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This study focused on patterns of drug use, injecting practices, risk behaviours for infectious disease, and experiences with treatment and health services among injecting drug users (IDUs) in Northern Ireland.¹ Semi-structured interviews were conducted between December 2003 and September 2004 with 90 individuals over 18 years of age who had injected one or more drugs (excluding insulin or other medication prescribed for injection) within the 30 days prior to the interview. The majority of respondents were male (70%) and resided in either the Eastern (45%) or Northern (41%) Health and Social Services Board areas. The average age at first injection was 23 years and 75% of respondents were found to have injected heroin at this stage, with 66% initiating injection in Northern Ireland.

Main findings

Although the majority of respondents had used new needles and syringes for most injections in the previous 30 days, there was a high incidence of injecting in the company of other people. On these occasions, sharing of needles, syringes and, to a higher degree, other equipment including filters, spoons/stericups and water took place.

The majority of respondents had used a needle and syringe exchange scheme in Northern Ireland at some stage since 2001. However, factors such as restrictions on the numbers of needles distributed per visit, opening hours, the quality of equipment , the perception of 'stigma' and concerns regarding confidentiality contributed to the risk behaviours of injectors to infectious disease. Respondents, primarily from the Northern Board area, had concerns with regard to police practices for those found to be carrying used injection equipment.

The study did not conduct viral testing for hepatitis C, hepatitis B or HIV. However, 30% of those who had been tested (n=53) claimed to have been diagnosed as positive for hepatitis C. Although no-one reported to be hepatitis B positive, only 17 of the respondents had been immunised. Approximately 15% had never been tested for HIV and 6% were unsure if they had been tested.

Sixty one percent had drunk alcohol within the 30 days prior to the interview and some of those participating on a Subutex maintenance scheme reported an increase in alcohol consumption with reduction in their opiate intake. A number of those interviewed were also consuming benzodiazepines daily, either as prescribed (37% diazepam) or through illegal sources and had no knowledge of the associated dangers.

There was considerable variation in the contact injecting drug users had with drug services and this varied also with board area:

• 40% were in contact during the 30 days prior to interview (Northern Board 62%, Eastern 23%)
• 43% had a history of contacting services but were not in contact during the 30 days prior to interview
• 17% had never been in contact with drug services
• Females were less likely to have contacted drug services, while those with children exercised more caution when visiting pharmacy-based needle exchanges, were less likely to have been tested for infectious diseases or to contact their GP regarding drug-related problems

The report made 20 recommendations based on the findings. These included such issues as the:

• lack of knowledge regarding safe injection practices among IDUs
• importance of regular testing for infectious disease in conjunction with counselling
• need to identify the prevalence of hepatitis B and C and HIV among IDUs
• barriers to IDUs visiting exchange schemes (eg number of needles/syringes supplied)
• need for more information for IDUs on the use of, and further research on their use of benzodiazepines
• independent evaluation of effectiveness of drug services with the potential to assist IDUs

The full report may be downloaded from: www.dhsspsni.gov.uk/publications/2005/drug_use_and_risk_behaviours.pdf

Reference

1. McElrath K and Jordan M. Drug use and risk behaviours among injecting drug users. Belfast: NISRA, 2005.