Identifying an individual’s reasons for “first-time” use of a substance is important for targeting prevention efforts. A recent study aimed to identify initiation paths for misuse of prescription opioids and distinguish them independently from reasons that might sustain misuse over time. Study participants included patients identified through community health programs in New York City that had misused prescription opioids within the past 6 months (n=19, age range of 20-47 years old). Through interviews during focus groups, the investigators identified three primary pathways that underlined first-time misuse of prescription opioids: recreational (initiated through peer use and drug experimentation, often as teens; n=6), medical (initiated through prescribed medical treatment, often as adults; n=4), and experienced (initiated following a history of opioid use, often heroin; n=10). Take Away: Although the sample size for this study was extremely low, recognizing the diverse pathways toward initiating prescription opioid misuse and how these pathways may influence prevention efforts remain valid. In addition, a correlation may exist between these pathways and age at initiation—suggesting prevention efforts that target teens may focus more on misperceptions related to safety and legality, while prevention efforts that target adults may focus on safe medication practices.