Evidence for controlled heroin use? Low levels of negative health and social outcomes among non-treatment heroin users in Glasgow (Scotland).

OBJECTIVES: This longitudinal study focused on 126 long-term heroin users who had never been in specialist treatment for use of any drug. The primary aim of the study was to assess whether this 'hidden' population resembled heroin users identified with drug treatment agencies, or alternatively, to test whether heroin could indeed be used in a controlled, non-intrusive fashion for an extended period of time. DESIGN AND METHODS: Recruitment was achieved through chain-referred purposive sampling methods, and data were collected through two semi-structured interviews. 67% of participants were re-recruited for follow-up. RESULTS: Participants had levels of occupational status and educational achievement comparable to that in the general UK population, and considerably higher than typically found in heroin research. At the conclusion of the study, six participants had entered treatment. While there was evidence of intensive risky patterns of drug use among the sample, there was equal evidence for planned, controlled patterns of use. Some drugrelated negative health and social outcomes had occurred on a lifetime basis, but ongoing problems were rare, and heroin was not a significant predictor in either context. In contrast to typical samples of heroin users, high levels of negative health and social outcomes did not appear to be inevitable within this sample. Frequency of heroin use was predicted by attributional items, indicating the importance of psychological factors in drug use and addiction. CONCLUSIONS: Drug research should more fully incorporate previously hidden populations to more fully inform theory and practice. The pharmacological properties of specific substances should not be assumed to inevitably lead to addictive and destructive patterns of drug use.

A qualitative exploration of the impact of cultural and social factors on heroin use in Shetland (Scotland).

In order to gain a greater understanding of the impact of social and cultural factors on patterns of heroin use and use-related behaviors, in-depth interviews were carried out with 12 heroin users in Shetland. Analysis revealed the existence of a small, highly organized and highly covert heroin subculture. Within this group, users were predominantly older, and their use was reported as being relatively self-controlled and unproblematic in nature, especially by comparison to the heroin use associated with deprived urban areas. There were indicators, however, that this situation seemed to have entered a phase of change, reflected by descriptions of an increasing number of younger, less controlled heroin users. Within the theoretical framework of drug, set and setting, the importance of drug-using norms and rules among heroin users in both regulating and maintaining patterns of use, even through periods of change, was identified. Shetland, with its relative affluence, small size and geographical isolation constitutes an unusual setting for research into heroin use, which customarily has been viewed as an urban phenomenon. Thus it offers the opportunity to gain insight into the nature of heroin use and associated behaviors from a relatively novel perspective.