Sex for Opioids: A Hidden Epidemic

Young adult opioid users are often the victims of sexual violence, according to results of a survey of opioid users in New York City.

Among 164 men and women aged 18 to 29 years reporting heroin and/or nonmedical prescription opioid use, 41% of women and 11% of men reported being forced to have sex without their consent while they were using the drugs.

"Our results are alarming," lead author Lauren Jessell, LMSW, of the National Development and Research Institutes (NDRI) in New York City, told Medscape Medical News. "In our qualitative interviews with our participants, we were taken aback by how often we discovered they were involved in sexual violence."

The study by Pedro Mateu-Gelabert, PhD, principal investigator at NDRI and affiliate of New York University's Center for Drug Use and HIV Research (CDUHR), and colleagues was published online August 3 in the Journal of Interpersonal Violence.

Quid Pro Quo

"Our findings describe a social setting in which opioids and other drugs are used that is conducive to sexual violence," they write. "The internalization of stigma associated with drug use and the negative sexual perceptions held about users contribute to a drug using culture with few social consequences for perpetrators of sexual violence and little support for those who are victimized."

The survey also revealed a quid pro quo expectation surrounding sex and drug use, with opioid users reporting that they have been in situations where they felt that someone expected them to have sex because they were using drugs together; 73% of women and 49% of men said this happened to them at least once.

"When drugs were provided free of cost to potential partners, there was an expectation that those receiving the drugs would provide sexual favors in return," Jessell notes in a news release. "Many users described fulfilling these implicit quid pro quo expectations with mostly men who have sex with men (MSM) and female users providing sexual favors to males who provided them with drugs."

In addition to implicit and explicit exchanges of sex for drugs, opioid users also described being sexually assaulted and seeing others unconscious as a result of drug users being sexually abused.

"Opioid users were at risk for sexual coercion, harassment, and/or assault if they did not fulfill the expectation that sex would occur in these situations," the researchers write.


"I think these findings really speak to the need for support and awareness about the issue of sexual violence among drug users. People who are using drugs at the time of an incident may be fearful of reporting it or receiving support," Jessell told Medscape Medical News.

The researchers note that the survey was conducted among New York City opioid users; it is possible that experiences of sexual violence in the context of opioid use may differ for young opioid users in more rural or less populated parts of the United States.

Sex for Drugs Not New

Commenting on the study for Medscape Medical News, Amanda Divin, PhD, assistant professor, Department of Health Sciences, Western Illinois University, in Macomb, noted that the participant eligibility requirements were "quite stringent." They had to be current users. "This gave the study's findings strength."

The fact that most of the participants reported that prescription opioid use preceded heroin use "lends support to prescription opioids being a gateway drug for harder drug use," added Dr Divin, who was not involved in the study.

"This whole idea of drug users trading sex for drugs is not a new phenomenon. In many ways, the increase in heroin use seen right now is similar to the rise and epidemic of crack use in the 1980s and 1990s, in that there is a lot of trading sex for drugs, high societal stigma, and potentially an increase in HIV/AIDS due to unsafe needle and sex practices," Dr Divin noted.

"Prescription opioid use, however, has historically been perceived as 'safe' and more socially acceptable, especially among young adults, than illicit drug use. Thus, the stigma perceived by prescription opioid users in this study may reflect a shift in social acceptance of prescription medication abuse," Dr Divin told Medscape Medical News.

She said that overall, the survey "reinforces the importance of drug prevention programs at younger and younger ages, as well as integrating risk reduction strategies and violence prevention, into such educational programs."

The study was funded by the National Institute on Drug Abuse. The authors and Dr Divin report no relevant financial relationships.

J Interpers Violence. Published online August 3, 2015. Abstract