Assessing non-injecting heroin use in Birmingham, UK : a comparison of characteristics and reasons for non-injecting in samples of never-injected and formerly-injecting heroin users in contact with adult drug treatment

Aims: To explore reasons why individuals who prefer to use heroin by routes other than injection have abstained from injecting despite entrenched heroin use. Methods: A cross-sectional interview using structured and semi-structured questions was carried out with 40 non-injecting heroin users (20 former injectors and 20 who had never injected) recruited at two Community Drug Team sites in Birmingham, UK. Results: The most endorsed reason for non-injection was worry about appearance. Additional reasons included identity issues and stigmatized status of injecting. ‘Never injectors’ were younger (p<0.05), more likely to have an educational qualification (OR: 4.89; 95% CI: 1.20, 19.94), had higher measured heroin dependence (p=0.05) and lower prior exposure to injecting (p<0.001) than former injectors. There was no difference between the groups in estimated prevalence of injection among peers. Conclusions: This study points to continuity between injecting and non-injecting cultures, challenges the concept of injection as a natural progression from non-injecting heroin use, and highlights personal addiction career factors in injection transitions.