NDARC Technical Report No. 60 (1998)
EXECUTIVE SUMMARY
In order to examine transitions between heroin and amphetamine injecting, structured interviews were conducted with 151 primary heroin injectors and 145 primary amphetamine injectors. Four major sub-groups were examined: i) current heroin injectors who initially injected heroin (N=91), ii) current heroin injectors who initially injected amphetamines (N=60), iii) current amphetamine users who initially injected amphetamines (N=121) and iv) current amphetamine users who initially injected heroin (N=24).
The major finding of this study was the complexity of transition patterns between primary injection of the two drug classes. Six major transition pathways were detected among these subjects: heroin-amphetamines-heroin (N=30), heroin-heroin (N=61), amphetamines-heroin (N=60), heroin-amphetamines (N=24), amphetamines-amphetamines (N=80) and amphetamines-heroin-amphetamines (N=41). While the transition from amphetamines to heroin injecting was more common than the reverse case, there was substantial movement in both directions. A simple pattern in which the move to heroin injection is viewed as an endpoint in terms of drug use career does not fit the complexity of transitional movement.
The main reasons given by subjects who had moved from injecting amphetamines to heroin related to a dislike of the negative physical and psychological effects of regular amphetamine use. Reasons for moving from heroin to amphetamines were more diverse and included the physical effects of heroin and the associated lifestyle, the positive effects of amphetamines such as energy and euphoria, and the injection of amphetamines for intoxicating effects whilst maintained on methadone. A transition from amphetamine to heroin was associated with more frequent injection, more money spent on drugs and more frequent crime.
Current primary heroin injectors appeared more socially dysfunctional in terms of crime, unemployment and general social adjustment. However, primary amphetamine injectors had higher levels of current polydrug use, were no less likely to have recently shared used injecting equipment, and had the similar levels of general and psychiatric health to primary heroin injectors.
While, overall, there was a small preponderance of movement from primary amphetamine injecting to primary heroin injecting, there was considerable movement in both directions. Contrary to expectation, heroin use is not necessarily a stable endpoint for injecting careers, but is in many cases simply a further transition in primary drug use.