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Abstract: Background: Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity. Method: In-depth interviews (n =54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users. Results: Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study''s participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group. Conclusion: Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate. [Copyright &y& Elsevier]

Abstract: Background: In Australia, sterile needles are distributed to people who inject drugs through formal services for the purposes of limiting the transmission of blood borne viruses (BBV). Secondary exchange (SE) involves people acquiring needles from formal services and redistributing them to others. This paper describes the extent, patterns and contexts of SE in south east Sydney, Australia and examines whether SE is independently associated with BBV risk practices. Methods: Quantitative and qualitative data were collected through a cross-sectional study using surveys and in-depth interviews. Respondents were people using community-based pharmacies to obtain sterile needles and syringes. Results: Data were collected from 229 survey respondents, over half of whom (54%) reported SE in the previous month. Of these, 40% engaged in distribution only, 25% in receipt only and 36% in both. Respondents reported passing on 21.7% of their needles to others in the last month, most commonly to friends (51.6%) and partners (27.4%). Recipients of SE were four times more likely than non-secondary exchangers to report borrowing used syringes in the last month. Respondents reported supplying sterile equipment to others to prevent reuse and to reduce risks associated with unplanned drug use. Conclusion: SE is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons. Harm reduction programs could capitalise on the prevalence of SE to reach injecting drug users who do not use formal distribution services. [Copyright &y& Elsevier]

Abstract: Background: Ecstasy use has increasingly become popular among young adults, many of whom view it as a safe drug with no or limited negative social and health consequences. In this paper, we explore the perceptions of ecstasy users about its recreational use as well as regarding the normalisation of use. Methods: The study participants were recruited using targeted and theoretical sampling. To be eligible, they had to be between 18 and 25 years and have used ecstasy at least four times within the past 90 days. In-depth interviews were conducted with 112 individuals. Data analysis included the constant comparison method commonly used in modified grounded theory. Results: The study participants associated their recreational ecstasy use with control, shaping both the timing and setting of their use. In addition, they supported that easy access/availability and social accommodations of use contributed to their acceptance of ecstasy use as a normal part of life. Moreover, low risk perceptions of the social and health consequences of ecstasy used were identified as resulting in normalisation. Conclusion: The study findings reveal the importance of considering recreational ecstasy use from the perspective of the users themselves for prevention efforts and when providing social and health services, including intervention strategies. In addition, the potential normalisation of ecstasy use must be considered. [Copyright &y& Elsevier]

Abstract: Background: This paper explores user perceptions and practices in contrasting legal-policy milieux—Amsterdam (de facto decriminalization) and San Francisco (de jure criminalization) on four policy issues: sources of cannabis and separation of markets for it and other drugs; user perceptions of effects of price on consumption; effects of potency on consumption; and perceived risk of arrest and accessibility of cannabis. Methods: Questions on these issues were added to surveys on career use patterns amongst representative samples of experienced cannabis users using comparable methods. Results: Most San Francisco respondents obtained cannabis through friends who knew dealers, whereas most Amsterdam respondents obtained it from regulated shops. Only one in seven Amsterdam respondents but half the San Francisco respondents could obtain other drugs from their cannabis sources. Majorities under both systems had never found cannabis “too expensive.” Amsterdam respondents preferred milder cannabis whilst San Francisco respondents preferred stronger; majorities in both cities reported self-titrating with potent cannabis. Risk and fear of arrest were higher in San Francisco, but most in both cities perceived arrest as unlikely. Estimated search times were somewhat longer in San Francisco, but a majority reported being able to access it within half a day. Conclusions: There is substantial separation of markets in the Dutch system. Policies designed to increase cannabis prices appear unlikely to impact consumption. Decriminalization was associated with a preference for milder cannabis, but under both policy regimes most respondents self-titrated when using more potent strains. Criminalization was associated with somewhat higher risk and fear of arrest and somewhat longer search times, but these did not appear to significantly impede access for most respondents. [Copyright &y& Elsevier]

