Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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2 THE EPIDEMIOLOGY OF INJECTION DRUG USE
2 THE EPIDEMIOLOGY OF INJECTION DRUG USE
Pages 57-73
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From page 57... ...
A critical issue in counting injection drug users is definitional: injection drug users vary greatly in the type and combinations of drugs they use, the frequency of injection, the settings in which injections occur, the amount of sharing of injection equipment that takes place, and so forth. The National Research Council dealt with this issue in a previous report, AIDS, Sexual Behavior, and Intravenous Drug Use (Turner et al., 19891.
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From page 58... ...
One year later, the National Institute on Drug Abuse (NIDA) estimated that there were about 1.1 to 1.3 million injection drug users in the United States (Schuster, 1988~.
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From page 59... ...
the estimated proportions of injection drug users should be consistent with the stratification of high-, medium-, and low-injection-use cities, as defined by the Drug Abuse Warning Network (DAWN) data, treatment providers, and ethnographers.
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From page 60... ...
provides an important source of data on drug use among the general population, although it cannot estimate the entirety of the injection drug user population in the country. In particular, it has major problems as a precise basis for estimating numbers of hard-core drug users, including injectors (National Institute on Drug Abuse, 1994a; U.S.
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From page 61... ...
That is, the survey is designed to capture drug use among households nationwide, not specific population subgroups such as injection drug users. As a result, there are too few members of certain specific subgroups (e.g., injection drug users)
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From page 62... ...
This difference is too small to change prevalence estimates noticeably, but it would result in a one-third increase in the population estimates often used by providers for estimating the number of people in need of treatment and, for that matter, HIV prevention services. One noteworthy point is that most of the injection drug users were found in the household population (about two-thirds)
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From page 63... ...
Thus, these estimates of one-third and two-thirds have some unknown degree of associated error.3 Surveys of Youth NIDA's Monitoring the Future survey provides the most accurate data available on drug use among secondary school students, but it has the same limitations as the NHSDA in its ability to estimate the hard-core subpopulation of drug users that includes injection drug users. However, like the NHSDA, the Monitoring the Future survey does pick up a small but substantial number of its sampled population who acknowledge having injected drugs.
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From page 64... ...
It is emphatically not the case that all injection drug users are male minorities located in large urban areas, as stereotypes would imply. Second, the composition and characteristics of this population are continually evolving and have changed markedly over time.
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From page 65... ...
The difference in frequency of daily injection by gender was negligible. An examination of types of sharing behaviors that place injectors at risk of HIV infection was conducted on 17,891 injection drug users in the NADR database who had reported a history of needle sharing (pp.
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From page 66... ...
As a consequence, it appears that NADR was more successful in recruiting well-established social networks of injection drug users than recent initiates or occasional users. Despite these limitations, the NADR study is important because it shows that a large proportion of injection drug users had no history of drug abuse treatment, despite mean duration of injection of 10 to 19 years.
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From page 67... ...
Sources of data include: · reports from researchers, often ethnographic, in major metropolitan areas about local situations, · DAWN data on drug-related deaths, as reported by medical examin ers, · DAWN emergency room reports of drug-related medical emergencies, treatment admissions data where available, · data from the Drug Enforcement Administration (DEA) Domestic Monitor Program drug intelligence reports on seizure, price, purity, prescription, distribution, and arrests, · results of urinalysis data from the Drug Use Forecast program sponsored by the National Institute of Justice, and · data on HIV and AIDS from the Centers for Disease Control and Prevention.
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From page 68... ...
The proceedings of the CEWG meeting in December 1993 show the trend of increasing intranasal heroin use to be most pronounced in Newark, Chicago, and New York City (National Institute on Drug Abuse, 1994a)
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From page 69... ...
This would provide policy planners with periodic updates as to whether the pool of injector drug users is likely to increase or decrease and whether there are any substantial shifts in the composition of the pool, including the emergence of injection as a route of drug administration among any previously unafflicted subpopulations. Recommendation The panel recommends that: · The Assistant Secretary for Health should charge appropriate agencies (i.e., the National Institutes of Health and the Centers for Disease Control and Prevention)
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From page 70... ...
Anthony 1992 Characteristics of intravenous drug users by history of arrest and treatment of drug abuse. Journal of Nervous Mental Disorders 180:48-54.
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From page 71... ...
Sorensen 1990 Changes in needle sharing behavior among intravenous drug users: San Francisco, 1986-88. American Journal of Public Health 80(8)
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From page 72... ...
Polk 1988 Intravenous drug users and human immunodeficiency virus infection in prison. AIDS Public Policy Journal 3:42-46.
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From page 73... ...
Chilcoat, and K.E. Nelson l991c HIV seroconversion and disinfection of injection equipment among intravenous drug users, Baltimore, Maryland.
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