Circumstances of first injection and factors driving or deterring injection initiation among males with opioid use disorder

Background: Opioid use through injection drug use is associated with a significant global health burden. In most patients, injection drug use is initiated after a transition period of 1–5 years. Aim: To assess the circumstances involving the first injection of drugs and the reasons for transitioning to injection drug use among injection drug users with opioid use disorder. Materials and Methods: One hundred males seeking treatment for opioid use disorders at a tertiary care drug dependence treatment center in North India were recruited through purposive sampling, comprising 50 injection drug users (IDU) and 50 noninjecting opioid users (NIOU). A semistructured proforma was used to obtain information about the circumstances of first injection and reasons for transition to injection drug use among IDU ( n = 50). Reasons preventing this transition among the NIOUs ( n = 50) were also assessed. Results: Mean duration of transition was 4.4 years. For the majority of participants, the first injection was spontaneous (64%) and involved suggestion (74%) and administration (90%) by someone else. Heroin was the most common drug (58%), and public places were the most common locations (28%). Peer/partner influence was the most common reason for transition (66%), followed by easy availability (60%) and environmental influence (44%). Among NIOU, fear of health consequences (86%), fear of blood/needle (58%), and environmental influence (20%) were the most common reasons deterring transition. Conclusions: This cross-sectional study found that the initiation of injection drug use is often a nonspontaneous event, with the idea coming from someone else.