Abstract: Background: Femoral vein (or groin) injecting by street drug users is an emerging public health issue in the UK. It has been proposed that groin injecting is becoming normalised among UK injecting drug users (IDUs), yet harm reduction strategies are currently piecemeal and some may be crossing the boundary of responsible provision of information. This paper discusses the interventions available to service providers dealing with groin injecting and explores the utility of ethical frameworks for informing service provider decisions. Methods: Methods analysis of possible service provider responses using White and Popovits’ ethical decision-making framework. Results: The use of ethical frameworks suggest that different types of groin injectors should receive different interventions. Injectors for whom the groin is a site of ‘last resort’ should be given information about how to inject there less dangerously, whereas ‘convenience’ groin injectors should be actively encouraged to inject elsewhere. Conclusion: Groin injecting is a behaviour which represents a boundary for some harm reduction practices (such as providing ‘how to’ booklets to all injectors) as well as being an argument for more complex and environmentally appropriate harm reduction responses such as drug consumption rooms and training IDUs to maintain healthier injecting sites. [Copyright &y& Elsevier]

Abstract: Aims: Non-injecting heroin use (NIU) has been identified as a potential precursor for the transition to injecting drug use (IDU). This paper examines and compares heroin transition risks between two groups of Mexican American cannabis users (daily (DU) vs. non-daily (NDU)) who are NIUs. Methods: Data for this analysis are from structured interviews with 300 street-based recruited male and female NIUs in San Antonio, Texas using an adaptive sampling methodology. Three variables (being a former injector, daily heroin use, and being dependent on heroin) were used to create a summative scale measuring heroin transition risk and dichotomized into “no attributes” and “1–3 attributes”. Results: Initial univariate logistic regression analysis indicated an association between heroin transition risk and the cannabis user groups with three fourths of the NDU having transition risk attributes. In the multivariate model, three factors were found to be independently associated with heroin transition risk. Heroin transition risk was positively associated with having used heroin for a longer period of time. An inverse relationship was found with DU of cannabis and those reporting alcohol use in the past month being less likely to be associated with heroin transition risks. Conclusions: Findings tentatively indicate that DU of cannabis may be interpreted as a form of self-regulation and potentially deterring problematic heroin use among Mexican American NIUs and possibly other polydrug users in similar social environments. However, the authors discuss alternative interpretations of these findings. Nevertheless, findings may be used to inform specific policies and intervention strategies to prevent transitions to injecting and other harmful health consequences among NIUs. [Copyright &y& Elsevier]

Abstract: This paper investigates drug use, knowledge of hepatitis C, and risk minimisation amongst participants of the Sydney inner city dance party/club scene. The aim is to identify factors that contribute to the limited success of hepatitis C education and prevention efforts in Australia and to suggest ways in which they might be improved. The method used was a thematic analysis of 31 semi-structured qualitative interviews with people drawn from the Sydney inner city dance party/club scene. This is a scene where the consumption of recreational drugs is normalised, and where the practice of injecting takes place, albeit less commonly to other routes of administration. In the material presented here, drugs are seen as sources of enjoyment and experimentation, but are not seen as necessary to the functioning of daily life. Indeed, dependency on drugs is largely seen as undesirable. Most participants consider themselves to be both well informed about the drugs they use, and in control of their drug use. Whilst participants in this scene are generally well informed about drugs (and deploy harm reduction strategies to avoid such things as overdose), their knowledge of hepatitis C is limited and vague. The marginal and stigmatised status of injecting both inside and outside the scene appears to contribute to an absence of information and communication about safer injecting and hepatitis C within the scene. Often information about safe injecting is perceived to lack relevance to scene participants and to be aimed at ‘other’ injecting drug users (IDU). The material discussed confirms the diversity of IDU and the crossover between social, sexual and drug networks. Whilst this poses challenges for education and prevention, the exploration of these networks or scenes has the potential to inform the content of education and prevention materials as well as identifying contexts for dissemination. [Copyright &y& Elsevier]

