Into my arms: Injecting drug use in New Zealand

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.

Key Findings from the IDMS 2006

• The opioids most commonly used by the injecting drug user (IDU) sample were ‘other opiates’ (i.e. morphine, MST, homebake heroin) and methadone.
• Forty percent of the IDU sample had used methamphetamine in the past six months.
• Forty-three percent of the IDU sample had used Ritalin in the past six months.
• Thirty percent of the IDU sample had used BZP party pills in the past six months, and 32 percent of these had injected BZP in the past six months.
• Internationally sourced heroin was used by only 24 percent of the IDU sample in the past six months.
• Ninety-three percent of the IDU sample had obtained their supply of needles from a needle exchange in the past six months.
• Forty-nine percent of the IDU sample who had been in prison had injected drugs while in prison.
• Fifty-two percent of the IDU sample who had been tested for Hepatitis C were positive.
• Thirteen percent of the IDU sample who had sex with casual partners had never used a condom.
• Twelve percent of the IDU sample had accessed an ambulance in relation to their drug use in the past six months.

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.

References

1. Kemp, R. and MacDonald, M. (1999) Injecting drug users have high rates of hepatitis C, but HIV infection remains uncommon. Public Health Reports 6: 17-19.
2. Brunton, C., Mackay, K. and Henderson, C. (2005) Report of the Needle Exchange Blood-borne Virus Seroprevalence Survey. Report prepared for the Ministry of Health. Department of Public Health & General Practice, Christchurch School of Medicine & Health Sciences, University of Otago and Needle Exchange, Christchurch.
3. O’Brien, S, Black, E., Degenhardt, L. Roxburgh, A. Campbell, G., de Graaff, B. Fetherston, J., Jenkinson, R., Kinner, S., Moon C., and White N. (2006) Australian Drug Trends 2006: Findings from the Illicit Drug Reporting System (IDRS). National Drug and Alcohol Research Centre Monograph No. 60, University of New South Wales, Sydney.
4. Wilkins, C. (2002) Designer amphetamines in New Zealand: challenges and policy initiatives. Social Policy Journal of New Zealand 19: 14-27.
5. Wilkins, C., Bhatta, K. and Casswell, S. (2002) The emergence of amphetamine use in New Zealand: findings from the 1998 and 2001 national drug surveys. New Zealand Medical Journal 115:1166, 256-263.
6. Rawson, R., Washton, A., Domier, C. and Reiber, C. (2002) Drug and sexual effects: role of drug type and gender. Journal of Substance Abuse Treatment 22: 103-108.
7. Semple, S., Patterson, T. and Grant, I. (2004) The context of sexual risk behavior among heterosexual methamphetamine users. Addictive Behaviors 29: 807-810.
8. Yen, C. (2004) Relationship between methamphetamine use and risky sexual behavior in adolescents. Kaohsiung Journal of Medical Science 20: 160-165.
9. Sheridan, J., Butler, R., Wilkins, C. and Russell, B. (2007) Legal piperazinecontaining party pills – a new trend in substance misuse. Drug and Alcohol Review 26: 335-343.
10. Wilkins, C., Girling, M., Sweetsur, P., Huckle, T. and Huakau, J. (2006) Legal party pill use in New Zealand: Prevalence of use, availability, health harms and ‘gateway effects’ of benzylpiperazine (BZP) and triflourophenylmethylpiperazine (TFMPP). June. Centre for Social and Health Outcomes Research and Evaluation (SHORE) & Te Ropu Whariki, Massey University, Auckland.
11. Wilkins, C., Girling, M. and Sweetsur, P. (2007) The prevalence of use, dependency and harms of legal ‘party pills’ containing benzylpiperazine (BZP) and trifluorophenylmethylpiperazine (TFMPP) in New Zealand. Journal of Substance Use 12: 213-.
12. Bye, C., Munro-Faure, A., Peck, A. and Young, P. (1973) A comparison of the effects of l-benzylpiperazine on human performance tests. European Journal of Clinical Pharmacology 6: 163-169.
13. Campbell, H., Cline, W. and Evans, M., et al. (1973) Comparison of the effects of dexamethamphetamine and l-benzylpiperazine in former addicts. European Journal of Clinical Pharmacology 6: 170-176.
14. Anderton, J. (2007) Party pill ban bill introduced [Press release: Hon Jim Anderton, Associate Minister of Health] New Zealand Drug Foundation. Accessed 6 December 2007.

Chris Wilkins is the principal investigator on the Illicit Drug Monitoring System. Charles Henderson is Needle Exchange Programme National Manager.