Injection Drug Users (IDUs)

Direct Measures of Risk Behavior

Among IDUs, the following measures of risk behavior are available in Louisiana to provide important information on factors that may affect risk of acquiring or transmitting HIV infection:

• injection or other substance use (Figures 20 and 21)
• sharing of needles (Figure 22)
• exchange of money or drugs for sex
• number of sex partners (Figure 23)
• frequency of condom use or unprotected sex (Figure 24)

HITS, NHSDA, and YRBSS provide information on risk behavior related to substance use. HITS is an anonymous, cross-sectional survey of populations at high risk for HIV infection, including IDUs, which was conducted in 3 cities in Louisiana (New Orleans, Baton Rouge, and Monroe) in 2001. Eligible IDUs were recruited from street locations. They had to be at least 18 years of age, able to give informed consent, and residents of the state for at least 1 year. In addition, to be considered eligible for the IDU risk group, a person had to report injection drug use within the past 12 months. NHSDA is an annual nationwide survey designed to collect data on substance abuse patterns and behaviors in the U.S. population aged 12 or older. Youth are oversampled to ensure precise estimates of substance abuse among younger persons. YRBSS is a self-administered questionnaire given to a representative sample of students in grades 9–12 at the state and local levels. In Louisiana, the survey is administered both at the state level and in Orleans Parish public schools; however, only the survey administered to Orleans Parish high school students includes questions related to sexual behavior. Because this survey is administered in school, students at highest risk, who may be more likely to be absent from school or to drop out, may be underrepresented in this survey; students in upper grades are more likely not to be in school. (For a more detailed description of each survey and its strengths and limitations, see Appendix A.)

Injection or Other Substance Use

Among the general population in Louisiana interviewed in NHSDA, 5% of persons aged 12 years or older reported having used an illicit drug at least once during the past month. Illicit drugs included marijuana/hashish, cocaine, inhalants, hallucinogens, heroin, and any other prescription-type psychotherapeutic drug used nonmedically. Regardless of the type of illicit drug, drug use was highest among persons 18–25 years of age: 13% reported that they had used illicit drugs during the past month (Figure 20). Reported drug use was highest in the younger age groups (12–17 and 18–25 years); however, relative to overall drug use, cocaine use seems to be higher in the older age group (≥26 years) than in the age group 12–17 years.

Figure 20: Substance Use by Age Group, Louisiana
National Household Survey of Drug Abuse, 1999

The New Orleans YRBS provides additional insight into drug use among high school students (Figure 21). Although the 1999 NHSDA reported that 10% of persons in Louisiana aged 12–17 had used an illicit drug in the past month, the New Orleans YRBSS for that same year reported that 3% had ever injected an illicit drug. Experience with injection drugs was higher among male students than among female students. In addition, 4% of students had used heroin at least once, and 4% had used cocaine (any form). More students reported having used heroin, compared with any injected drug or cocaine, at least once.

Figure 21: Drug Use Among New Orleans High School Students
Youth Risk Behavior Surveillance Survey, 1999

Drug use seems to increase according to grade level, with the exception of the 12th grade. However, it is important to keep in mind that one limitation of YRBS is that it is administered in school. Because the students at highest risk may be more likely to be absent from school or to drop out, they may be underrepresented, especially among upper grades.

Because injection drug use during the past year was an eligibility requirement for this risk group in HITS, all the participants had injected drugs during the past year. Heroin was the drug most commonly injected (87% of participants [data not shown]). Next was heroin and cocaine together (speedballs; reported by 61%), followed by cocaine (reported by 65%). Of the participants, 22% had injected amphetamines.

Sharing of Needles

In HITS, 59% of IDUs reported having shared needles always or some of the time. Needle-sharing among whites than among blacks (Figure 22). It also seems to be more common in the younger age groups: the largest proportion who always shared (19%) were persons aged 18–24; the smallest proportion who never shared (14%) were also in this age group. Note that these results are limited by small sample sizes.

Figure 22: Needle Sharing Among Injection Drug Users
Louisiana HIV Testing Survey, 2001

Exchange of Money or Drugs for Sex

Of the IDUs interviewed in HITS, nearly half (44%) reported having exchanged money or drugs for sex during the past 12 months (data not shown).

