Retrospective cohort study examining incidence of HIV and hepatitis C infection among injecting drug users in Dublin.
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Adolescent↗
Biomedical subjects
B P Smyth
Publications and source records attributed to B P Smyth.
Heroin smoking by "chasing the dragon" in young opiate users in Ireland: stability and associations with use to "come down" off "Ecstasy".
We explored the frequency of commencing opiate use by "chasing the dragon" to "come down" off Ecstasy and the stability of heroin smoking in young opiate takers by assessing 102 subjects in Dublin using a semistructured interview. Ninety-two subjects had used Ecstasy. Of these, 68 reported "chasing" to "come down" off Ecstasy at some point in their history and were found to have used Ecstasy more frequently and in larger amounts. Thirty-six reported that their first experience of using opiates was to "come down" off Ecstasy, 28 citing this as their main reason for commencement.Eighty-six of the 102 commenced opiates by "chasing" heroin, 61 of whom progressed to injecting after a mean of 2.9 years. This was associated with starting illicit drug use earlier, starting heroin earlier, and a history of using Ecstasy. Implications for service planners in developing responses to illicit drug use among adolescents are discussed.
Administration, Inhalation↗
Syringe borrowing persists in Dublin despite harm reduction interventions.
AIMS: To measure the frequency of syringe borrowing in young Irish injecting drug users (IDUs) and identify associated characteristics. DESIGN: Cross-sectional survey. SETTING: Addiction treatment services in Dublin. PARTICIPANTS: Treated IDUs (N = 246). MEASUREMENTS: Data on drug injecting and syringe borrowing in the previous 6 months. FINDINGS: The median age was 22 years and the median length of injecting history was 19 months. Syringe borrowing was reported by 173 (70.3%) participants. A multivariate analysis identified seven characteristics significantly associated with syringe borrowing. These included early school leaving and parental unemployment. IDUs with long injecting histories who had injected less frequently were more likely to borrow. Injection of more than one substance was significantly associated with borrowing of syringes. Syringe borrowing was associated with having more intimate social relationships with other IDUs, less perceived risk in borrowing from acquaintances and usually opting to inject in the company of other IDUs. CONCLUSIONS: Syringe borrowing is commonly practised by young IDUs. Those with a background of social deprivation are more likely to engage in this risk behaviour. IDUs who report borrowing are more intimately involved with other IDUs and tend to perceive less risk or dangerousness in borrowing. In addition to syringe exchange, there is a need to work cognitively with IDUs to identify and challenge assumptions that they may have regarding the safety involved in borrowing from others, particularly from those with whom they have close social relationships.
Adult↗
Health effects of prisons. Many injectors stop injecting while imprisoned.
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Hepatitis C↗
Trends in treated opiate misuse in Dublin: the emergence of chasing the dragon.
AIMS: To examine trends in treated opiate misuse and identify factors associated with route of heroin use. DESIGN: Cross-sectional survey. SETTING: Services providing addiction treatment in Dublin. PARTICIPANTS: Individuals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996. MEASUREMENTS: Data on socio-demographics and current drug use. FINDINGS: The study population was 3981. Over the 6-year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate-using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use. CONCLUSIONS: Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of individuals into heroin use.
Adult↗
Evaluation of the impact of Dublin's expanded harm reduction programme on prevalence of hepatitis C among short-term injecting drug users.
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Adult↗
Bloodborne viral infection in Irish injecting drug users.
AIMS: In Dublin, harm reduction strategies have greatly expanded since 1990. We sought to determine the prevalence of, and factors associated with, hepatitis C (HCV), hepatitis B (HBV) and HIV infections among injecting drug users (IDUs) against this background. DESIGN: Cross-sectional survey. SETTING: Addiction treatment clinic. PARTICIPANTS: Seven hundred and thirty-five IDU tested for antibody to HCV (anti-HCV) between September 1992 and September 1997. MEASUREMENTS: Socio-demographic and drug use characteristics. Serology tests for anti-HCV, HBV surface antigen (HBsAg) and HIV. FINDINGS: The vast majority (89%) commenced injecting since 1990. Prevalence of anti-HCV was 61.8% (453/733), of HBsAg was 1.0% (7/729) and of HIV was 1.2% (7/600). Logistic regression analyses indicated that longer history of injecting and increased daily drug expenditure were the only independent variables associated with significantly increased risk of HCV. The only characteristic associated with increased prevalence of HBsAg was a history of injecting prior to 1990 (3.8%, 3/80). HIV prevalence was significantly higher when aged over 24 years (3.7%, 6/162), when injecting commenced prior to 1990 (6.3%, 4/64) and when injecting over 5 years (6.5%, 4/62). CONCLUSIONS: HIV prevalence has sustained a low level in this population. Interventions which aim to halt transmission of HCV are necessary and will need to target IDU very early in their injecting careers and also those at risk of commencing to inject.
Adult↗
Assessment of hepatitis C infection in injecting drug users attending an addiction treatment clinic.
BACKGROUND: Injecting drug users represent a high risk group for hepatitis C (HCV) infection. Currently, screening of this group for HCV is inconsistently implemented. AIM: We designed a HCV assessment algorithm and sought to determine the frequency with which injecting drug users completed the assessment process. METHODS: Prospective study of a HCV assessment algorithm in the setting of a specialist outpatient addiction treatment clinic. Participants consisted of consecutive new attenders over a six-month period with a history of injecting. RESULTS: Only 21 (18%) of 119 patients reached a satisfactory endpoint of assessment. Forty-eight injectors were tested for antibody to HCV, of whom 26 (54%) tested positive. Thirteen of those with positive test results were no longer attending when the test result became available. Only four of the 19 patients who were referred, attended the on-site hepatology clinic. CONCLUSIONS: Thorough screening of injecting drug users for HCV within one treatment service is difficult. There is a need for explicit policies on this issue involving co-operation between primary care providers and addiction services and hepatology services.
Adolescent↗