
Drugs. Heroin, Methamphetamine, Cocaine, and Ketamine—for the majority of us these drugs are nothing more than terms we have heard in Health class, or things we have seen portrayed in Hollywood films; however, sadly for the group of 222 subjects involved in a study conducted by Stephen E. Lankenau they are drugs, that when injected for the first time, made them nothing more than statistics relating injection to hopelessness, depression, and homelessness. Lankenau, an associate professor at Drexel University, conducted a study between 2004 and 2005 during which he interviewed young injection drug users (IDUs) about their initial injection session with hopes to draw conclusions based on differences from injection drug users based on what the initial drug injected was: heroin, methamphetamine, cocaine, or ketamine. Despite the fact many people would argue any study based off of teenage runaways with a history of being strung out on hard drugs would be questionable at best, after analyzing the data it is apparent that the type of drug first injected is related to certain characteristics of the initiate, risk behaviors at initiation, and future drug-using trajectories.For this study participants were chosen from as young as 16 up to 29 from public settings in New York, New Orleans, and Los Angeles based on a commonality that they had all injected ketamine at least once in the two previous years. The division based on which of the four primary drugs were initiated is as follows: heroin 48.6%, methamphetamine 20.3%, Ketamine 17.1%, and cocaine 14%. The variables that seems to be the most significant to drug type were: age at injection initiation, level of education, region of initiation, setting, mode of administration, patterns of self injection, number of drugs ever injected, current housing status, and their hepatitis C virus (HCV) status.
This study, described in the article
The First Injection Event: Differences Among Heroin, Methamphetamine, Cocaine, and Ketamine Initiates., used Questionnaire Development Software to help ensure the reliability of the results and conclusion. The overall mean age during enrollment was 22.3 years, and the subjects were mostly white, heterosexual males; a majority of which had histories of mental health care, HIV or HCV testing, and were not employed full or part time. These characteristics remained relatively invariable despite the drug type initiated. There were some significant differences pertaining to which drug type was used such as the age of the first injection: ketamine initiates began injection around 18.8 years old, cocaine was approximately 16.4, methamphetamine 16.2, and heroin 15.9 years old. Other interesting facts that differed among drug type were education difference, homeless status, history of drug treatment and arrest, and the HCV status. Based on the group of Ketamine initiates, 76.3% graduated from high school or obtained a GED, 62.1% were homeless, 31.6% had a history of drug treatment, and only 5.3% reported being HCV positive. While these figures are nothing to brag about they are impressive when compared to the fact that only 44.4% of methamphetamine initiates had comparable educations, 92.6% of cocaine initiates are homeless, 60.2% of heroine initiates have received drug treatment, 97.8% of methamphetamine initiates has a history of arrest, and 28.9% of methamphetamine initiates are HCV positive.
The characteristics of the first injection event was a topic focused on during the study, and in general a minority of IDUs initially planned their first injection, most initiated in groups of two or more and had used drugs prior to initiation, very few supplied their own syringe and sharing paraphernalia was common amongst all drug types. There were seven main variables which proved significant to the study: region of initiation, injection event setting, history of using the drug before the injection event, payment for the drug, mode of administration, who gave the injection, and the number of injections taken during the event.
The rationales expressed by the IDUs regardless of which drug they initially injected all seemed to mirror each other and were condensed into five main groups: curiosity, peer influence, efficiency of injection as a mode of administration, self-medication, and lowered inhibitions. Lankenau includes quotes from different users as they defend their rationale. There is records of a heroin initiate using curiosity for rationale stating that “I was just getting curious about it and I’d been thinking about it for a while.” The influence of peer pressure was shared amongst all drug types sometimes explained as passive, being exposed to injections from others, or active, being coerced into injecting for the first time. A methamphetamine initiate said: “I wanted to get high and I’d done drugs before, but if I wanted to get high at that point in time, I had to shoot it. That’s the only way they’d [friends] give it to me for free.” Other IDUs claimed that injecting was the more practical mode of administration because they were able to get the “biggest bang for the buck” and all users except for ketamine initiates blamed increased tolerance for their switch to injection. As can be expected self-medication was often cited, mostly among methamphetamine and heroin initiates. Subjects relied on injecting drugs to treat psychological symptoms like depression or to dull physical pain. Hopelessness was a common rationale shared by heroin initiates claiming they had nothing to live for, not caring about anything, or feeling self-destructive. Finally, lowered inhibitions towards needles as a result of using other drugs were one shared only by ketamine initiates.
The subjective recollections of experiences during the first injection are often influenced by the properties of the drug, use in combination with other drugs, drug history, mode of administration, quality and quantity, features of the user group as well as the setting of the event. The majority of heroin and methamphetamine initiates recall their initiation as being “blissful”, “heavenly”, and “euphoric”. Ketamine and cocaine initiates did not share the same euphoric state, and often described unpleasant physical sensations, auditory hallucinations, and uncomfortable intensity. Often times bad experiences during the first time resulted in negative opinions towards injections and some vowed never to inject again while others worried about the consequences of injection, both cases were most common in ketamine initiates. On the other hand, many participants, mostly those who started with methamphetamine and heroin, claim to have discovered a new affinity for injecting and plan on continuing.
There are many parallels shared between the type of drug first injected, other types of drugs injected, the number of drugs injected, and the “current drug of choice”. Very few ketamine initiates injected other drugs after initiation; whereas most of the heroine, methamphetamine, and cocaine initiates injected a variety of drugs. Only 21/1% of the ketamine initiates injected other drugs whereas 84.4% methamphetamine, 83.3% heroine, and 77.4% of cocaine initiates injected several others and 71.1% of ketamine initiated never injected another drug other than ketamine again. Only a small percentage of initiates of methamphetamine, ketamine, and cocaine refer to their initiation drug as their drug of choice; however 59.3% of heroine initiates due which may be due to the potency, euphoria or duration of high experienced from heroin.
This study, though it is the first to investigate the relationship between drug type and a variety of factors at the first injection event, has many facts which were previously reported in other results; however has drawn conclusions that have never before been studied. As a result of the study Lankenau suggests ketamine initiates could be a unique type of IUD which is older, more educated, less likely to be homeless or to have histories of drug treatment and arrest or to be HVC positive in comparison to initiates of the other drugs studied. Ketamine initiation also differs in that it is usually given free and injected intramuscularly by the initiate as opposed to into a vein. Also, given that ketamine was not linked to a precise region suggests its general availability. Ketamine initiates were also least likely to transition into injecting other drugs and carry the lower risk subgroup of IDUs.
As a result of Lankenau’s in depth analysis on the first injection event and its impact on the type of drug injected, we are able to see that amongst the four drugs studied-- methamphetamine, heroin, cocaine, and ketamine—ketamine appears to have the most unique factors contributing to it. This article relates how demographic characteristics, first injection event situations, as well as the trajectories of drug careers following initiation can be associated with the drug injected.
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