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Femoral (or groin) injecting is an emerging public health challenge to all drug-related services within the UK. Recent work in the area has proposed that groin injecting in the UK has moved from being a 'risk boundary' to an 'acceptable behaviour'. This article uses data from 10 in-depth qualitative interviews with service users from a supervised injectable opiate treatment service in South London to report on pathways to, and reasons for, groin injecting. Our findings indicate that even though groin injecting constitutes a risk boundary for some injectors, the practice is no longer heavily stigmatised and is perceived by some to be an acceptable risk. Narratives also pointed to the importance of peers in the initiation of groin injecting. Interviewees described the groin as a site of 'last resort' in contrast to 'convenience' groin injectors described in some previous research. We conclude that it might be helpful to distinguish between convenience and last resort groin injectors and support the call for innovative interventions which aim to reduce modelling of groin injection and which promote social norms supportive of using peripheral injecting sites. [ABSTRACT FROM AUTHOR]

Drug related deaths (DRDs) have been increasing in Scotland over at least the past decade. This study aimed to describe the characteristics (gender, age, ICD10 cause of death), toxicology and circumstances of all Scotland's DRDs in 2003 to help inform a national overdose prevention strategy. Coronial files for 300/317 (95%) DRDs registered with the General Register Office for Scotland (GROS) in 2003 were examined retrospectively (in 2004). Characteristics: 241/300 (80%) were male. Mean age at death was 32.8 years (SE 0.63, range 16-82). Route of administration was injecting for 137/268 (51%) who were classifiable. Classified injectors were more likely to be male (91%: 124/137) and younger (mean age of 32 years) than those whose death was by a non-injecting route (male: 87/131 (66%) and mean age of 35 years). Twenty-five to forty-four year olds made up 108/137 DRDs by injecting (79%), but only 62/131 (47%) by non-injecting routes. Cases of intentional self-poisoning (injectors 1; non-injecting 34) and undetermined intent (injectors 14; non-injecting 26) were infrequent among injectors. Of those who died by the injecting route, 108/137 were known intravenous drug users, but so too were 29/131 DRDs by non-injecting routes. Toxicology: overall 38/300 cases of DRD (13%) were negative for opioid drugs-only 2/137 DRDs by injecting (1%) were negative for opioids compared with 33/131 (25%) by non-injecting route. Methadone was present for 15/137 DRDs by injecting route (11%) and for 57/131 DRDs by non-injecting routes (44%, p < 0.001). Presence of dihydrocodeine, and anti-depressants was about three times and six times respectively, more likely in DRDs by non-injecting routes. Irrespective of route, two-thirds of DRDs tested positive for benzodiazepines (202/300 DRDs). Circumstances: time between overdose and death was within the hour for 61/137 DRDs (45%) by injecting, but rarely by non-injecting routes (3%: 4/131). Three out of four DRDs occurred in a house or flat: 98/137 DRDs (72%) by the injecting route and 101/131 (77%) by non-injecting routes. Interpretation: A relatively high proportion of cases died by non-injecting routes. National mortality databases should separate out cases of injecting-related DRD from non-injecting cases, and public health strategies to reduce DRDs should distinguish between these groups. Widespread availability in Scotland of prescribed and illicit benzodiazepines needs attention. [ABSTRACT FROM AUTHOR]

Aims: To examine methadone prescribing in public drug treatment services in inner London; compare levels of methadone prescribing with national guidelines and surveys; investigate whether methadone reduces illicit opiate use; and compare clients treated in specialist clinics with those in shared-care in general practice. Methods: A cross-sectional survey of four drug treatment services in north central London. Findings: Data were collected on 715 clients. Mean methadone dose was 57.2 mg but for clients on methadone maintenance, the mean dose was 63.4 mg. Reported heroin use fell from 24.8 days in the last 30 at initial assessment to 11 days (p < 0.001). Clients on methadone doses greater than 60 mg were more likely than those on lower doses to test negative for morphine on urinalysis (49% vs. 39.4%, p < 0.01). Clients in GP shared-care were more likely to have been in treatment for less time, be on lower doses of methadone and have stabilization or detoxification as their treatment goal. Conclusions: Methadone treatment is associated with a reduction in illicit opiate use but not abstinence. Inadequate doses and lack of supervised consumption may in part explain the relatively poor response to treatment. Clients in GP shared-care received substantially different treatment from those in the specialist clinics. [ABSTRACT FROM AUTHOR]

One hundred and forty-one (141) heroin users were interviewed at the time of their most recent overdose of which 34% returned for in-depth interviews within seven days. Subjects were predominantly male (77%), aged between 18 and 29 (53%), highly dependent, and unlikely to be (8%) or to have ever been (68%) in MMT. Poly-drug use was prevalent (54%) at the time of overdose despite most subjects' awareness of the association between poly-drug use and overdose. Subjects consumed other drugs with heroin in order to increase the pleasurable effects of drug use rather than to medicate symptoms of withdrawal or depression. The overdose did not appear to change subjects' low level of concern about overdosing -- only a minority (11%) said they would seek treatment following overdose. Experience of overdose therefore does not appear to be a motivating factor for entry into treatment. A variety of harm reduction initiatives needs to be supported in order to reduce the frequency and hazards of overdose. [ABSTRACT FROM AUTHOR]