Chasing the Dragon: Research into Heroin Smoking in Britain

Abstract

There have been important changes in the ways in which British drug users have used heroin in recent years. In the 1960s, nearly all heroin users in the UK used their drugs by injection. During the late 1970s and throughout the 1980s, there has been an increase in heroin smoking. The issue of transition between different routes of heroin administration, e.g. moving from chasing to injection, was identified as an important research question. In addition, obtaining access to the hidden population, i.e. people who use illegal drugs and are not in contact with treatment services, has proved to be a major challenge. The Privileged Access Interviewers (PAI) team has proven to be a particularly suitable and effective research method. With the PAI method a large number of drug users from different social networks could be approached in a short period of time. In this sample, two main routes of heroin administration were observed: 54% of the sample used injection as a route of administration and 44% used by chasing the dragon. Only 8% did not have a single primary route of administration. The preferred route of administration changed at least once in more than a third of heroin users. Multiple transitions in route were uncommon. Different groups of heroin users were identified: stable injectors, stable chasers, those who moved from chasing to injection and those who had previously been injectors and had now moved to chasing. Stable chasers characteristically have little contact to the heroin subcultures. A survival analysis indicated a small but continuing risk of moving to injection. Our results show that there are positive associations between drug dose, the route by which the drug is taken and the severity of dependence. Potential relationships between the severity of dependence and the following factors have been studied: drug dose, the route of administration, diversity of drug rates of passive sharing, circumstances in which heroin was used and differences in types of sharing partners.