Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Harm Reduct J. 2019 Dec 5;16(1):65. doi: 10.1186/s12954-019-0337-z.
In several countries, especially in Africa, the dominant method of heroin intake is smoking a joint of cannabis laced with heroin. There is no data exploring the impact of smoking heroin with cannabis on treatment outcomes.
To compare treatment outcomes between people who inject heroin and people who smoke heroin with cannabis.
Three hundred heroin users were assessed on admission to inpatient rehabilitation and after treatment. We compared drug use, psychopathology, criminality, social functioning and general health between heroin injectors and heroin-cannabis smokers at treatment entry, and at 3 and 9 months after rehabilitation.
The sample comprised 211 (70.3%) heroin-cannabis smokers and 89 (29.7%) heroin injectors. Eighty-four percent were followed up at 3 months and 75% at 9 months. At 9 months, heroin-cannabis smokers had a higher proportion of those who relapsed to heroin use compared with intravenous (IV) users (p = 0.036). The median number of heroin use episodes per day was lower for IV users than heroin-cannabis smokers at both follow-up points (p = 0.013 and 0.0019). A higher proportion of IV users was HIV positive (p = 0.002). There were no significant differences in psychopathology, general health, criminality and social functioning between IV users and heroin-cannabis smokers at all three time points.
Heroin users who do not inject drugs but use other routes of administration may have increased risk for relapse to heroin use after inpatient rehabilitation and should therefore have equal access to harm reduction treatment services. Advocating a transition from injecting to smoking heroin in an African context may pose unique challenges.
在一些国家，特别是非洲，海洛因的主要吸食方式是吸食大麻卷中的海洛因。目前尚无数据探讨吸食掺有大麻的海洛因对治疗结果的影响。
比较注射海洛因和吸食掺有大麻的海洛因人群的治疗结果。
300 名海洛因使用者在入院接受住院康复治疗时和治疗后接受评估。我们在治疗开始时、治疗后 3 个月和 9 个月比较了海洛因注射者和海洛因-大麻吸食者的药物使用、精神病理学、犯罪行为、社会功能和一般健康状况。
该样本包括 211 名（70.3%）海洛因-大麻吸食者和 89 名（29.7%）海洛因注射者。84%的患者在 3 个月时和 75%的患者在 9 个月时得到了随访。在 9 个月时，与静脉注射（IV）使用者相比，海洛因-大麻吸食者中有更多的人复吸海洛因（p = 0.036）。在所有随访点，IV 使用者的每日海洛因使用次数中位数均低于海洛因-大麻吸食者（p = 0.013 和 0.0019）。IV 使用者中 HIV 阳性的比例更高（p = 0.002）。在所有三个时间点，IV 使用者和海洛因-大麻吸食者在精神病理学、一般健康、犯罪行为和社会功能方面均无显著差异。
在住院康复治疗后，不注射毒品但使用其他给药途径的海洛因使用者可能有更高的复吸海洛因的风险，因此应平等获得减少伤害治疗服务。在非洲背景下提倡从注射转为吸食海洛因可能会带来独特的挑战。
