Transition to injection

Patterns of drug use can change over time, and tend to differ in places depending on which drug is most frequently injected - e.g. cocaine versus heroin. For example, cocaine users inject more frequently than heroin users, and thus may be at higher risk for disease transmission. Moreover, whereas some individuals begin drug-use careers with drugs of injection, the majority transition to them from non-injection drugs. Studies from the US have shown that as many as 85 percent of injection drug users transitioned from snorted heroin or cocaine or crack to injecting (Fuller et al., 2001). In Asian countries, shifts have been noted from opium smoking to heroin smoking (commonly referred to as "chasing the dragon") to heroin injection (Stimson and Choopanya, 1998). The reasons for transition are both complicated and variable. In many countries, the custom of self-injection for

Figure 3.2 Estimates on global prevalence of injection drug use, 1998-2003. Source: Reference Groups on the Prevention and Care of HIV/ AIDS among IDUs (2002).

medication makes the practice of injecting very acceptable (Rhodes et ad, 1999a; UNDCP, 1998). Increased migration and communication also facilitate transitions toward injection, because new techniques for drug administration become easily transferable (Deany, 2000). However, most often transitions to drug injection are associated with law enforcement restricting drug supply and production, changes in drug production and distribution technologies, and the globalization of drug markets resulting in altered drug-trafficking routes and distribution networks (Crofts et al., 1998; Rhodes et al, 1999b; Stimson and Choopanya, 1998). Injection is a more effective method of drug delivery than smoking or sniffing, so people are especially likely to turn to injecting when the purity of the drug drops or the cost of the drug increases. In particular, when drugs become scarce as a result of law enforcement and drug-control efforts, it may become inefficient for a user to smoke or inhale the drug because much of the drug is lost in the smoke (des Jarlais et al, 1992). Importantly, injectable forms of drugs are also more easily concealed (Deany and Crofts, 2000).

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