Heroin chasers and heroin injectors: differences observed in a community sample in London, UK.

"Chasing the dragon" has spread rapidly as a method of use of heroin in many countries over the last quarter of a century, and is now the most widely used method of heroin use worldwide. However, little examination has been made of the differences in characteristics and drug-taking patterns between heroin chasers and injectors. In this study, a comparison is made of the personal, social and drug-taking characteristics of heroin users in a community sample (i.e., not drawn from treatment services, contacted through a range of non-treatment access routes), according to whether the heroin user was currently a heroin chaser or injector, and according to whether or not they had ever injected. Data were examined on 400 heroin users contacted and interviewed in South London by privileged access interviewers using a structured interview schedule. Severity of dependence was measured using the Severity of Dependence Scale (SDS). Heroin chasing and injecting were almost equally prevalent among this community sample. Of the 400 heroin users, 178 (44.5%) identified "chasing the dragon" as their current route of heroin use, and 222 (55.5%) injecting. Heroin chasers were younger, though they had first used at an older age, had a larger proportion of non-using friends, and contained larger proportions of women and people of Afro-Caribbean origin. Injectors were using higher daily doses and were significantly more likely to be using on a daily basis. Those who had never injected were more likely to be women and to have friends who did not use drugs. Severity of Dependence (SDS) scores were greater amongst injectors, with scores for injectors almost all being above the informal clinical threshold of greater than 5; while one third of the chasers had SDS scores below this level. Heroin chasing had been a longstanding pattern of behavior for a large proportion of the study sample. Chasers were generally less deeply involved in a heroin-using culture and were less likely to be using heroin daily. Almost all low scores for severity of dependence were seen among the chasers, though a significant number of chasers had dependence scores at the most extreme. Heroin chasers display distinctly different personal and drug-taking characteristics and will need to be the subject of separate research studies and clinical programs.