Differences in Characteristics of Heroin Inhalers and Injectors at Admission to Treatment

1. Differences in Characteristics of Heroin Inhalers and Injectors at Admission to Treatment J. C. Maxwell, R. T. Spence, & T. M. Bohman UT Center for Social Work Research Introduction Results Discussion • Purpose: to understand why heroin inhalers (“snorters”) in Texas enter treatment sooner than injectors. • This study extends earlier findings by comparing the characteristics of heroin injectors versus inhalers at their first admission to publicly-funded treatment using CODAP/TEDS data. • This study will build on earlier studies, but looks at differences in patterns of heroin use in a much larger sample characterized both by its race/ethnic diversity and by the use of black tar heroin, a type of heroin primarily seen only in the western United States and Mexico. • This project has three phases: 1) analysis of CODAP/TEDS data on clients who had a primary problem with heroin; 2) in-depth interviews with heroin users in public and private programs; and 3) interviews and focus groups with heroin inhalers and injectors who are not in treatment. • This poster reports on the first phase only. • Consistent with other studies, we found that there are significant differences between injectors and inhalers at admission to treatment. Inhalers are younger, more likely to have used heroin for fewer years, to be first admissions to treatment, to have children in the home, and to have higher annual incomes. • Texas injectors and inhalers reported no difference in number of days that heroin was used in the month prior to admission. We would speculate that some of the inhalers had reached a level of dependence where their habits could no longer be maintained through daily inhaling and that faced with the need to shift to injecting, they had, instead, chosen to enter treatment. • Our study found that there were very large differences by race/ethnicity, with African Americans in the sample being much more likely to be inhalers than injectors. This finding is not well understood and will be the focus of additional study. • While the bivariate analysis showed that injectors were more likely to have problems with the legal system and to be on parole, which would be a reflection of their longer crime careers, these patterns were not significant in the multivariate prediction model, which controlled for age. • Having minor children in the household was a significant predictor of being an inhaler. • Only higher income was a significant economic predictor of inhaling when age, gender, and race/ethnicity were controlled. However, findings about the economic status may be confounded because TCADA programs give priority to poverty-level clients. Sample • 9,732 unduplicated adults who were first admissions to TCADA-funded residential, outpatient drug-free, or outpatient methadone treatment programs between January 1, 1997 and December 31, 2001. • Clients had a primary problem with either inhaled or injected heroin which they had used in the month prior to admission. • While they were first admissions to TCADA programs, 64% had been treated previously in non-TCADA-funded programs. • 92.5% were injectors and 7.5% were inhalers. • Mean age at admission was 35.8 years (SD 10.6). Age of first use of heroin was 22.9 years (SD 8.0). • The mean lag between first use and admission to TCADA-funded treatment was 13.5 years (SD 10.8). • 69% were male; 49% were Hispanic, 40% were Anglo, and 12% were African American. • Average annual legal income was $5,522; 17% were employed and education level was 11.1 years. • 75% lived with their families, 28% were married or co-habiting with a partner, 11% were homeless, and 30% were involved with the criminal justice or legal system. • 33% reported a secondary problem with powder cocaine, 12% with alcohol, 7% with marijuana, and 4% with crack cocaine; 38% reported no problems with other drugs. Limitations/Further Study • The findings from this first phase of the study are limited by the variables collected in CODAP/TEDS and they cannot be generalized to all heroin users in treatment in Texas since only 9 of the 69 methadone programs in the state report CODAP/TEDS data. Collecting comparable data on clients in private programs is part of Phase 2 of this research study. • Phase 2 will be in-depth face-to-face interviews with heroin users to determine reasons for shifting or not shifting to needles. Data will be collected on patterns of use of other drugs, attitudes towards needle use (fear of needles or “needle fixation”), prior sexual and physical abuse, mental and physical status, childhood and family history, criminal history, and reasons for remaining an inhaler or for shifting to injection. • Phase 3 will be interviews and focus groups with heroin users who have never been in treatment. Analysis • Statistical models included a generalized linear model with the outcome modeled as a binomial and multinomial distribution and a hierarchical linear model for continuous outcomes. • The Generalized Estimating Equation (GEE) model was used to account for the variation in heroin user characteristics due to treatment program. • All analyses were conducted using SAS v8. Acknowledgements • Funding from NIDA (R21 DA014744) • Cooperating treatment providers and study participants • Accepted for publication in Substance Use and Misuse. • Contact Jane Maxwell 512 232-0610 jcmaxwell@mail.utexas.edu