Abstract: In recent years, controversial interventions such as ‘heroin-assisted treatment’ (HAT) and ‘supervised injection facilities’ (SIFs) have been established in attempts to minimise the high morbidity and mortality consequences of illicit drug use. This paper examines public opinion towards HAT and SIF using data from the 2003 Centre for Addiction and Mental Health (CAMH) Monitor, a representative population survey conducted among adults residing in Ontario, Canada. Data relating specifically to SIFs and HAT were isolated from the main database (n =885); agreement scores were collapsed to create a scale and analysed using independent sample t-tests and ANOVAs. Results revealed that 60 percent (n =530) of the sample agreed that SIFs should be made available to injection drug users, while 40 percent (n =355) disagreed. When asked about the provision of HAT, a similar pattern emerged. Variables significantly associated with positive opinions toward SIFs and HAT were: income; higher education; the use of cocaine or cannabis within the last 12 months; being in favour of cannabis decriminalisation; support of needle exchange in prison; view of illicit drug users as ill people; and agreement that drug users are in need of public support. Given the current political climate and the tentative position of SIFs and HAT in Canada, understanding the public''s opinion is crucial for the feasibility and long-term sustainability of these interventions. [Copyright &y& Elsevier]

Abstract: This paper examines the use of gamma-hydroxybutyrate (GHB) among a sample of gay men in New York City, who identify GHB as their most frequently used club drug. The sample was drawn from a larger longitudinal investigation of club drug using men. Thematic analysis yielded findings regarding perceived stigma for GHB use, tolerance of potential adverse side effects, and reasons for why some prefer this substance to other club drugs. Specifically, our findings suggest that GHB is viewed unfavorably in many social circles, that side effects are tolerated by frequent GHB users, and that the drug is chosen over other substances because the short duration of action, energy boost, sleep assistance, increase in libido, and limited after-effects. Examining the reasons why men use this substance will lead to the development of GHB specific prevention strategies, which accurately address the consequences of use as well as the motivations that individuals possess for using the substance. [Copyright &y& Elsevier]

Abstract: While policy makers in the Republic of Ireland had been concerned with illicit drug use since the late-1960s, it was only from 1980 onwards that the emergence of a culture of intravenous heroin use in areas of generalised social deprivation in Dublin gave urgency to this policy process. This paper traces the gradual introduction, on public health grounds, of harm reduction practices and services – such as methadone maintenance, needle exchange and the creation of outreach and locally-based services – following the identification in the mid-1980s of needle-sharing amongst injecting drug users as one of the key routes for the transmission of HIV in this country. It is argued that harm reduction in the Republic of Ireland has been largely implicit, in the sense that political leaders have generally not encouraged or participated in explicit public debate on this topic, nor have they ever publicly announced that this concept now underpins much of the healthcare system''s responses to illicit drug use. It is also argued that this covert style of policy making has persisted, despite the more recent proliferation of formal policy-making structures and the dominance of a rhetoric which emphasises strategic management and the allegedly transparent and evidence-based nature of drug policy. This tactic of shrouding drug policy in ambiguity is discussed in the context of the wider tendency within Irish political culture to manage sensitive and potentially divisive social issues in such a manner. It is concluded that the ambiguity which surrounds harm reduction in Ireland has been functional in that it has confused and frustrated ideological opponents of this concept, but dysfunctional in that it has not facilitated the emergence of more tolerant or respectful attitudes towards drug users and may have delayed the introduction of a wider range of harm reduction practices. [Copyright &y& Elsevier]

Abstract: This paper examines the drug-related decisions of a previously under researched group of children; those in their pre-teen and early teenage years. Based on a prospective study of 92 ‘at risk’ children, it explores the reasons which they gave for their use or non-use of illegal drugs. The accounts of those who used drugs on a regular or occasional basis are strongly supportive of the importance of personal choice, emphasising the role of enjoyment and boredom as the main motivating factors. The reasons given for not using drugs included a lack of interest in the activity, fear of the effects of the drug and a concern that drug taking would compromise other valued activities or pursuits. The anticipated reaction of parents, and the extent to which they had internalised parental values on drugs, also appeared to act as an important restraint for some of the children. While there is a vital role for drug education in seeking to influence children''s drug-related decisions, the study''s conclusions also emphasise the significance of parents in this regard. The fact that the overwhelming majority of the children reported using drugs because they enjoyed them or because they were bored also suggests that the provision of alternative activities should be central to any preventive strategy. [Copyright &y& Elsevier]

