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Needle Use Soars In Young Heroin Users

Reverses 15-year trend; disease spread a concern

THURSDAY, May 17, 2001 (HealthDayNews) -- 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.

The 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 snorting them.

The 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.

That 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 those messages."

While 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.

Indeed, 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 says.

Dr. 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.

"We 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 similar trends.

Inhaled 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.

A 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.

Increase seen in needle exchanges

One, 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.

Thirty 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.

Mytri 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.

Another 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.

Emergency 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.

"Abscesses 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 died."

Soft 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.

Kral 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.

Purity 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 up."

To 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.

What To Do

The National Institute on Drug Abuse has a primer on heroin. For more on drug treatment, visit Phoenix House. To learn more about drug abuse, check out the University of Pennsylvania's Internet Alcohol Recovery Center.

For more on needle exchange programs, try the Center for AIDS Prevention Studies at the University of California at San Francisco.

Read other HealthScout articles about heroin.

SOURCES: Interviews with Dr. George DiFerdinando, M.D., deputy commissioner, New Jersey Department of Health and Senior Services, Trenton, Mytri Pritam Singh, M.P.H., needle exchange researcher, Beth Israel Medical Center, New York, Terry Horton, M.D., medical director and vice president, Phoenix House, New York, Dan Ciccarone, M.D., assistant professor of family and community medicine, University of California, San Francisco, and Alex Kral, Ph.D., epidemiologist, University of California, San Francisco; May 18, 2001 Morbidity and Mortality Weekly Report
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