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University of Texas at Austin

Normalization of Heroin: A Study of Heroin as a "Club Drug"

Principal Investigators:  Richard T. Spence, Ph.D. and Jane Maxwell, Ph.D.
Sponsor: National Institute on Drug Abuse, National Institutes of Health
Duration: 10/1/01-6/30/05

The objective of this study was to investigate of an emerging drug trend of heroin inhalation or "snorting". Previous studies indicate that these users may be different from heroin injectors. Increased numbers of heroin inhalers have entered treatment in recent years and compared to injectors, these patients enter treatment after a shorter period of heroin use. This study examined key questions that are important for improving the knowledge base for treatment and prevention strategies in dealing with these problems.

The first stage of this project compared heroin inhalers and injectors entering treatment programs statewide through analysis of the state's client data system. More information and findings from the study appear in the following article: Maxwell, J.C., Bohman, T.M., & Spence, R.T. (2004). Differences in characteristics of heroin inhalers and heroin injectors at admission to treatment: A preliminary study using a large database of client records. Substance Use and Misuse, 39, 989-1008. Read the abstract.

The second phase of the study examined the characteristics of patients in narcotic treatment programs who started their use of black tar heroin either as inhalers or as injectors and compared them with those who started as inhalers but shifted to injecting. A purposive sample of 199 patients in 6 methadone programs in Texas were interviewed in 2002-2003 using a structured instrument. At admission to treatment, those who were heroin inhalers were more likely to be African American, to live with their families, to have income from wages, and to report fewer days of problems on most of the ASI measures. Those who shifted from inhaling to injecting were more likely to be Hispanic and to have had mental health problems that interfered with their lives and to have had less nurturing while growing up. Injectors were older at this treatment admission, had more treatment episodes and more times in jail, and were more likely to have hepatitis C, AIDS, or gonorrhea. There were high levels of physical and mental problems and histories of traumatization as children and adults for almost all the respondents. Males were as likely as females to have been sexually abused as children or as adults.

The study concluded that the high rates of mental and physical problems among all the clients interviewed showed the need for comprehensive services to be delivered within the substance abuse treatment programs. Histories of trauma and sexual abuse should be addressed for both male and female clients. More information and findings from the study appear in the following article:

Maxwell, J. C. and Spence, R. T. (2006). An exploratory study of inhalers and injectors who used black tar heroin. Journal of Maintenance in the Addictions, 3 (1), 61-81. Read the abstract.

Maxwell, J. C. & Spence, R. T. (2003). Differences in characteristics of heroin inhalers and heroin injectors at admission to treatment. Poster presented at the College on Problems of Drug Dependence Meeting, Bal Harbour, FL. View the poster

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