Beverly Powis

The differences between male and female drug users: community samples of heroin and cocaine users compared.

Although gender-related issues are often cited as playing an important part in determining patterns of illicit drug use, little is known about the differences between male and female drug users outside treatment settings. In the present study, 558 heroin and cocaine users recruited from a range of community settings were interviewed by Privileged Access Interviewers. The women were found to be younger than the men. Differences existed in their drug use; women used smaller amounts, for a shorter duration, and were less likely to inject than their male counterparts. No differences existed between treatment contact for the heroin users, but differences were found among the cocaine-using sample, with men being more likely to have contacted a treatment agency. Men were financing themselves through more criminal activities than women. Drug-using sexual partners were found to be an important influence over womens drug use, with most female injectors having been given their first injection by a male sexual partner. Structural differences in patterns of drug use found among female drug users and the influence of male sexual partners are likely to play an important role in determining appropriate treatment options for women drug users.

Drug-using mothers: social, psychological and substance use problems of women opiate users with children

The present study looks at patterns of drug use and alcohol use, social and economic circumstances, criminal involvement and health problems among a sample of 66 women opiate users with children. Data were collected using a structured interview. The women reported a wide range of substance use and other problems including depression. Many were heavy and regular drinkers. Most of the women were in a relationship with an opiate user: one-third reported that their partner had been physically violent towards them. Almost all of these women were living in a state of poverty. Many of the mothers were in conflict regarding their dependence upon drugs and their fears about their children being taken into care. The women who were most severely dependent upon both heroin and alcohol felt that if they sought treatment this might help them to avoid having their children taken into care. At the same time they were afraid that, by approaching treatment, this might increase the risk of their children being taken from th...

Female prostitutes in south London: Use of heroin, cocaine and alcohol, and their relationship to health risk behaviours

The present study looks at the association between drug and alcohol use and sexual risk behaviours in a sample of 51 women who were currently working as prostitutes and also currently using opiates and/or stimulants. Most women reported regularly using condoms with clients but a substantial minority sometimes had unprotected sex with clients. There was no overall association between any of the drug use variables (including the use of crack cocaine) and the likelihood of unprotected sex. The use of drugs appears to have affected the sexual practices of different women in different ways: a substantial minority (just under a quarter of the sample) reported that for them, drug use did reduce the chances that they would use a condom. There was a link between willingness to have unprotected sex for more money and drinking larger amounts and drinking more often. The results also indicate that these women were exposed to a variety of health risks, including sharing injecting equipment and having unprotected sex with their regular partner who was often a current or former drug injector. A sub-sample (n = 34) completed a confidential questionnaire which showed that one-third had previously had at least one sexually transmitted disease and 15% of them had been infected during the previous year. These findings about rates of STD infection raise questions about the extent to which self-reported condom use by prostitutes can be used as an indicator of actual levels of infection risk.

Severity of heroin dependence and HIV risk. I. Sexual behaviour

The HIV risks associated with the sexual behaviour of drug injectors have sometimes been overshadowed by the more obvious risks of injection behaviour. In this study, 408 heroin users were interviewed in the community; 50% were not currently in treatment and 42% had never had any treatment contact. In addition to data on drug use, information was collected on sexual risk behaviour by means of a linked anonymous questionnaire (96% returned). Eighty-nine per cent of the sample had had at least one sexual partner in the previous year and 58% had a regular sexual partner at the time of interview. Drug users who had a sexual partner who was injecting drugs were more severely dependent upon heroin. Twenty-three per cent of the men and 20% of the women reported having had anal intercourse in the previous year. Seventeen per cent of the women and 6% of the men had engaged in some form of prostitution. Severity of heroin dependence was positively related to the occurrence and to the frequency of sex-for-money transactions and to the less well recognized phenomenon of sex-for-drugs; this association with severity of dependence applied to the women and to the men who have sex with men. The overall level of condom use was low in this sample, though condom use was more frequent among those involved in sex-for-money or sex-for-drugs transactions. Low levels of condom use were reported even for such high risk activities as anal sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Continuing drug risk behaviour: Shared use of injecting paraphernalia among London heroin injectors

The study investigates donor sharing and recipient sharing of different types of injecting equipment and the frequency of sharing activities with sexual partners, close friends and casual acquaintances. Structured interviews were conducted with 303 injectors recruited as part of a study of early and episodic opiate use. Subjects were contacted in non-clinical, community settings by a peer recruitment method (Privileged Access Interviews). Spoons and water containers were more frequently shared than needles and syringes. Significant differences were obtained between the frequency of sharing different types of injecting equipment. Many injectors had shared spoons or water containers, but had not shared needles or syringes. Frequency of sharing with others was also associated with intimacy of relationship to the subject. Almost two-thirds of the sample had shared some sort of injecting equipment during the previous year. The sharing of injecting paraphernalia presents a risk of infection with HIV hepatitis B and hepatitis C. Injectors and drug workers should be more clearly aware of the risks involved in such activities. Harm reduction advice given to drug injectors should target the sharing of injecting paraphernalia. Research into sharing should explicitly include questions about the use of different types of injecting equipment.

