Frequently asked questions
What do we know about injecting drug use among Indigenous people?
- What is injecting drug use? (June 2003)
- What are the health problems related to injecting drug use? (June 2003)
- What strategies have been initiated to reduce the harm associated with injecting drug use? (June 2003)
- What do we know about the prevalence of injecting drug use among Indigenous people? (June 2003)
For more detailed information about injecting drug use among Indigenous Australians view the illicit drug use web resource
Australian Indigenous HealthInfoNet (2003) Frequently asked questions: what do we know about injecting drug use among Indigenous people? Retrieved [access date] http://www.healthinfonet.ecu.edu.au/html/html_keyfacts/faq/faq_health_behaviours/idus.htm
What do we know about injecting drug use among Indigenous people?
What is injecting drug use? (June 2003)
Injecting drug use (IDU) is a public health problem of global dimensions, which has major implications for the health of people who inject and the communities in which they live [1].
Most injecting drug users (IDUs) inject their drugs intravenously (directly into a vein), but drugs can be injected also intramuscularly (directly into a muscle), or subcutaneously (just under the skin) [2]. These routes of administration share a number of features. In general, drugs are absorbed more rapidly when administered by injection than when taken by mouth. The onset of the drug effect is approximately 15-30 seconds for the intravenous route, and 3-5 minutes for the intramuscular and subcutaneous routes.
The effect of an injected drug cannot be reversed easily, and the rapid rate of absorption leaves little time for a person to respond to an unexpected drug reaction or accidental overdose [2]. Unless clean, sterile equipment and techniques are used by IDUs, they risk transmission of various infectious diseases.
The most commonly injected drugs are amphetamines (speed) and opiates (heroin), but buprenorphine, benzodiazepines and barbiturates are also injected [2].
What are the health problems related to injecting drug use? (June 2003)
Injecting drug use can be associated with a number of health consequences, and has major significance for the health of people who inject and the communities in which they live [1].
Injecting drug use is largely responsible for the transmission of blood-borne infections among drug users. The risk of overdose is high when multiple dosages of drug combinations are taken simultaneously, and direct effects on mental functioning are not uncommon [1]. The manner of administration can be linked to physical damage and infection at the injection site, including blood poisoning.
In a study examining injecting drug use in an Indigenous community, a number of participants identified health problems that they believed related to their injecting drug use [7]. These problems included; sleeping problems, lack of appetite, bruising, mood swings, dehydration, depression, headaches, dental problems, paranoia, nausea, constipation, heart problems and abscesses.
Recent studies have also reported on community harm, such as concerns about unsafe disposal of used injecting equipment, risk of violence, public nuisance, loss of trade, and fear surrounding the use of public amenities [8].
The introduction of safe injecting rooms and similar facilities has the potential to reduce some of the harms associated with injecting drug use, such as the incidence of fatal and non-fatal heroin overdose, blood-borne virus transmission (hepatitis B and C, and HIV), and the prevalence and incidence of street-based injecting and disposal issues that may be associated with street injecting [8].
What strategies have been initiated to reduce the harm associated with injecting drug use? (June 2003)
Prevention, early intervention and health promotion activities are powerful means of reducing the harm associated with the injection of drugs [6]. These activities are most effective when they are adequately resourced and linked with the training of professionals.
Life skills training, primary prevention, community education, early intervention and treatment facilities are all important strategies for the reduction of harm associated with injecting drug use [6]. Employing a wide range of strategies that provide potentially life-saving advice and assistance to people who inject drugs is essential in minimising the harm related to injecting drug use. These strategies include education about safe injecting practices (to prevent the transmission of diseases), making the drug 'Narcan' (naloxone: a drug used in the reversal of overdoses caused by opiates like heroin) more widely available, and the wider availability of methadone (a legal drug used as a substitute for opiates (heroin, morphine, etc.)) and other medical drugs (such as 'Subutex' (buprenorphine)) [5].
There are a number of harm reduction strategies in place throughout Australia that aim to reduce the harm associated with injecting drugs. The distribution of clean needles and syringes is an important component of harm reduction, with evidence supporting its role in preventing the spread of diseases such as HIV/AIDS and hepatitis B and C [6]. Needle and syringe programs supply sterile injecting equipment to injecting drug users. (The nature of the programs differ, with exchange programs issuing sterile injecting equipment conditional on the return of used equipment.) The availability of these distribution services has been responsible for limiting the numbers of new cases of HIV/AIDS and hepatitis C in Australia [6]. For more information on needle and syringe programs, ANCAHRD has published two documents - A review of the evidence and Your questions answered.
