Understanding Injecting Drug Use

Various routes through which drugs can
be taken
Only very few drugs can be
taken through oral route
In general oral route is one of
the least efficient route of drug
intake since
A lot of drug is destroyed before
it reaches the brain
It takes substantially longer for
the drug to reach the brain and
exert its effects
However, oral route is also least
harmful for taking drugs, in
Various routes through which drugs can
be taken
•Drug reaches the blood circulation
through lungs and then onwards to
the brain fairly early
•This route is harmful as it damages
the linings of the lungs and can give
rise to various respiratory diseases
Various routes through which drugs can
be taken
•The most efficient route of drug
•Drug reaches brain fairly quickly
and gives sudden effects
•Requires much less amount of
drug (hence cheaper)
•Most damaging or harmful route
of taking drugs
Common drugs injected in India
Heroin (pure/white heroin/ ‘No. 4’): mainly in the northeastern states.
Heroin (Smack / brown sugar): not readily injectable as it comes in the form of crude, impure
• Before injecting, a user has to prepare or ‘cook’ the drug.
• Most users mix the powder with an injectable sedative drug (like
chlorpheniramine), boil it, filter it with a cotton swab and then inject it.
Buprenorphine (Tidigesic/Norphine) or pentazocine (Fortwin): probably the most popular
drugs for injecting among IDUs in India.
• Most users mix them with one or more of the following sedatives for
enhancement of the effects:
• Diazepam (calmpose),
• Chlorpheniramine (Avil),
• Promethazine (Phenargan).
Dextrprpoxyphene (Proxyvon / Spasmo- Proxyvon / SP): available as capsules and NOT AS
• Users open the capsules, take the powder out, mix it with another liquid /
drug and then inject it.
• Seen only in the northeastern states, very rare in other parts of the country
Opioids in modern India
Early 1980s: Opium replaced
with heroin
 Rural
areas: Opium users
continued with Opium, some
switched to heroin
 Urban areas: Heroin use started
Opium in modern India
India’s proximity to ‘Golden Triangle’ and ‘Golden Crescent’
Opioids in modern India
Early 1990s: Injecting Drug Use
started in North East India;
gradually spread to other
IDU in India
Currently, India figures among the developing and
transitional countries with the “largest populations
of IDUs”.
The National AIDS Control Organisation estimates
that currently there are about 2 Lakh IDUs in India.
HIV among IDUs in India
the HIV among IDUs is also progressing in India at an
alarming rate.
At the national level IDU is the vulnerable group (among
other vulnerable groups such as Female Sex Workers and
Men-Who-Have-Sex-with-Men) which has highest
prevalence of HIV.
The states / areas particularly affected by HIV among IDUs
 Manipur, Nagaland, Mizoram, Punjab, Chandigarh, Delhi,
Kerala, Tamil Nadu and parts of Orissa, Bihar, and UP.
HIV estimates in India, 2008
HIGH-RISK GROUPS: IDU – high prevalence
(NACO ,2007)
The usual drug use career
by a doctor
Injection Tidigesic /
Heroin / Smack
Charas / Ganja
Alcohol / Tobacco
Profile of a usual IDU
Most vulnerable: underprivileged section of the
IDUs catered to by an IDU TI: belong to poorest
section of the society
The typical IDU
 in his productive years, but not likely to be regularly
and gainfully employed.
 May be married, but likely to have poor social support.
 Severe dysfunction in almost all aspects of his life.
Profile of a usual IDU
Also likely that a IDU TI will encounter IDUs who are:
Thus, IDU would require help regarding
may have limited means to sustain themselves, to maintain their
hygiene, or even to have two square means a day.
In conflict with law
high-risk behaviours
many other areas of life.
Exceptions, i.e. atypical IDUs which may require attention
Women IDUs,
IDUs belonging to better socio-economic strata, holding white
collar jobs and staying with their families
IDUs which are also other HRG members (FSWs, MSM etc.)
Injecting practices
When injections are administered
in a health-care setting  usual
aseptic precautions
Location: clean and hygienic.
The area to be injected:
thoroughly cleaned with a
Body parts: safe for injecting
Injecting equipment: sterile
needle and syringe
After injecting: the site is
pressed with a clean cotton swab
for few seconds (to prevent
For IDUs  not possible to
maintain aseptic precautions
 Location: hidden from public
(parks, public toilets, unused
buildings or open spaces,
garbage dumps, near the drains
and nullas etc. )
 The area to be injected: not
usually cleaned
 Body parts: Unsafe parts of
body such as groin / thigh or
 Injecting equipment: reuse or
Which of the following YOU can share with a friend
of yours?
towel / napkin
 A plate of food
 A spoon
 A glass for drinking a beverage
 A dress
 Undergarments
 Toothbrush
Injecting is very often a group activity
The sharing may involve:
 Sharing
 Sharing Syringes
 Sharing injecting paraphernalia (i.e. the cookers or pots
in which drug has been prepared for injecting).
Why do IDUs share?
Economic reasons: Unavailability of injecting
equipments - the drug may be procured from a drugpeddler, but the injecting equipment may be available
only at a pharmacy, which may be reluctant to sell
needles-syringes or may choose to sell them at a
Psychological reasons: Sometimes IDUs may choose to
share their injecting equipments, just because they feel
their bonding with each other will be strengthened by
this act.
Poor awareness: of consequences of sharing or of safe
injecting practices also contributes to risky practices
Risks of sharing
Transmission of blood borne infections such as
Risks of Injecting
Risk of local (injection site) infections like
Thrombophlebitis (blocked veins), abscess,
gangrene, amputation etc.
Risk of spread of local infection to other parts of
body like septecemia, endocarditis, etc.
Risk of accidental injury to arteries leading to
severe bleeding
Risk of spread of blood borne infections like HIV,
Hep-B and Hep-C
Risk of overdose and Toxicity