The transition from injection to non‐injection drug use: long‐term outcomes among heroin and cocaine users in New York City

Jarlais, Don C. Des; Arasteh, Kamyar; Perlis, Theresa; Hagan, Holly; Heckathorn, Douglas D.; McKnight, Courtney; Bramson, Heidi; Friedman, Samuel R.

doi:10.1111/j.1360-0443.2007.01764.x

Cited by 59 publications

(65 citation statements)

References 31 publications

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“…However, in another prospective study conducted in Iran, the switching from IDU to NIDU was reported to be more prevalent than the other way around (31). At least three studies from United States (New York), the Netherlands (Amsterdam), and India (Chennai) have corroborated the possibility of reverse transition, as well (13,(33)(34)(35).…”

Section: Discussionmentioning

confidence: 90%

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Transition to and Away from Injecting Drug Use among Young Drug Users in Tehran, Iran: A Qualitative Study

Rahimi-Movaghar

Noroozi

Page

et al. 2016

Iran J Psychiatry Behav Sci

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Background: Iran has a large population of non-injection opioid users potentially at risk of initiation of drug injection. Objective: We implemented a qualitative study to characterize the factors facilitating transition from non-injection drug use (NIDU) to injection drug use (IDU) and vice versa. Materials and Methods:We conducted 42 in-depth interviews among purposefully selected groups of injecting and non-injecting drug users and health workers, in 2011 in Tehran, Iran. The interviews were audio-recorded, transcribed and coded using OpenCode 3.6 software. Results: The predominant factor for transition from NIDU to IDU was a high level of drug dependence. IDU decreased the cost associated with drug use by several fold in the short-term. The influence of other injectors, either by learning directly from, encouraged by, feeling coerced by, or identifying with a lifestyle was also mentioned as a causal factor in the transition to IDU. Pleasure-seeking or desire to experience an immediate rush were rarely reported; rather, themes of the need to maintain functionality, reduce pain, and overcome financial difficulties emerged. Vein damage and other IDU-related physical health problems, as well as pressure from family were reasons for reverse transition (IDU to NIDU). Conclusions: New harm reduction approaches could focus on blocking the transition from NIDU to injection and promoting the return to less harmful routes of administration.

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Section: Discussionmentioning

confidence: 90%

“…Therefore, the window of opportunity to intervene after someone starts injecting drugs is short (12). Preventing initiation of injection and promoting the transition from injecting to non-injecting drug use can therefore be considered primary methods for preventing multiple infectious diseases and other health problems (13,14).…”

Section: Introductionmentioning

confidence: 99%

Transition to and Away from Injecting Drug Use among Young Drug Users in Tehran, Iran: A Qualitative Study

Rahimi-Movaghar

Noroozi

Page

et al. 2016

Iran J Psychiatry Behav Sci

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“…31 Research indicates that sexual transmission is surpassing injection transmission as the means of transmission among NYC IDUs; a 2009 study by Des Jarlais et al found that female, black, and younger ( < 40 years of age) IDUs were disproportionately infected with herpes simplex type 2. 32 A study of drug use in NYC, found that for those who had transitioned from injection to non-injection drug use, the duration of abstinence from injection was approximately 10 years; 33 likewise, the time since last injection for all those who reported ever injecting drugs in the current study was a median of 12 years (IQR: 3, 23), indicating a greater potential for heterosexual transmission. Moreover, former injection drug users may be less likely than their current injector counterparts to be targeted by public health programs, which encourage regular testing for HIV infection.…”

Section: Discussionmentioning

confidence: 99%

High HIV Prevalence Among Low-Income, Black Women in New York City with Self-Reported HIV Negative and Unknown Status

Reilly

Neaigus

Jenness

et al. 2013

Journal of Women's Health

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Background: Black women are disproportionally affected by human immunodeficiency virus (HIV). This study investigates factors associated with newly identified HIV infection among previously self-reported HIV negative or unknown status black women living in high risk areas (HRAs) of New York City (NYC). Methods: Heterosexuals residing in or socially connected to NYC HRAs were recruited using respondent driven sampling for participation in the United States Centers for Disease Control-sponsored National HIV Behavioral Surveillance System in 2010. Eligible individuals were interviewed and offered an HIV test. The analysis reported here focused on black women with valid HIV results who did not report being HIV positive, and examined factors related to HIV infection in this group. Results: Of 153 black women who did not report being HIV positive at enrollment, 15 (9.8%) tested HIV positive. Age ‡ 40 years, ever injected drugs, and in the last 12 months had unprotected vaginal sex, exchange sex, last sex partner used crack, non-injection crack use, and non-injection heroin use were significantly associated with HIV infection ( p < 0.05). Only ever injected drugs (prevalence ratio: 5.1; 95% confidence interval: 2.0, 12.9) was retained in the final model. Conclusions: Black women who had reported being either HIV negative or unaware of their serostatus had high HIV prevalence. Efforts to identify and treat HIV positive black women in HRAs should target those with a history of injection drug use. Frequent testing for HIV should be promoted in HRAs.