Number of Sex Partners

Of the IDUs interviewed in HITS, 83% of the men and 77% of the women reported that they had been sexually active (heterosexual sex) during the last 12 months. More than half of the sexually active persons had had 2 or more sex partners during the past 12 months (62% of women; 56% of men). Four or more sex partners were reported by 39% of the women and 35% of the men. Of the sexually active IDUs, 83% of the women and 72% of the men reported having had at least 1 casual sex partner (Figure 23). Of those with at least 1 casual sex partner, 61% of the males and 50% of the females reported not knowing the HIV status of their most recent sex partner. These results, too, are limited by small sample sizes.

Figure 23: Casual Sexual Partners of Injection Drug Users
Louisiana HIV Testing Survey, 2001

Frequency of Condom Use or Unprotected Sex

Most IDUs in HITS did not always use condoms with their casual sex partners (Figure 24). Sometimes or never using condoms was reported by 87% of the men and 67% of the women. Of the 3 risk groups surveyed in HITS (MSM, IDUs, heterosexual clients at STD clinics), the largest proportions of those who never used condoms during sex with a casual partner were IDUs (39% of women; 20% of men). Again, small sample sizes are a limitation.

Figure 24: Condom Use by Injection Drug Users with Casual Sex Partners
Louisiana HIV Testing Survey, 2001

DAWN and TEDS provide information about the potential occurrence of behaviors related to injection drug use. DAWN is an ongoing national drug abuse surveillance system that monitors visits to hospital emergency departments and deaths attributable to drug abuse, which are reviewed by medical examiners and coroners. In addition, DAWN provides population-based estimates for selected metropolitan areas, such as New Orleans. DAWN estimates for New Orleans provide indicators of current and emerging trends in drug abuse in the city. To be reported to DAWN, a person must be aged 6–97 and show evidence, during an emergency department visit, of intentional abuse or misuse of a drug (intentional abuse includes drug abuse, drug dependence, recreational use, or suicide attempt).

TEDS, which is maintained by SAMHSA, offers another way to indirectly measure the prevalence of injection drug use in Louisiana. For this survey, admissions data for substance abuse treatment are compiled from facilities that receive state and federal funding. Because TEDS is an admission-based system, the admissions may represent multiple admissions of a person within a calendar year. (For more detailed descriptions of DAWN and TEDS, see Appendix A.)

In New Orleans, population-based estimates of drug-related emergency visits during 2000 were higher than national estimates for cocaine, heroin/morphine, and marijuana (Figure 25). In 2000, DAWN reported 162 cocaine-related visits per 100,000 population, 81 heroin or morphine visits per 100,000 population, and 87 marijuana visits per 100,000 population. Compared with 20 other metropolitan areas participating in DAWN, New Orleans ranked 8th for cocaine-related visits and 9th for heroin-related visits.

Figure 25: Drug Related Emergency Department Visits
Drug Abuse Warning Network, 2000

With the exception of methamphetamine, the rates of visits related to “club drugs” (drugs associated with “raves” and dance clubs) in New Orleans were higher than national estimates. In 2000, the rates of emergency department visits for these drugs in New Orleans ranged from 5.6 for gamma-hydroxybutyrate (GHB), 3.6 for Ecstasy (MDMA), 2.8 for LSD, 2.2 for methamphetamine, to less than 1 per 100,000 for ketamine and Rohypnol (national estimates: 2.0 for GHB, 2.0 for MDMA, 2 for LSD, 5 for methamphetamine, <1 per 100,000 for ketamine and Rohypnol).

In 2001, there were 21,005 substance abuse admissions in Louisiana, of which 21.9% were related to smoking cocaine, 4% to cocaine through another route, and 2% to heroin use. Of the admissions due to smoking cocaine, 62% were among persons 26–40 years of age (Figure 26). Men accounted for two thirds of these admissions.

Figure 26: Cocaine (Smoked) Treatment Admissions by Age Group, Louisiana (n=4,608)
Treatment Episode Data Set, 2001

Heroin-related treatment admissions reported through TEDS were primarily among men (78%). The age distribution of persons admitted for heroin use (Figure 27) was younger than that of persons admitted for cocaine treatment. For example, 38% of heroin admissions were among persons aged 18–25 years compared with only 9% of admissions related to smoking cocaine.

Figure 27: Heroin-related Treatment Admissions by Age Group, Louisiana (n=428)
Treatment Episode Data Set, 2001

Go to Heterosexual Populations