Understanding HIV Risks and Drug Use Trajectories Among Women Opioid Users in Specialized Drug Court

UB Principal Investigator: Sarahmona Przybyla, PhD, MPH

Co-Principal Investigator: Diane Morse, MD (University of Rochester)

Funding Agency: University of Rochester Center for AIDS Research

Period: 7/2018 – 4/2019

Abstract: Opioid-related deaths are increasing rapidly across the United States. Between 1990 to 2016, opioid use disorders jumped from the 11th to the 7th leading cause of disability-adjusted life-years (DALYs), representing a 74.5% change. Coinciding with increases in prescription opioids for pain as a precursor to heroin use, of people entering treatment for heroin addiction treatment in the 1960s, more than 80% began with heroin compared with those entering treatment in the 2000s, of whom 75% reported starting with a prescription opioid. Women also dramatically increased their use of opioids during this time period: in the 1960’s 82% of those seeking treatment were men but by the 2010 there was near equal representation of women. There is little information on specific driving forces and trajectories for women’s increasing pain medication to heroin use. There is also limited understanding of their related paths to recovery, co-morbid HIV risk behaviors and treatment, and reproductive health. This study aims to shed light on these poorly understood and critically important questions as part of a concerted strategy to improve SUD outcomes and decrease HIV infections. Coinciding with women’s growing representation in opioid use disorders is their increasing presence in the justice system, risks of HIV/AIDS, and childhood and adult gender-based trauma which have been termed “syndemic risks.” Ways of addressing the SUD and incarceration components of these co-occurring risks for women and men across North America include Drug Treatment Court (DTC). The rapid rise in opioid-related deaths has spurred action; recently, a Buffalo, NY judge and staff started a rapid response opioid track in their DTC. Additionally, increased medical risks including HIV/AIDS among female participants in particular have spurred recommendations for and action taken in medical-legal partnerships. Given the needs of women in DTC and the lack of knowledge regarding women with opioid use disorder who progressed to heroin from prescription pills, this court represents a unique opportunity to combine the complementary expertise of University of Rochester, University at Buffalo, and Columbia University co-investigators. Specifically the research team will conduct and qualitatively analyze semi-structured interviews regarding the lived experience of female opioid track DTC participants with regard to addressing the trajectory of substance use and recovery, HIV-related medication use, and reproductive health behaviors. These results will inform both medical and justice systems about the SUD, medical, and trauma-related needs of women with opioid use disorders.