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“…In Vancouver, willingness to use an inhalation room was associated independently with working in the sex trade, sharing crack pipes, having crack pipes confiscated by police, smoking crack in public places and having burns from hurried drug consumption [9]. As many cities are witnessing decreasing numbers of drug injectors but increasing numbers of people who smoke/snort drugs [18], SIRs warrant a close second look.A powerful case can be made in support of SIRs based upon the personal experience of one of the authors of this commentary (J.R.N. ), who helped to coordinate a drug consumption facility in the city of Bilbao, in Spain's Basque region.…”

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confidence: 99%

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confidence: 99%

Commentary on Salmon et al. (2010): The case for safer inhalation facilities—waiting to inhale

Strathdee¹,

Navarro²

2010

Addiction

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Commentary on Salmon et al. (2010):The case for safer inhalation facilities-waiting to inhalea dd_2917 684..685 In recent years, a flurry of scholarly reports have demonstrated the effectiveness of supervised injection facilities (SIFs) as a strategy to reduce physical and social harms associated with injection drug use. Empirical data on SIFs lagged well behind their scale-up, but SIFs have now been shown to decrease HIV risk behaviors [1], overdose deaths [2] and public disorder [3], and increase uptake of detoxification services [4]. In this issue, Salmon and colleagues [5] demonstrate dramatic decreases in ambulance attendances at opioid-related overdoses in the period following the opening of the Sydney SIF, a finding that supports program cost-effectiveness [6]. While SIFs remain controversial, there are at least 90 SIFs in 40 cities globally. To this end, SIFs are becoming increasingly viewed as a necessary component of a comprehensive strategy to reduce drug-related harms and facilitate uptake of medical care and drug treatment among streetbased drug users [3,7].A logical extension of SIFs are supervised inhalation rooms (SIRs), intended for individuals who smoke or snort drugs such as crack cocaine, heroin and methamphetamine; yet most supervised drug consumption programs target drug injectors exclusively. In fact, SIRs operate in only a few countries (e.g. Germany, Holland, Switzerland and Spain) [8][9][10][11], and none have been evaluated formally.The rationale for SIRs may be less obvious than that for SIFs, but is no less important. Sharing of crack pipesparticularly among individuals with sores on their lips as a result of burns and cuts-may contribute to infectious disease transmission [12,13]. Inhalation of methamphetamine has been associated independently with human immunodeficiency virus (HIV) infection among female sex workers, even after accounting for injection drug use [14]. A recent laboratory study suggests that methamphetamine accelerates HIV replication [15]. Furthermore, police crackdowns often drive drug users into clandestine spaces (e.g. abandoned buildings, etc.), where their health is placed at risk [16]. Displacement of drug users contributes to their low uptake of public health and social services [17]. Because many drug smokers are stimulant users who are historically very difficult to engage in drug treatment, SIRs represent a pivotal entrypoint where they can begin to be reached. In Vancouver, willingness to use an inhalation room was associated independently with working in the sex trade, sharing crack pipes, having crack pipes confiscated by police, smoking crack in public places and having burns from hurried drug consumption [9]. As many cities are witnessing decreasing numbers of drug injectors but increasing numbers of people who smoke/snort drugs [18], SIRs warrant a close second look.A powerful case can be made in support of SIRs based upon the personal experience of one of the authors of this commentary (J.R.N.), who helped to coordinate a drug consumption facilit...

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The transition from injection to non‐injection drug use: long‐term outcomes among heroin and cocaine users in New York City

Cited by 59 publications

References 31 publications

Transition to and Away from Injecting Drug Use among Young Drug Users in Tehran, Iran: A Qualitative Study

Transition to and Away from Injecting Drug Use among Young Drug Users in Tehran, Iran: A Qualitative Study

High HIV Prevalence Among Low-Income, Black Women in New York City with Self-Reported HIV Negative and Unknown Status

Commentary on Salmon et al. (2010): The case for safer inhalation facilities—waiting to inhale

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