We’ve previously updated readers on findings from the Illicit Drug Monitoring System (IDMS). In this update, Chris Wilkins and Charles Henderson focus on injecting drug use behaviour with data from the IDMS and Needle Exchange New Zealand’s seroprevalence surveys.
In New Zealand, pharmaceutically sourced opioids, such as morphine, methadone and ‘homebake heroin’, are the main opioids currently in use. Internationally sourced heroin was used by only a quarter of the IDU sample in the past six months (compared with 56 percent in Australia). Methadone and Ritalin (i.e. Methylphenidate) were also commonly injected in New Zealand. Each is taken orally as part of a drug treatment or medical programme, so this level of injection indicates recreational rather than medical use.
The emergence of methamphetamine since the late 1990s appears to have influenced injecting drug use patterns in New Zealand. Forty percent of the IDU sample had used methamphetamine in the past six months, but it is not yet clear whether this level of use represents experienced users taking advantage of methamphetamine’s greater availability, or primary methamphetamine smokers changing to injection to overcome increasing tolerance or economise on the cost of the drug.
This research question has serious public health implications. If younger methamphetamine users are increasingly opting to inject rather than smoke the drug, this could indicate change in the demographic profile of the IDU population in New Zealand, which otherwise appears to be aging. These new younger users may have less contact with established needle support networks, such as needle exchanges, and so may be more likely be involved in unsafe injection practices and the spread of blood borne viruses.
Alternatively, if existing users are increasingly using methamphetamine rather than traditional opioids, they may be at greater risk of unsafe sexual behaviour and spreading blood borne viruses due to the stimulating effects of methamphetamine on the sex drive and the existing high rates of infection of Hepatitis C within the IDU population.
Both the 2006 IDMS and the 2004 seroprevalence survey indicate fairly good levels of safe injection practices in New Zealand. Similar proportions of those surveyed had never used a needle after someone else (88 vs. 85 percent). A higher proportion of the IDU sample of the 2006 IDMS compared to the 2004 seroprevalence survey had used a new sterile needle on every occasion (63 vs. 50 percent). Nearly all the IDU sample from the 2006 IDMS and 2004 seroprevalence survey had obtained needles from a needle exchange (93 and 95 percent). A minority of the IDU sample from the 2006 IDMS had obtained their needles from a drug dealer, which raises some safety concerns.
There are currently no needle exchange services offered in New Zealand prisons. Both surveys indicate that many continue to inject while in prison with potential implications for the transmission of blood borne viruses among users, their families and the wider community. Similar proportions from each survey had been in prison at some time during their lifetimes (38 and 45 percent), and an identical proportion (9 percent) had been in prison in the past 12 months. The 2004 seroprevalence survey found an association between prison history and Hepatitis C infection, with 80 percent of those imprisoned testing positive for Hepatitis C compared to 61 percent of those who had never been in prison.
Thirty percent of the IDU sample from the 2006 IDMS had used BZP party pills in the past six months, and one-third of these BZP users had injected BZP in the past six months. Previous research on BZP use in New Zealand has not identified the injection of BZP as a common occurrence. A national household survey conducted in early 2006 found only one respondent who reported they usually injected their BZP party pills. Three respondents reported having ever injected them.
The legality of BZP party pills, their resulting ready availability and relatively low price may explain their attraction. It is a stimulant with characteristics similar to low potency amphetamine. BZP is likely to be prohibited soon, and it will be interesting to track the extent to which it remains a drug of choice for New Zealand’s IDU population in future years.
Further research findings concerning injecting drug use can be found in the main 2006 IDMS report, which is available to download from the National Drug Policy website or from the SHORE website.
Chris Wilkins is the principal investigator on the Illicit Drug Monitoring System. Charles Henderson is Needle Exchange Programme National Manager.
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