Methadone therapy involves replacing the illicit drug that someone is dependent on with a prescribed, legal drug [9]. It acts to block heroin-induced effects and is less sedative then heroin [9]. Methadone programs provide people with the opportunity of improving their physical health, their relationships, and their emotional wellbeing. They also play an important role in the need to engage in criminal behaviour to support the drug habit, and decrease the likelihood that people will engage in high-risk harmful behaviours (such as injecting heroin with a used syringe) [9].
Some countries have set up safe injecting rooms to reduce some of the harm that is associated with injecting drug use [8]. Safe injecting rooms are legally sanctioned, indoor facilities where injecting drug use occurs under the supervision of medically trained personnel, and in safe and sterile conditions with access to sterile injecting equipment.
It is important that a wide range of treatment facilities and harm reduction strategies are made available for people who are dependent on drugs, as no single approach is effective for all people [6]. Services needs to be based on individual needs. They should not only address the specific drug that is the subject of dependency, but should also seek to address underlying or contributing factors (such as homelessness, lack of education or training, unemployment, social support, life skills and so forth).
What do we know about the prevalence of injecting drug use among Indigenous people? (June 2003)
This section is being updated currently, and further information should be available soon
Injecting drug use among Indigenous people has not been examined closely, and there is limited evidence available on its extent and associated harms [10]. As a result, it is difficult to accurately describe changes in injecting drug use trends. Evidence has existed since the 1980s of Indigenous people injecting drugs, but it has not been seen generally as a big a problem as alcohol use [4].
The first comprehensive data on Indigenous injecting drug use patterns was collected in 1994 for the National Drug Strategy Household Survey. This survey found that 2 per cent of urban Indigenous people had injected drugs, compared with 0.5 per cent of the non-Indigenous urban population [3]. Since that time, rates of injecting use among the general population have risen significantly, and recent research undertaken in Western Australia shows that this is reflected also in the Indigenous population [10].
References
1. Stimson
GV, Fitch C, Rhodes T (Eds.) (1998). The rapid assessment and response
guide on injecting drug use. (Draft) Geneva: World Health Organization.
2. Julien R (1995) A primer of drug action:
a concise non-technical guide to the actions, uses and side effects
of psychoactive drugs. Seventh ed. New York: WH Freeman.
3. Commonwealth Department of Human Services and
Health (1994) National Drug Strategy household survey: urban Aboriginal
and Torres Strait Islander peoples supplement 1994. Canberra: Commonwealth
Department of Human Services and Health.
4. Gray D, Sputore B, Stearne A, Bourbon D, Strempel
P (2002) Indigenous drug and alcohol projects 1999-2000. Canberra:
Australian National Council on Drugs.
5. Heather N, Wodak A, Nadelmann E, O'Hare P (Eds.)
(1993) Psychoactive drugs & harm reduction: from faith to science.
London: Whurr Publishers.
6. Alcohol and other Drugs Council of Australia
(2000) Drug policy 2000: a new agenda for harm reduction. Canberra:
Alcohol and other Drugs Council of Australia (ADCA).
7. Shoobridge J, Vincent N, Allsop S, Biven A
(1998) Using rapid assessment methodology to examine injecting drug
use in an Aboriginal community. A collaborative project conducted by
the Aboriginal Drug and Alcohol Council, the Lower Murray Nungas Club,
and the National Centre for Education and Training on Addiction.
Adelaide: National Centre for Education and Training on Addiction.
8. Fry C (1999) Establishing safe injecting rooms
in Australia: attitudes of injecting drug users. Australian
and New Zealand Journal of Public Health;23(5):501-504.
9. Hamilton M, Kellehear A, Rumbold G (1998)
Drug use in Australia: a harm minimisation approach. Melbourne:
Oxford University Press.
10. Gray D, Saggers S, Atkinson D, Carter M,
Loxley W, Hayward D (2001) The harm reduction needs of Aboriginal
people who inject drugs. Perth: National Drug Research Institute.
This web site contains PDF documents that require the most current version of Adobe Reader to view. To download click on the icon below.
