From the deal to the needle : drug purchasing and preparation among heroin users in drug treatment in south London

The article uses a semi-structured interview method to assess the acquisition, preparation and use of heroin in a cohort of 114 drug users in contact with treatment services in south-east London, and examines the impact of the increase in crack availability on heroin use and preparation in this population. Seventy-six participants reported using heroin on a daily basis, involving an average of 2.8 hits and using a mean of 0.75 g on each using day. Although almost all of the sample bought their own heroin, very few were confident of assessing its quality, and the mean estimated purity level of heroin bought was 22.7%. Similarly, most of the sample believed that the heroin purchased was adulterated and, although most believed that the heroin quality was evident during the preparation stage, relatively few would ask about quality at the point of purchase, and it is apparent that the beliefs held by much of the sample about drug purity issues did not impact upon their behaviour. Seventy individuals reported the joint use of heroin and cocaine with 41 of these reporting that they used heroin to come down from the high of crack, although 17 of them reported simultaneous administration (either combined in the syringe or on the foil). The variations in patterns of behaviour identified and the lack of awareness of risk reported would suggest that there are significant implications for the development of both the harm reduction strategies for multiple drug users and for the treatment services for whom complex multiple drug use is increasingly the norm.