The non-medical use of prescription opioids (POs) has become an area of increasing public health concern in the United States and rates of use are particularly high among young adults. In the past decade, an emerging "epidemic" of non-medical PO use has been reported.

Among young adults, self-reported use is 11% and overdose deaths involving POs now exceed deaths involving heroin and cocaine combined. Sexual violence is also a serious problem in the United States receiving increased national attention, and the relationship between substance use and sexual violence is well supported in the literature.

Despite the importance of these problems, there is a dearth of research on sexual violence within the context of drug use among young adult opioid users. Now, a mixed methods study explores young adult opioid users' experiences of sexual violence as it relates to their drug use.

Pedro Mateu-Gelabert, PhD, Principal Investigator at NDRI and affiliate of New York University's Center for Drug Use and HIV Research (CDUHR), sought to identify the potential role of drug use in increasing risk of sexual violence among young adult opioid users in New York City, and to identify the specific social and contextual factors surrounding this group's experiences of sexual violence.

"Participants reported experiencing frequent incidents of sexual violence as well as knowing many peers who had similar experiences. Many participants described negative sexual perceptions ascribed to opioid users and their own internalized stigma. They also reported exchanges of sex for drugs or money that increased their risk for sexual violence. We found that the drug-using context facilitated victimization of users who were unconscious or semi-conscious as a result of using drugs."

One hundred and sixty-four young adults (ages 18-29) who reported lifetime heroin and/or non-medical PO use completed structured assessments that inquired about their drug use and sexual behavior and included questions specific to sexual violence. The researchers noted a striking finding -- 41% of females and 11% of males reported being forced to have sex without their consent while they were using drugs. The research also found that there was a quid pro quo expectation surrounding sex and drug use.

In the structured interviews, 57% of participants reported having been in situations in which they felt that someone expected them to have sex because they were using drugs together. Forty-nine percent of males and 73% of females reported this happening 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," notes Lauren Jessell, LMSW, lead author of the paper. "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."

Participants were at increased risk for sexual victimization when these expectations were unmet and when those seeking sex did not receive the sexual favors from drug users they felt entitled to. These findings describe a social setting in which the use of opioids and other drugs is conducive to sexual violence.

Service providers and educators should address and challenge sexual coercion in the context of drug exchanges and the negative sexual characteristics assigned to drug users.