ILLICIT-DRUG INJECTION AMONG PSYCHIATRIC-PATIENTS WITHOUT A PRIMARY SUBSTANCE USE DISORDER

Objective: To increase understanding of HIV infection risk among patie nts with severe mental illness, the study sought to identify predictor s of injection drug use among patients who did not have a primary subs tance use disorder Methods: A total of 192 patients recruited from inp atient and outpatient public psychiatric facilities were interviewed b y trained mental health professionals using the Structured Clinical In terview for DSM-III-R (SCID), the Positive and Negative Syndrome Scale , and the Parenteral Drug Use High-Risk Questionnaire. Results: Sixty percent of the sample met SCID criteria for lifetime substance abuse o r dependence. Although only two patients reported drug injection in th e past six months, 38 (20 percent) had injected drugs since 1978, the year that HIV began to spread in the U.S. A lifetime diagnosis of opio id abuse or dependence was a strong predictor of drug injection, but o nly 11 of the 38 patients with a recent history of injection drug use had either of these diagnoses. The likelihood of injecting drugs was f oul times greater among patients with a history of intranasal substanc e use compared with those without such use, three and a half times gl eater among African-American patients than among non-African-Americans , and five times greater among patients aged 36 or older compared with younger patients, Conclusions: In assessing HIV risk among patients w ith severe mental illness, it may be more important to identify the ro ute of drug administration than the specific substances used because o f the strong association between intranasal drug use and history of in jection.