Injection drug using women and the means by which they support their drug use AIMS AND METHODS The purpose of the present paper is to investigate the ways in which women who inject heroin or amphetamines procure drugs and finance their drug use. The results are based on standardised interviews conducted at the needle exchange programme in Malmö between 1 July 2005 and 30 September 2006. In total, 188 out of the 232 women who visited the programme during this period were interviewed. RESULTS A vast majority of the women (93%) buy most of the drugs they use themselves. Among the women interviewed, the most common sources of income were; social benefits (45%), dealing (23%), prostitution (22%), theft (21%) and paid work (16%). A majority of the women (53%) reported use of both formal and informal incomes to finance their drug use over the last two weeks, just over a third of the women (36%) reported only formal incomes, and a small minority (12%) reported only informal incomes. A majority of the women also reported to have been provided with drugs by others. In most cases, the provider was a man (p>.01). Women with heroin as their principal drug more frequently reported multiple sources of income (p>.01), income through prostitution (p>.001), dealing (p>.01) or theft (p>.05), whereas women with amphetamines as their principal drug more frequently reported income through paid work (p>.05) or pensions (p>.01). CONCLUSIONS Few women correspond to the stereotypical image of the homeless and outcast street addict who supports her drug habit mainly through prostitution and illegal activities or by contacts with male addicts. The majority of the women in this study have a relatively stable housing situation, the vast majority (93%) are active actors on the drug market who buy most of the drugs they use themselves, and most of the women use incomes from both formal/legal and informal/illegal sources. For most of the women, drugs provided by others only constituted a complement to those obtained by the women themselves. A few women, however, who did not report any personal income, seem to be highly dependent on others to secure a safe supply of drugs. Some women also reported that they had had to perform sexual services in order to get access to drugs from male suppliers. For women with heroin as their principal drug, it seemed much more difficult to finance their drug use by legal incomes only. KEYWORDS Women, injection drug use, heroin, amphetamines, needle exchange programme, income, drug economy.

Women Who Inject Heroin or Amphetamines - Differences in Life Situation, History of Treatment and Request for Help

The purpose of the present paper is to investigate differences between women who inject heroin and women who inject amphetamines, particularly as regards their life situation, treatment history and current request for help. The results are based on standardized interviews with 188 women at the needle exchange program in Malmö. A larger proportion of amphetamine users had stable housing combined with exclusively legal/formal sources of incomes (wage labour, pension, social benefits), whereas a larger proportion of heroin users had unstable housing combined with illegal/informal sources of income (prostitution, dealing, theft). This implicates that amphetamine users, in general, are more socially included whereas heroin users are more marginalized. Women with heroin as their principal drug reported to a higher extent, experiences of all types of treatment, lifetime history of treatment, treatment at several different occasions and contact with the social services and outreach groups during the last year. Several factors where significantly related to a request for help, whereas heroin as principal drug was the single factor showing a significant relation to request for help in a multivariate logistic regression equation. The differences between the two groups as regards their history of treatment and present requests for help may have several explanations. One probable explanation has to do with different levels of abuse and dependence in the two groups, where heroin users, due to a higher level of dependence, have a greater demand for care and treatment. A second explanation concerns differences in treatment supplies available for the two groups. To this day there is no evidence-based treatment for amphetamine abuse. Treatment options for heroin abuse, on the other hand, are well documented and well recognized and heroin users are a prioritized group for interventions within the Swedish care system.

Background: Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. Methods: The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. Results: The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. Conclusion: The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services. (C) 2014 Elsevier B.V. All rights reserved.