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Transitions Between Routes of Administration Among Caucasian and Indochinese Heroin Users in South-West Sydney

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Transitions Between Routes of Administration Among Caucasian and Indochinese Heroin Users in South-West Sydney TRANSITIONS BETWEEN ROUTES OF ADMINISTRATION AMONG CAUCASIAN AND INDOCHINESE HEROIN USERS IN SOUTH-WEST SYDNEY Wendy Swift, Lisa Maher, Sandra Sunjic and Vincent Doan NDARC Technical Report No. 42 TRANSITIONS BETWEEN ROUTES OF ADMINISTRATION AMONG CAUCASIAN AND INDOCHINESE HEROIN USERS IN SOUTH WEST SYDNEY Wendy Swift1, Lisa Maher1, Sandra Sunjic2 and Vincent Doan3 1 National Drug and Alcohol Research Centre, The University of New South Wales 2 South Western Sydney Area Health Service, Liverpool Hospital 3Cabramatta Community Centre, Cabramatta ©NDARC 1997 This research was funded by a grant from the Drug and Alcohol Directorate, NSW Health NDARC Technical Report No. 42 ISBN 0 947 229 70 1 TABLE OF CONTENTS ACKNOWLEDGMENTS ........................................................................................................ i EXECUTIVE SUMMARY ..................................................................................................... ii 1.0 INTRODUCTION .............................................................................................................. 1 1.1 Review of the literature ............................................................................................ 2 A brief history of routes of opiate administration .............................................. 2 Opiate use in Australia ....................................................................................... 4 Factors influencing routes of administration ..................................................... 6 The diffusion of non-injecting routes of administration in the UK and Europe ................................................................................................... 7 Diffusion of injecting drug use in Asia .............................................................. 8 The diffusion of non-injecting routes of administration in Australia .............. 10 1.2 Rationale of the study ............................................................................................ 12 1.3 Aims of the study ................................................................................................... 14 2.0 METHODS ....................................................................................................................... 16 2.1 Procedure ............................................................................................................... 16 2.2 Survey instrument .................................................................................................. 16 2.3 Translation ............................................................................................................. 18 2.4 Statistical analyses ................................................................................................. 18 3.0 RESULTS ......................................................................................................................... 20 3.1 Sample characteristics ............................................................................................ 20 3.1.1 Demographics ......................................................................................... 20 3.1.2 Treatment history/Service utilisation ...................................................... 22 3.2 Heroin use .............................................................................................................. 23 3.3 Routes of use .......................................................................................................... 25 3.3.1 Exclusive smoking/injecting ................................................................... 25 3.3.2 Transition from smoking to injecting/injecting to smoking ................... 26 3 3.3 Other routes ............................................................................................. 26 3.3.4 Route of use in last 6 months .................................................................. 26 3.4 HIV Risk-taking ..................................................................................................... 29 3.5 Severity of dependence .......................................................................................... 30 3.6 Other drug use ........................................................................................................ 33 3.7 Correlates of ethnicity ............................................................................................ 33 3.8 Social context ......................................................................................................... 35 3.9 Crime ...................................................................................................................... 37 3.10 Health ................................................................................................................... 38 3.11 Smoking context .................................................................................................. 40 3.12 Street methadone .................................................................................................. 44 4.0 CONCLUSIONS .............................................................................................................. 45 4.1 Major findings of the study .................................................................................... 45 4.1.1 Demographic and drug use characteristics ............................................. 45 4.1.2 Transitions .............................................................................................. 45 4.1.3 Severity of dependence ........................................................................... 46 4.1.4 Risk-taking behaviours ........................................................................... 46 4.1.5 Social isolation ........................................................................................ 47 4.2 Implications of the study ............................................................................ 48 4.2.1 Service provision/Access to services ...................................................... 48 4.2.2 Research implications ............................................................................. 49 4.2.3 Promoting alternatives to injecting ......................................................... 50 5.0 REFERENCES ................................................................................................................. 51 ACKNOWLEDGMENTS We would like to thank the following people for their valuable contributions to this project: • the NSW Drug and Alcohol Directorate, NSW Health, for funding the research; • Sharon Dawe, Sam Everingham, Richard Carbury, Tung Minh Pham and April Pham for their assistance in the early stages of project development; • Shane Darke for his permission to use the Amphetamine Transitions Questionnaire, and his comments on drafts of this report; • Quong Nguyen and Ninh Nguyen for their translation and back-translation of the questionnaire; • Wayne Hall for his helpful advice on analysis, and for comments on drafts of this report; • Ian Webster and Gilbert Whitton for their interest in, and support of, the research; • the management and staff at the three methadone clinics involved in the study, for their patience and cooperation; • and finally, the heroin users themselves, who agreed to be interviewed for this project. ι EXECUTIVE SUMMARY This report presents the findings of the first study of routes of heroin use in Australia, and the first detailed survey investigating heroin use among Indochinese users in NSW. A total of 200 heroin users in South West Sydney were interviewed for the study. The sample was equally split between Caucasian and Indochinese heroin users and those in methadone maintenance treatment and those not in treatement. The study aimed to gather data on the patterns and correlates of heroin use in the two groups, and, in particular, on routes of administration, social and cultural contexts of use, health, crime and use of treatment and other services. The study documents the use of heroin by smoking or inhalation ("chasing the dragon"), as well as injecting. Prior to this research, it was believed that non-injecting routes of heroin administration were rare: our findings indicate that smoking is a popular route of administration among both Caucasian and Indochinese heroin users. Smoking was much more common among Indochinese heroin users, although many had made a transition to injecting. Many smokers often expressed a fear of injecting, and/or the belief that injecting was more addictive than smoking. Those who favoured injecting believed it provided a better "rush", and was more cost-effective than smoking. Indochinese users were more likely to associate negative identities with the term "junkie" than Caucasian users. Smoking appeared to be more culturally acceptable than injecting among Indochinese users. Data on risk-taking behaviours, specifically the sharing of injecting equipment, revealed a small but significant risk for the transmission of blood-borne diseases, such as Hepatitis and HIV. This risk appeared greater for the Indochinese group, those who were not in treatment, and those who were more dependent on heroin. Our results also confirm the emergence of a street-based injecting culture in the Cabramatta area: more than half of those interviewed reported injecting in public places, including on the streets, in the stairwells and garages of local flats, public toilets and trains. Although Caucasian users were more likely to have experienced an overdose, this was primarily explained by
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