Young heroin users in Baltimore: a qualitative study.

This study describes the characteristics of 67 young heroin users, interviewed using a semistructured qualitative questionnaire (QQ) as part of a larger study of 18- to 25-year-old heroin users seeking detoxification with buprenorphine at a drug treatment center in Baltimore. This new generation of heroin users has a different demographic profile compared to older heroin users in this area. Our data, supported by data from another clinic and from the Maryland State Alcohol and Drug Abuse Administration, seem to indicate that the younger heroin users in treatment settings are predominantly White, with a high proportion of women, often living in the suburbs. Based on responses to the QQ, all subjects initiated heroin use intranasally, usually in a group setting; 75% had subsequently gone on to use intravenously. The typical young heroin user in Baltimore Metropolitan area appears to be a young White man or woman from a middle/working-class background, with exposure to drug use among close contacts while growing up, experimenting with gateway drugs with peers before proceeding first to intranasal, and then intravenous heroin use, engaging in criminal activities to support the habit, repeatedly seeking help with assistance from family, but failing to sustain abstinence due to continued exposure to drug using peers and a poorly implemented plan of aftercare. Further research should focus on efforts to engage peer groups and families in order to improve treatment outcomes in young heroin users.

A comparison of the patterns of drug use among patients with and without severe mental illness.

We compared the patterns of substance use among patients with severe mental illness (SMI) served by three community treatment teams, substance users with non-severe mental illness (NSMI), and substance abusers without mental illness (no mental illness: NMI). There were highly significant differences in substance use patterns among the groups: among patients with SMI, the order of drug preference was alcohol, cocaine, cannabis, and then heroin; in the NMI group, it was cocaine, alcohol, heroin, and then cannabis; while in the NSMI group, it was alcohol, cocaine, heroin, and then cannabis. The data suggest that the choice of drugs by individuals with SMI may be determined by factors related to their illness, in addition to the price and availability of the particular drug.

Short-term outcomes after brief ambulatory opioid detoxification with buprenorphine in young heroin users.

AIMS: This study examines the outcomes at 1, 3 and 6 months after a very brief outpatient detoxification with buprenorphine in 18-25-year-old heroin users. DESIGN: Prospective follow-up study. SETTING: Outpatient drug treatment clinic, providing brief detoxification in downtown Baltimore, Maryland, USA. PARTICIPANTS: One hundred and twenty-three subjects between 18 and 25 years old; 56% male; 95% Caucasian; seeking detoxification; living in Baltimore City and five surrounding counties. INTERVENTION: Detoxification with buprenorphine over 3 days. Follow-up at 1, 3 and 6 months. MEASUREMENTS: Drug use history, the Addiction Severity Index at baseline and follow-up, urine drug screens, evaluation of the detoxification experience. FINDINGS: By self-report, 37% of the total sample were not currently using heroin at 1 month, 32% at 3 months and 29% at 6 months, and 6.7%, 10.1% and 11.8% had an opioid negative urine test at 1, 3 and 6 months, respectively. There was a significant reduction from the baseline in mean Addiction Severity Index drug use composite score, as well as the mean number of days of heroin and cocaine use during past 30 days, that was sustained over the three follow-up points. Engagement in aftercare was generally poor. CONCLUSIONS: The findings show a reduced frequency and intensity of drug use, suggesting a possible role for brief outpatient detoxification in reducing the severity of dependence for some younger heroin users who may not yet be ready to engage in long-term abstinence-oriented or opioid substitution treatments.