Reasons for initiating and continuing drug use: findings from qualitative interviews with opioid overdose survivors

Abstract

Background: Opioid overdose deaths continue to rise in Boston, MA (Massachusetts Department of Public Health, 2021). Understanding reasons why people start and continue using opioids can help inform prevention and treatment strategies.

Methods: We conducted a qualitative research study that included surveys and interviews with Boston residents who had survived an opioid overdose. Interviews happened between January and September 2021, were conducted between 3 weeks and 3 months after their most recent overdose, and explored participants’ drug use history and perspectives on substance use and treatment. The Framework Method was used as the analysis approach.

Results: Most (74.1%) of our 59 participants reported starting to use opioids as teens (aged 15-17) or young adults (aged 18-29). Almost all reported recent polysubstance use, mostly involving opioids and stimulants, and many described heroin and/or fentanyl as causing problems in their lives. Overdose survivors described the circumstances when they started using opioids, with common reasons for initiation including exposure to drug use through friends/family, coping with stress or mental health issues, experiencing traumatic events, and dealing with a physical injury or pain. Participants shared their motivations for continued drug use, with some relating it to coping with ongoing trauma and stress, and others attributing it to their addiction severity.

Conclusion: Among overdose survivors in Boston, trauma and mental health concerns were common reasons for initiating and continuing opioid use, despite recognizing its negative consequences. These results suggest that trauma-informed approaches, structures to foster prosocial relationships, and mental health supports should be incorporated into prevention and treatment strategies.

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