Needle Use Soars In Young Heroin Users
Reverses 15-year trend; disease spread a concern
By Adam Marcus
THURSDAY, May 17 (HealthScoutNews) -- The number of young heroin
addicts in New Jersey who said they injected the drug spiked
sharply in the last decade, state health officials say. And
they suspect the problem isn't unique to the Garden State.
trend, reported by the Centers for Disease Control and
Prevention, reversed a 15-year decline and could have ominous
implications for the spread of AIDS, hepatitis, and other
blood-borne infections, experts say. It could also signal an
increase in drug overdoses, since shooting up drugs like
heroin and cocaine is generally more dangerous than smoking or
number of addicts age 18 to 25 who reported injecting heroin
rose from 22 percent in 1993 to 46 percent in 1999, the report
says. Rates of injection drug use, including both heroin and
(to a much smaller degree) cocaine, among older users held
roughly steady or declined over the same period.
suggests older injection drug users may have heeded warnings
in the 1980s and 1990s about the dangers of needles,
especially AIDS, says Dr. George DiFerdinando, a deputy
commissioner in the New Jersey Department of Health and Senior
Services in Trenton. "I don't think this proves that
prevention messages are not getting through, but it does say
that as each new generation comes along, we have to reiterate
the report covers only New Jersey, and includes only the
habits of addicts in drug treatment facilities, DiFerdinando
says other states should be equally concerned about the
findings. "We see this throughout the state of New
Jersey, not just in the urban areas but in the suburbs and in
the rural areas, too," says DiFerdinando.
while urban heroin use fell in the 1990s the number of
suburban and rural addicts seeking treatment tripled. "If
anybody still has the presumption that heroin use and
injection of it is a problem that's limited to certain parts
of the population, that's not the case," DiFerdinando
Terry Horton, medical director of Phoenix House, an umbrella
group of 80 drug treatment facilities in eight states, says
the New Jersey findings aren't surprising.
sort of anticipated more IV drug use because of the surge in
inhaled heroin use," says Horton, who notes that Phoenix
House centers in New York City and Long Island have seen
heroin has become purer in recent decades, which allows
experimenters a chance to try the drug without a needle.
"But just because someone starts out inhaling heroin
doesn't mean they're going to continue inhaling heroin,"
Horton says. Addicts often start shooting up the drug because
they get a more potent high for their money. "Your dollar
goes a lot farther," he says.
write-up of the New Jersey drug problem appears in the May 18
issue of the CDC publication Morbidity and Mortality Weekly
Report, which includes several other studies of injected
drug use in the United States.
seen in needle exchanges
by New York researchers, showed that the number of known
needle exchange programs in this country nearly doubled
between 1994 and 1998, from 68 to 131. In that time, the
number of syringes passed out more than doubled, from 8
million in 1994 to 19.4 million in 1998.
one states, along with Washington, D.C. and Puerto Rico, and
81 cities were running syringe swapping efforts in 1998, many
of which provide addiction counseling, HIV testing,
vaccinations and other health services.
Pritam Singh, a needle exchange expert at Beth Israel Medical
Center in New York City and leader of that study, says the
number of known programs has continued to swell, reaching 168
last March. "It's in response to the HIV epidemic in
injection drug users," says Singh, who adds that the
programs are effective at cutting the spread of AIDS.
study by San Francisco scientists found that visits for
abscesses and cellulitis -- common problems for injected drug
users -- in one of that city's largest public hospitals rose
41 percent between 1996 and 2000.
room discharges at San Francisco General for these infections,
which can be accompanied by tetanus, botulism, and gangrene,
were up 103 percent over the period. Hospital admissions in
that time fell by 11 percent, but the drug was the result of
changes in hospital protocol and not the seriousness of the
infections, the researchers say.
are a significant portion of morbidity" for injected drug
users, says Alex Kral, an epidemiologist at the University of
California at San Francisco and a co-author of the study.
"These are very hardcore infections. Some people have
tissue infections are particularly problematic for users of
"tar" heroin as opposed to those who inject powder,
Kral says. Why that's true isn't entirely clear. But tar
heroin, which is more prevalent in California, may be harder
on the veins, eroding them and forcing addicts to
"pop" the drug into muscle or under the skin where
the lesions appear.
says the increase in soft tissue infections probably reflects
at least two patterns: A rise in heroin use and a growing
number of homeless addicts, who are more likely to take drugs
under unsanitary conditions.
of heroin is up and its price is falling, so it's likely that
more people are using the drug, says Dr. Dan Ciccarone, an
assistant professor of family and community medicine at the
University of California at San Francisco. Also possible,
Ciccarone says, is that the number of addicts has stayed flat
but users are buying more heroin than before, putting
themselves at increased risk of infection. In either case,
"if heroin facilitates an abscess, abscess rates go
help control soft tissue infections, cities should boost the
capacity of drug abuse treatment facilities, especially for
methadone, the researchers say. They should also make sterile
needles available to addicts and widen the services of health
centers that treat injected drug users.