a container in the last month. Correlates of this outcome were identified using logistic regression analyses.

Results: Of the 122 participants who reported PO injection during the study period, 41.8% had injected PO residues. Reporting an unstable source of income (AOR=4.26; 95% CI: 1.03-17.69), a recent overdose (AOR=5.45; 95% CI: 1.50-19.88) and a preponderant use of opiates (mostly opiate use versus other drugs excluding alcohol and cannabis) (AOR=2.46; 95% CI: 1.08-5.63) increased the risk of PO residue injection. The odds of reporting PO residue injection rose by 7% per unit increase in the score of psychological distress (AOR=1.07 per unit increase; 95% CI: 1.01-1.12).

Conclusions: The findings of this study suggest that PO residue injection is associated with markers of vulnerability. Further investigation is needed in order to better understand this understudied drug injection practice.

Keywords: Drug residue injection; Injection drug use; Injection risk behaviors; Prescription opioids.

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / analysis
  • Canada / epidemiology
  • Cohort Studies
  • Cross-Sectional Studies
  • Drug Overdose / diagnosis
  • Drug Overdose / epidemiology
  • Drug Overdose / prevention & control
  • Female
  • Humans
  • Injections / adverse effects
  • Male
  • Middle Aged
  • Needle Sharing
  • Prescription Drug Misuse / prevention & control*
  • Prevalence
  • Prospective Studies
  • Substance Abuse, Intravenous / diagnosis
  • Substance Abuse, Intravenous / epidemiology*
  • Substance Abuse, Intravenous / prevention & control*
  • Syringes / adverse effects


  • Analgesics, Opioid

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