The following drug type overview aims to provide a concise overview of three main drug types injected. It offers insights to the availability and use, health issues from use, typical risk behaviours, and the consequences of poly-drug use. This pages is updated periodically, and is based upon international and regional data.
Amphetamine type stimulants
The following is an overview of aspects related and specific to ATS (amphetamine type stimulants) – including their availability and use, health issues common to their injection, common risk behaviours surrounding their use, the people injecting and consequences of poly-drugs use.
Availability & Use
Amphetamine type stimulants include: (meth)amphetamine, cocaine, etc. The last decade saw a pronounced increase in the production and use of ATS worldwide. Amphetamines act as stimulants to our central nervous system – hence the colloquial term ‘speed’. Their use in great quantities results in euphoria. ATS use increases libido (sexual desire) and the ability to have sex for extended periods. Amphetamines also act as appetite suppressants – historically prescribed for this purpose. Methamphetamine – a very potent form of amphetamine – is now the leading amphetamine used.
Health issues
Methamphetamine use is associated with frequent other drugs use. Methamphetamine users experience more severe psychiatric and medical consequences compared to cocaine or ecstasy.
Heavy methamphetamine use is well associated to debilitating mental states – paranoia, aggression, volatility and violence – that can persist for several weeks. The injection of methamphetamine is associated with greater risks of BBV transmission. Violence and cardio-toxicity are major contributing factors associated to mortality and trauma.
Risk behaviours
Tolerance to methamphetamine develops quickly – users may compensate by increasing dose and indulge in prolonged periods of binging. Methamphetamine IDU have been noted not to filter the solution before injecting, using tap water instead of the sterile water available from NEP. The injection solution may be to be mixed in ‘point bags’ – non-sterile baggies. Injecting environments can be very unsanitary, including cars, pubs and public toilets.
ATS users show greater interest in sex & and exhibit sexually compulsive behavior. Users of ATS show more high-risk sex behaviors – including multiple partners and unprotected sex and risky sex work. Often injectors fail to take precautions when ‘high’ or in preparation to get ‘high’. ATS injectors appear not to be accessing NEP services as frequently or consistently as other IDU.
The people injecting
A significant proportion of people who inject drugs report the injection of ATS. Smoking, sniffing or ingestion still remains the most popular methods of use. Tolerance, price and the ‘high’ appear to be drivers toward the injection of this drug. Methamphetamine users are a ‘heterogeneous group’ and that this diversity is not often appreciated. The risk factors associated to this (new) group of users is not being adequately addressed. The injection of ATS may be increasing. This group appears to be younger and not mentored by an experienced IDU – compared to perhaps opiate injectors.
Consequences of poly-drug use
Methamphetamine and alcohol increases the effects of methamphetamine beyond its use alone. Several stimulants taken together are of even more significance to health. Cocaine and alcohol results in a toxic metabolic by-product, effectively increasing its half-life.
Opioids
The following is an overview of aspects related and specific to OPIOIDS – including their availability and use, health issues common to their injection, common risk behaviours surrounding their use, the people injecting and consequences of poly-drugs use.
Availability and Use
Opioids are widely used in medicine to treat chronic and acute pain & substitution therapies. Availability is likely to increase proportional to our burgeoning modern lifestyles and aging population. Diverted pharmaceuticals constitute the majority of opioids injected in New Zealand – morphine and methadone. Methadone is reported, by people who inject drugs, to be amongst the ‘drugs of choice’.
Health issues
Pharmaceutical opioids tend to have high dependence burden because of their rapid effect, relatively brief duration action, high purity and water solubility. The increase in availability of pharmaceuticals opioid will see a continuation of the injecting trends. Health risks of injecting include:
- overdose deaths;
- non-fatal overdose and the psychological and physical trauma;
- bacterial and viral infections;
- injecting site complications – injecting solids and particles; and,
- drug dependence.
Methadone is not a benign drug, there are reports yearly of drug-drug interactions leading death.
Risk behaviours
Filtering of drugs substances remains relatively poor amongst this group. The additives in pharmaceutical preparations are problematic – i.e. vascular complications etc. ‘needle fixations’ are relatively common and impact on the effectiveness of OST (i.e., methadone). Methadone injecting is associated with more injection-related health problems, psychological distress, needle sharing and criminal activity.
The people injecting
Opioids are injected by a broad group of people in New Zealand. The opioids class of drugs are by far the most injected drugs in New Zealand. Tolerance, price and the ‘high’ appear to be drivers toward the injection of these drugs. Most people who inject opioids are aged between 25 – 49 years.
Consequences of poly-drug use
The use of prescribed drugs, including anti-depressants further complicate the overall issue. The concurrent use of benzodiazepines is linked to numerous overdoses and deaths. Alcohol, opiates, TCAs, SSRI’s and benzodiazepines are the most commonly detected drugs postmortem. Poly-drug use and poly-drug toxicity is the norm and opioid only overdose does not exist or is not the norm. In cases of death, the association appears to be alcohol use fist, then heroin/opioid, then death.
Steroids
The following is an overview of aspects related and specific to STEROIDS – including their availability and use, health issues common to their injection, common risk behaviours surrounding their use, the people injecting and consequences of poly-drugs use.
Availability & Use
Steroids are available on the internet and on our own black market. Medsafe data suggest many are counterfeit black market – sourced from Thailand, India or China. The overall quality of these steroids is questionable at best. Medsafe data suggest most common are testosterone, anabolic steroids and growth hormone. Other substances used include insulin, anti-oestrogens, appetite and weight loss regulators and diuretics. Steroids markedly and very quickly improve performance and physical appearance.
Health issues
Steroid misuse implicated is cases of poisoning, infection and mental illness – particularly amongst heavy and long-term users. Other risks include cardiovascular disease (high blood pressure, fluid retention, cholesterol rise), liver damage (tumours), infertility and loss of libido, acne (face and body), and aggression.
Steroids affect the bodies normal function, including principal hormonal balance. The black market supply is neither constant nor dependable – reduced ability to safely taper dose. Serious lack of professional opinion exists surrounding their use.
Risk behaviours
Steroid injectors have been noted to state that the NEP as a place for ‘junkies’ and not ‘sportsmen’. Abrupt withdrawal can be fatal – discontinuation should always tapered (gradually decreasing dose). Some use is long term – increased risk of mental illness and aggression. The use of many drug types, including different steroids can be dangerous to health. Injectors have limited knowledge of appropriate injecting practices, needles or syringes to use etc.
The people injecting
The size of the steroid using population is difficult to establish. Steroid injectors accessing NEP services appears to vary by region – there is poor engagement. The draw to these substances is by ‘sports people or athletes’ and ‘body-builders’. Young people are accessing steroids and appear not to have adequate mentoring in their use.