How constant is an individual's route of heroin administration?: Data from treatment and non-treatment samples

Abstract

Three routes of heroin use were identified—injecting, `chasing the dragon' and snorting. Whilst injecting and `chasing the dragon' accounted for virtually all current heroin use, snorting had been the first route of use for nearly a fifth of heroin users in both the treatment and community samples. Overlap of lifetime experience of the different routes was widespread, with the majority of heroin users in both the treatment and community samples having used heroin by more than one route. Although less than half of the treatment sample had used heroin by injection on the first occasion, more than 90% had injected at least once, and over 80% had at some time used by `chasing the dragon'. Only a quarter of the community sample had first used heroin by injecting, and yet, by the time of interview, two-thirds of the sample had injected. The majority of durable changes in route of heroin use were towards injecting and `chasing the dragon', with transitions to snorting being extremely rare. For both the samples, transitions to injecting were twice as frequent as transitions to `chasing'. Snorting appeared to be an unstable route of use, with almost all who initially snorted their heroin now using by injecting or `chasing the dragon'.