Call for special help for young people who inject drugs

Government and health care services are being urged to make special help available for young people who inject drugs, in a bid to minimize drug-related deaths. In a newly-published study of causes of death amongst a group of injecting drug users in Edinburgh since the early 1980s, University of Edinburgh researchers now show conclusively that harm minimisation strategies like needle and syringe exchange schemes have been effective in saving lives from HIV/AIDS and hepatitis. The findings are revealed in the current edition of the Archives of Internal Medicine.

Researchers looked at all patients who had ever injected drugs, in a large family practice of 10,000 patients in Edinburgh, from 1980 until 2001. There was a well-described epidemic of HIV, Hepatitis B and Hepatitis C in Edinburgh between 1982 and 1984, as fictionalised in the film Trainspotting, but since then, the transmission of HIV has been minimal amongst the drug-injecting population. The main cause of death in the early years of the 21-year study was drug overdose, followed by HIV/AIDS in later years. Hepatitis C claimed most lives towards the end of the study period. These death rates reflect the changed patterns of damaging injecting which took place from the mid to late 1980s onwards, as public health measures like needle exchange schemes and methadone prescribing took effect.

Deaths from AIDS peaked in the 1990s— reflecting the long incubation periods of HIV— but then showed a marked decline. Taken together, the deaths from all causes in the first decade and deaths from blood borne viruses in the second decade account for three-quarters of all deaths in the study. Other causes of deaths included suicide and disease of the liver, other than Hepatitis C. In total, of 667 patients in the study, there were 153 deaths (110 men and 43 women).

Dr Roy Robertson of the University’s General Practice section of the Division of Community Health Sciences, who is also an Edinburgh general practitioner, co-authored the report. He says: “Clear indications are that injecting drug users need to be targeted at a younger age by government and health care services so they can be offered harm minimization advice with substitute prescribing if appropriate, physical health care and counselling support when they are most at risk. By looking at this and other specific groups, we can gather information about the natural history and career of addiction that will be vital in the areas of prevention, treatment and social policy. Studies like this are invaluable in identifying the key factors involved in injecting drug use and assessing the impact of this behaviour on individuals and society as a whole.”