Transitions between the injection of heroin and amphetamines

Aims. To assess in current injecting heroin and amphetamine users to what e xtent their history of injecting represents a transition from amphetamine t o heroin. Design. Cross-sectional survey. Setting. Sydney, Australia. Parti cipants. One hundred and fifty-one primary heroin injectors and 145 primary amphetamine injectors recruited through advertisements, needle exchanges, methadone maintenance clinics and by word of mouth. Findings. Six major tra nsition patterns were detected: heroin-heroin (n = 61), amphetamines-heroin (n=60), heroin-amphetamines-heroin (n=30), amphetamines-amphetamines (n=80 ), amphetamines-heroin-amphetamines (n=41) and heroin-amphetamines (n=24). A logistic regression analysis predicting presence or absence of a transiti on from the original primary drug indicated that length of injecting career , years of education and original drug injected were independent predictors . Thus, the longer the injecting career, the greater the likelihood of a tr ansition. If the original drug injected was amphetamine, the greater the li kelihood of transition; and the more prior years of education, the lower th e chances of a transition. Conclusions. While there was a small preponderan ce of movement from primary amphetamine injecting to primary heroin injecti ng, there was also movement in the other direction. Heroin use is not neces sarily a stable endpoint for injecting careers.