September 2013

Risky behaviour among young injectors

While evidence suggests that Australia’s population of people who inject drugs (PWID) is getting older, a study found that, due to their high-risk injecting drug behaviours, young PWID are still an important target for harm reduction messages.

Previous research comparing younger PWID (generally regarded as those under
30 years old) with older users has found that the former group report:

  • injecting at a higher frequency;
  • higher levels of sharing of injecting equipment;
  • higher levels of engaging in risky injecting behaviours; and
  • lower engagement with health and treatment services.

These activities and characteristics have implications for acquiring blood borne viruses and injecting-related injuries and raising awareness of prevention practices.

Lead researcher Danielle Horyniak from Burnet Institute began exploring risk behaviours and health outcomes among young PWID as part of her PhD. Danielle told the Bulletin that, while there had been past studies that identified youth and high-risk injecting behaviours, they had tended to compare across just one or two groups.

“There’s only limited understanding of this relationship, as we can’t tell whether there are differences within these groups. For example, is the risk the same for an 18-year-old as a 25-year-old?”

Having coordinated the Victorian arm of the study a few years ago, Danielle was familiar with the Illicit Drug Reporting System and “knew that we had data from thousands of participants of all ages on a range of injecting practices and related health outcomes.”

Using 11 years of survey data, the study looked at almost 7000 regular PWID. Four areas were examined: the incidence of public injecting; needle sharing; injecting-related problems such as absesses or dirty hits; and non-fatal heroin overdose. The study found that age is related to the extent to which PWID engage in high-risk injecting behaviours, and that this has remained stable across the past decade.

I wasn’t surprised to find that younger participants were more likely to report recent risk behaviours, as this supported what had been found in other studies. But I was surprised by the strength of the findings.

Danielle Horyniak

Danielle told the Bulletin: “I wasn’t surprised to find that younger participants were more likely to report recent risk behaviours, as this supported what had been found in other studies. But I was surprised by the strength of the findings – each five-year increase in age was associated with a 16% reduction in the likelihood of reporting receptive needle sharing in the past month and a 10% reduction in the likelihood of reporting that their most recent injection took place in a public setting.

“The other thing that surprised me was finding that there was also a significant relationship between younger age and having had a non-fatal heroin overdose in the past six months. There hasn’t been a great deal of research on non-fatal overdose, and although there have been a few studies which show greater risk among younger PWID, statistics show that it is older, long-term users who are most likely to die of a heroin overdose, and it is these users who have been the target of overdose prevention campaigns in the past.

“Since the rates of both fatal and non-fatal overdose decreased dramatically after the Australian heroin shortage in 2001, overdose prevention hasn’t received much attention. Our findings suggest a need for prevention campaigns which address overdose risk among both younger and older users.”

A number of explanations were put forward for the higher-risk characteristics found in young people, including:

  • less knowledge of safe injecting practices and limited access to clean injecting equipment;
  • a lack of planning and less stable financial situations may lead to sharing of equipment and high rates of public injecting;
  • public injecting could also be attributed to young PWID still living in the family home or sharing accommodation; and
  • high-risk behaviours are the result of the general risk-taking and impulsiveness typically associated with young adulthood.

These results demonstrate that younger PWID are clearly an important target for prevention and harm reduction, particularly in relation to heroin overdose.

As Danielle said: “Our findings suggest that it will be really important to ensure that younger PWID have access to naloxone programs.”