Abstract
BackgroundIn several countries, especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin. There is no data exploring the impact of smoking heroin with cannabis on treatment outcomes.AimTo compare treatment outcomes between people who inject heroin and people who smoke heroin with cannabis.MethodologyThree hundred heroin users were assessed on admission to inpatient rehabilitation and after treatment. We compared drug use, psychopathology, criminality, social functioning and general health between heroin injectors and heroin-cannabis smokers at treatment entry, and at 3 and 9 months after rehabilitation.ResultsThe sample comprised 211 (70.3%) heroin-cannabis smokers and 89 (29.7%) heroin injectors. Eighty-four percent were followed up at 3 months and 75% at 9 months. At 9 months, heroin-cannabis smokers had a higher proportion of those who relapsed to heroin use compared with intravenous (IV) users (p = 0.036). The median number of heroin use episodes per day was lower for IV users than heroin-cannabis smokers at both follow-up points (p = 0.013 and 0.0019). A higher proportion of IV users was HIV positive (p = 0.002). There were no significant differences in psychopathology, general health, criminality and social functioning between IV users and heroin-cannabis smokers at all three time points.ConclusionsHeroin users who do not inject drugs but use other routes of administration may have increased risk for relapse to heroin use after inpatient rehabilitation and should therefore have equal access to harm reduction treatment services. Advocating a transition from injecting to smoking heroin in an African context may pose unique challenges.
Highlights
In several countries, especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin
At 9 months, heroin-cannabis smokers had a higher proportion of those who relapsed to heroin use compared with intravenous (IV) users (p = 0.036)
The median number of heroin use episodes per day was lower for IV users than heroin-cannabis smokers at both follow-up points (p = 0.013 and 0.0019)
Summary
Especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin. There is no data exploring the impact of smoking heroin with cannabis on treatment outcomes. Injecting and chasing heroin are the most common methods of heroin use described in the literature. South Africa, Kenya and Tanzania have reported a significant proportion of heroin users who smoke heroin. Data are limited and the papers from Kenya and Tanzania are qualitative and do not report on the specific numbers of heroin-cannabis smokers. In South Africa between 60 and 90% of heroin users entering treatment facilities report smoking heroin as their main method of heroin use [9]. The common street names for heroin in South Africa are nyaope, whoonga and thai. Unique cultural factors, pricing, availability of paraphernalia and the user’s subjective experience of the drug are said to play a role [6, 10, 11]
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