Which drugs cause overdose among opiate misusers? Study of personal and witnessed overdoses

Concern has been expressed at the widespread prescribing of methadone in view of its inherent toxicity. Commentators have opined that methadone is more toxic than heroin and causes more overdose deaths. However, data deficiencies and flawed analyses leave continuing uncertainty about this crucial policy issue. The relative contributions of heroin, other opiates (e.g. methadone) and non-opiate drugs to overdose and overdose deaths among drug misusers were examined in a community-recruited sample of 312 injecting drug misusers in London. Data were collected on last personal overdose (n=117), last witnessed overdose (n=167) and last witnessed fatal overdose (n=55), and on the different drugs that had been involved with these overdoses. Heroin was involved in 83% of last personal overdoses, 90% of last witnessed overdoses and 80% of last witnessed fatal overdoses, while other opiates were involved in only 18%, 8% and 26%, respectively. Methadone accounted for about half of these “other opiate” overdoses. Overdoses involving a combination of heroin and a non-opiate were common − 29%, 21% and 39%, respectively. Heroin was the drug most frequently involved in overdose across all three areas of study. However, combinations of heroin and a non-opiate were surprisingly frequent, especially in witnessed fatal overdoses (as reported recently by other investigators using different methodologies). Considering the wide extent of methadone prescribing to this group, methadone was remarkably infrequently reported as responsible (solely or in combination) for either personal overdoses, witnessed overdoses or witnessed fatal overdoses.

Drug Use and Offending Behaviour Among Young People Excluded from School

Increasing concern is being placed upon the long-term outcomes of pupils excluded from school and their possible increasing involvement in drug use and crime. Data presented in this paper explore levels of drug USE and offending behaviour of a sample of 14-Z6-year-olds excluded from school. Interviews were conducted with 86 school excludes attending Pupil Referral Units (education centres for young people excluded from school) in North West London during 1996, as part of an ongoing evaluation of a drugs education intervention being delivered by the Home Office Drug Prevention Initiative. The majority of the excludes lived in single parent families with nearly two-thirds having no adult wage earner. Over half of subjects were from ethnic minority backgrounds. Offending behaviour among the sample was high. Nearly all had committed a criminal offence, with nearly half having committed an assault or wounding, and nearly a third having committed a burglary. Levels of lifetime, current drug use, and the range o...

Measuring Met and Unmet Need of Drug Misusers: Integration of Quantitative and Qualitative Data

This paper reports on the combination of qualitative and quantitative methods which were used to record the attitudes to, and perceptions of, drug treatment services by current, ex-, and potential clients in south-east London. Three research instruments were employed: a structured current client satisfaction survey (n = 333); a questionnaire which included open-ended questions, administered to drug users not currently in treatment (n = 88), and focus groups for young drug users not in treatment (n = 14), women in treatment (n = 7) and men in treatment (n = 11). The data thus collected were used to construct a picture of local met and unmet need and obstacles to the uptake of health care, which is supported by more than one perspective, and which can reasonably be used as the basis for the planning of local health care purchase. Three major concerns were revealed by the data: the inadequacy of existing GP drug services; the deterrent effect of long waiting lists for methadone treatment, and the role of treatment services in relation to those drug users who acknowledge that their drug use is problematic, but believe that treatment services have nothing to offer them.

Heterosexual Vaginal and Anal Intercourse Amongst London Heroin and Cocaine Users

A community-derived sample of 392 heroin users and 145 cocaine users were interviewed about their drug use and sexual behaviour, with (optional) collection of saliva specimen for linked anonymous HIV/HBV testing. The heroin sample was stratified (50/50) across current treatment and non-treatment status. For cocaine users 80% were not in current contact with any treatment. Overall levels of sexual activity were several times higher than reported in recent national surveys. Last-year prevalence of heterosexual anal intercourse was 23% and 20% for heroin-using males and females respectively (last-month figures—12% and 10%); and 23% and 15% for cocaine-using males and females respectively (last-month figures—7% and 9%). Two-thirds of subjects rarely or never used condoms during heterosexual anal intercourse. For females, receptive anal intercourse was positively related to a history of sex-for-money activity, high scores of severity of dependence, and injecting as a current route of use.

Multiple risks for HIV and hepatitis B infection among heroin users.

This study investigates the extent to which heroin users are exposed to multiple forms of infection risk. Structured interviews were administered to a prospective network sample of 408 heroin users. Subjects were contracted in south London in a wide range of social settings by specially recruited privileged access interviewers. Most heroin users (74.5%) had been exposed to more than one infection risk factor and more than half of the sample had been exposed to three or more risk factors. HIV serostatus was primarily related to men having sex with men. Hepatitis B seropositive status was primarily related to the number of years injecting drugs. At this stage of the HIV epidemic in London, HIV infection among heroin users may be related more to homosexual risk behaviour than drug risk factors. Heroin injectors were at greater risk of infection than heroin chasers both through their sexual behaviour as well as through their injecting practices. Heroin users who refused to give a saliva sample for analysis were found to be more likely to engage in several health risk behaviours than those who provided samples. This finding has important methodological implications for seroprevalence surveys. Other implications of the results for prevention programmes aimed at health risk behaviours of heroin users are also discussed.