Abstract: Open street drug markets in the western industrialized world often create fear and outrage in the community. Many arguments posited by resident groups and local businesses against the introduction of harm reduction initiatives, such as fixed site needle and syringe programmes (NSP) and supervised injecting facilities (SIF), are based on the fear that such facilities will attract street drug markets. In this paper, we explore the fear produced in a city''s encounter with street heroin use. Through linking a Deleuzian ontology to spatial practices associated with the street drug market, we provide a deeper understanding of the fear of public drug use. After examining how fear is produced, we then connect fear with the flows of capital in street drug markets and to the political and economic outcomes from such encounters. [Copyright &y& Elsevier]

Background: In January 2003, the Canadian federal government announced its support of the scientific evaluation of safer injecting facilities (SIFs) in Canada. As emerging evidence from Europe and Australia has demonstrated that SIFs contribute significantly to reductions in the injection of drugs in public areas, the objective of this paper is to examine the nature of public injecting in Ottawa and its implications for a prospective SIF in the city. Methods: Between October 2002 and January 2003, street-recruited active IDUs consented to personal interviews. Multiple logistic regression was used to determine factors related to public injecting. Content analysis was undertaken of responses to an open-ended question regarding reasons for injecting in public locations. Findings: Overall, 65% of 506 participants reported injecting in any public place in the previous six months. Homelessness was the strongest predictor of public injecting (adjusted odds ratio: 6.6, 95% confidence interval (CI): 3.8–11.6). IDUs injecting in public locations were also significantly more likely to be males; to have initiated drug injecting at younger ages; to score higher on a severity of addiction scale; and to report sharing used needles, injecting most often with any opiate other than morphine, injecting with five or more different people in the previous six months, and trading sex with male clients. Receiving most income from welfare was protective. IDUs who injected predominantly in public places were in chronic need of a location offering privacy and safety, whereas casual public injectors tended to report injecting in public only when in immediate need of a drug fix. Conclusions: These findings suggest that the implementation of a SIF could help alleviate harms related to public injecting among IDUs in Ottawa by the provision of a clean, private, and safe place to inject, with access to sterile injection equipment and housing and addiction services. [Copyright &y& Elsevier]

In drug treatment courts, denial is a pervasive issue in both the legal procedures of the court and in drug treatment itself. This paper explores the meaning of denial for youth and programme staff in a juvenile drug court (JDC) located in a metropolitan jurisdiction in the U.S. Midwest. Thirty-seven interviews were conducted with juveniles attending the JDC, a judge, defender, prosecutor, probation officers, and treatment counsellors. These interviews raised several issues regarding the use of denial in treatment. For staff, the meaning of denial came to encompass the ambivalence and resistance of non-addicted youths toward the programme and its staff. The primary source for the youths’ resistance was based in conflict with staff over definitions of drug abuse and responsible or moderate drug use. The implications of these phenomena are briefly considered in light of insights from the harm reduction perspective. [Copyright &y& Elsevier]

Although needle and syringe programmes in Western nations are superficially similar, they are a response to and reflection of the time, place and circumstances of their conception and evolution and therefore distinctively different from each other. A Needle and Syringe Exchange Programme (NSEP) was established in New Zealand in the late 1980s, shortly after the implementation of needle and syringe programmes in some Australian states. New Zealand’s NSEP is unusual in several key respects, notably the fact that drug user groups operate peer-based needle exchanges under contract to the government, and its principle of full cost recovery for needle and syringe provision. This paper seeks to describe the context in which needle and syringe exchange was established in New Zealand and explain how it has affected the programme’s evolution. [Copyright &y& Elsevier]

