Heroin dependence: Consequences and precursors related to route of administration

Abstract

R. Heroin dependence: Consequences and precursors related to route of administration. Nord J Psychiatry 1999;53:153-158. Oslo. ISSN 0803-9488. Two random samples of Danish prisoners on remand (solitary confinement (SC) and non-SC)) were examined using semistructured and standardized psychiatric and social interviews, cognitive tests, and questionnaires. Heroin dependence was divided into injection heroin dependence (IHD) and smoke heroin dependence (SHD). Comparisons corrected for confounders were made with regard to IHD versus SHD and dependent versus non-dependent subjects. Thirty-two per cent of the sample had lifetime heroin dependence, and the IHD versus SHD ratio was 3:1. The IHD subjects were more severely strained than SHD with regard to somatic complications (blood-transferred infections), early social strain, psychiatric comorbidity (mood disorders), personality dimensions (introversion), and cognitive performance (low performance scale score). The IHD subjects were considered more vulnerable than SHD subjects, both premorbid and during the dependence. SHD subjects may be recruited from other groups than the traditional (that is, IHD) heroin-dependent ones. The social strain immediately before imprisonment was, however, on the same very high level in both groups of heroin dependence.

Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort)

“…Furthermore, risk behaviors related to non-injection forms of substance use (e.g., the sharing of cocaine or crack use paraphernalia) have been tentatively associated with possible HCV transmission [33][34][35] . As for mental health, Andersen et al [23] found a higher prevalence of psychiatric disorders in the injector group compared to non-injectors in a prisoner sample. Dinwiddie et al [30] reported higher rates of antisocial personality disorder -but no differences for mood disorders -for injectors in comparison to non-injectors in a sample of street drug users.…”

“…Heroin injectors tend to start drug use at an earlier age than non-injectors [12,23] , who typically indicate shorter duration of regular drug use [12,[14][15][16]24] . Injectors often indicate more intense patterns of drug use, as expressed through higher levels of dependence or higher frequency of use [14,[24][25][26][27] , and consequently higher drug expenditures [28] .…”

“…In terms of poly-drug use, heroin non-injectors have been described to be less likely to use cocaine or other stimulants [8,14,15] , although select studies have found a strong relationship between heroin smoking and oral crack use [29] . Injectors also typically report greater lifetime involvement in alcohol and other non-opioid drug use [23,28,30] .…”

“…Studies from several countries evidence that non-injection users are less likely to have been infected with HIV, Hepatitis B (HBV) or Hepatitis C (HCV) [7,15,16,23,28,31] . Noninjection users, however, are still at risk for transmission of HIV, HBV or HCV, especially those involved in sex work [32] .…”

“…For instance, Griffi ths et al [12] found that 75% of their heroin injector sample and only 37% of current non-injectors had been in contact with drug treatment programs. In a sample of opiate-dependent detoxifi cation inpatients, Andersen et al [23] reported that injectors were more likely to enroll in treatment programs after completion. Finally, evidence on drug users' experiences with the criminal justice system suggests that injectors commit more offences, presumably due to a greater need for acquisitive crime to cover the expense of more extensive drug use.…”