Drug and sexual HIV-risk behaviors among adolescents and young adults with opioid use disorder

Opioid use disorder (OUD) among adolescents and young adults (youth) is associated with drug use and sexual HIV-related risk behaviors and opioid overdose. This mixed methods analysis assesses risk behaviors among a sample of 15–21-year-olds (N = 288) who were being treated for OUD in a residential drug treatment program in Baltimore, Maryland. Participants were enrolled in a parent study in which they received either extended-release naltrexone (XR-NTX) or Treatment as Usual (TAU), consisting of outpatient counseling with or without buprenorphine, prior to discharge. At baseline, participants were administered the HIV-Risk Assessment Battery (RAB), and clinical intake records were reviewed to determine participants' history of sexual, physical, or other abuse, as well as parental and partner substance use. A sub-sample of study participants completed semi-structured qualitative interviews (N = 35) at baseline, three-, and six-month follow-up periods. This analysis identified gender (e.g., female IRR = 1.63, CI 1.10–2.42, p =.014), the experience of dependence (e.g., previous detoxification IRR = 1.08, CI 1.01–1.15, p =.033) and withdrawal (e.g., severe withdrawal symptoms IRR = 1.41, CI 1.08–1.84, p =.012), and the role of relationships (e.g., using with partner IRR = 2.45, CI 1.15–5.22, p =.021) as influencing high-risk substance use behaviors. Similarly, high-risk sex was influenced by gender (e.g., female IRR = 1.43, CI 1.28–1.59, p <.001), and the role of relationships (e.g., using with partner IRR = 0.78, CI 0.62–0.98, p =.036). These are key targets for future prevention, treatment, and intervention.