The recreational/dependent drug use dichotomy has very quickly become the established wisdom within drugs literature. The paper uses the concept of ‘drug career’ to demonstrate that this bipolar distinction is problematic. The research it reports suggests that, alongside ‘recreational drug use’ and ‘dependent drug use’, a third form or ‘episode’ of drug use can be observed: what we call here ‘persistent drug use’. Following this exploration of drug careers, the article examines the interaction between drug use and crime. It is purported that a simple unilateral causal explanation is overly simplistic as the relationship is not consistent throughout the career of a drug user and through the qualitative exploration of drug careers the nuances of this relationship are identified. It is therefore suggested that both classifications of drugs and the relationship between drug use and crime are products of local social contexts and environments. [Copyright &y& Elsevier]

International bodies including the United Nations, the World Health Organisation and the European Monitoring Centre for Drugs and Drug Addiction have highlighted the increasing problem of opiate use and have recommended the truncated Poisson methods and capture–recapture methods, with more than two data sources, for prevalence estimation. This recommendation is difficult to implement however in regions where data sources are limited. The truncated Poisson method, which requires a single data source, is less publicised but is also endorsed by the EMCDDA. Within this paper, we implement both of these methods in Western Australia for the first time. We provide the first multi-source enumeration of opiate prevalence for this region, and in addition develop the two methods for use with in-patient hospital data and police records. We found from the multi-source enumeration that a total of 2826 unique individuals were identified as opiate users in the 2-year study period. In addition, using unstratified capture–recapture models we estimated that the population of hidden opiate users was 17,233 (95% CI of 8960–35,055) during the same period. This gives us a total 2-year prevalence estimate of 20,059 opiate users in Western Australia in the period from the 1st July 1996 to 30th June 1998. This corresponds to an estimated prevalence rate of approximately 18 per 1000 of the population aged between 14 and 55. The need for these methods in the coming decade will increase as we see expansion of the European Union and the increased reporting of drug use in developing and emerging nations. [Copyright &y& Elsevier]

Across Europe, but especially in the UK, a large youthful ‘going out’ sector is being identified which prioritises ‘psycho-active’ weekends in which tobacco use, heavy drinking, recreational drug use and substance mixing play a key role. Based on an on-going longitudinal cohort study of a thousand young Britons followed from 13 to 18 years of age, this paper describes the onset and development of these ‘recreational’ multi-substance careers using repeat survey and interview data. At 18 years a third of the cohort were long term smokers. Almost three-quarters (74%) were regular drinkers of which one-third drank more than twice recommended levels. Over half (54%) had tried an illicit drug by 18 years of age with 41% being drug active (past year). Most drug experiences were rated positively but respondents disclosed a range of worries and negative outcomes including out of character behaviour, being sick, feeling paranoid, spending too much money on substances, getting into dangerous situations, etc. Formal sources of information about drugs were little trusted and consequently young substance users relied on informal and incomplete drugs ‘stories’ from peers. A harm reduction-public health agenda to meet the needs of this sector is described. [Copyright &y& Elsevier]

Much research (mostly from general population surveys) suggests that people typically use alcohol, tobacco and then marijuana, so called ‘gateway drugs’, prior to any potential use of ‘hard drugs’ like cocaine powder, crack and heroin. Other research (mostly with surveys of special populations) indicates that hard-drug use is associated with numerous social problems such as crime, routine violence, and lower productivity. A muddled interpretation of these separate findings has been widely misused in support of the US drug abuse prevention policies to suggest that gateway drugs cause hard-drug use and its associated problems. This paper superimposes secondary analyses of data from the National Household Survey on Drug Abuse (NHSDA) and the Arrestee Drug Abuse Monitoring (ADAM) program. The findings indicate that (1) extremely few members of the general population become persistent daily hard-drug-using criminal offenders; and (2) an increasing percentage of daily hard-drug-using criminal offenders did not follow the gateway sequence of substance use progression. These results strongly suggest that the use of gateway drugs by youths is not the central cause of hard-drug use and its associated problems. Thus, fighting the use of gateway drugs by youths may not be a particularly appropriate approach to drug abuse prevention. [Copyright &y& Elsevier]

