Injecting Pills in the Late Fentanyl Era: A Qualitative Investigation of the Procedures Used to Prepare and Inject Prescription Opioids

BACKGROUND: The current study offers updated information on how PWID prepare and inject prescription and illicit drugs. The main objective was to identify potential pathways and reservoirs of infection associated with the tools and techniques used to inject prescription opioids. METHODS: We conducted 57 interviews with people who inject prescription opioids. Participants were recruited from two syringe-services programs in North Carolina. Eligibility included >18 years, fluent in English, able to provide informed consent and having injected POs during the past 3 months. RESULTS: All participants injected POs in the past 90 days, with a majority (n = 40, 70%) injecting them with illicit drugs (e.g., methamphetamine). Nearly everyone preferred prescription over illicit opioids. Many participants reported injecting the entire pill solution in a single injection episode, but most administered multiple injections per each injection episode (MIPIE). DISCUSSION: The techniques and tools used to prepare and inject POs in NC are practically identical to those responsible for the HIV cluster outbreak in Scott County, IN. This finding raises concern that people who inject POs remain at higher risk for HIV and HCV infection than people who only inject illicitly made opioids.