Grounded in intersubjective participatory action research, the people and dancefloors project has sought to produce a space for the co-creation of knowledge about dancefloors and drug taking, building a platform for developing insights from the positionality of current drug users. Through film, it provides hermeneutic insight while legitimising their voices. In this paper, we share some reflections as researchers/users/activists arising from our involvement in the project. To begin with, we reflect on the motivations for the project, and the epistemic suppositions that animated it. This is followed by conversational style interviews where we re-evaluate our position in light of the project, with a particular focus on the tensions that drug use introduces between professional, personal and political domains in our lives. These reflections are useful to people who use drugs and hold privilege by nature of their social and cultural position. While questioning the silencing of personal experiences in relation to drug use, we also react to some of the traditional tendencies of academia, including institutionalised individualism, which isolates researchers and discourages them from finding political collectivity, and the subjectivist/objectivist dichotomy, which supports a tendency to objectify research participants while removing the self from the equation. Despite the challenges that arise from disentangling our multiple experiences and identities, our intersubjective dialogue inspires deeper learning about ourselves and each other, encouraging us towards a more openly political stance. [ABSTRACT FROM AUTHOR]

Hospitals are a critical touchpoint for people who use drugs (PWUD). However, hospital policies, both formal and informal, can have a detrimental impact on PWUD in acute care settings. Introducing new policies, or revising existing policies that inadvertently harm or stigmatize PWUD while hospitalized, could be an effective harm reduction intervention for this high-risk population. This paper explores seven areas where institutional policy change could improve the hospital experience of PWUD: (1) use of nonprescribed substances in hospital, (2) supporting inpatient addiction consultation services (3) in-hospital supervised consumption spaces (4) supply and distribution of safe drug use equipment and naloxone, (5) role of security services and personal searches, (6) use of hospital restrictions, and (7) involvement of PWUD in policy development. [ABSTRACT FROM AUTHOR]

This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities. [ABSTRACT FROM AUTHOR]

Dublin appears to have performed very well as compared to various scenarios for COVID-19 mortality amongst homeless and drug using populations. The experience, if borne out by further research, provides important lessons for policy discussions on the pandemic, as well as broader lessons about pragmatic responses to these key client groups irrespective of COVID-19. The overarching lesson seems that when government policy is well coordinated and underpinned by a science-driven and fundamentally pragmatic approach, morbidity and mortality can be reduced. Within this, the importance of strategic clarity and delivery, housing, lowered thresholds to methadone provision, Benzodiazepine (BZD) provision and Naloxone availability were key determinants of policy success. Further, this paper argues that the rapid collapse in policy barriers to these interventions that COVID-19 produced should be secured and protected while further research is conducted. [ABSTRACT FROM AUTHOR]

Background: In August 2010, extended-release OxyContin® products, including oxycodone 80 mg, were reformulated and released as abuse-deterrent medications. This paper describes changes in individual prescription filling patterns that followed the reformulation of oxycodone 80 mg.Methods: Using New York State prescription monitoring program data, we conducted a retrospective analysis of a cohort of New York City residents who had filled at least three consecutive prescriptions for oxycodone 80 mg immediately prior to the reformulation. We classified cohort members into one of three groups (continuers, switchers, and discontinuers) based on prescription filling patterns post-reformulation. Descriptive analyses were conducted to identify prevalence of filling patterns. Differences in median morphine milligram equivalents (MME) pre- and post-reformulation were compared using the Wilcoxon signed-rank sum test. Analyses were completed in 2018.Results: A cohort of 4,098 New York City residents filled continuous prescriptions for oxycodone 80 mg immediately prior to reformulation. Post-reformulation, 14% of the cohort discontinued filling opioid analgesic prescriptions; 46% continued to fill prescriptions for oxycodone 80 mg; and 40% switched to a different opioid analgesic, most commonly oxycodone 30 mg. Post-reformulation, the median MME dose decreased significantly among all three groups: 45 mg among continuers, 150 mg among switchers, and 360 mg among discontinuers.Conclusion: Post-reformulation, more than half the cohort changed their filling patterns. Following reformulation, median MME dose decreased significantly among the cohort. We hypothesize that the dramatic decrease in MME dose prompted many to transition to heroin in order to avoid severe withdrawal. [ABSTRACT FROM AUTHOR]