Abstract: Aim: The injection of non-sterile methadone designed for oral consumption is associated with serious health risks. There is only a small number of studies on this topic, with divergent results. The main aim of the present study was to obtain data on the frequency of methadone injecting in a state out-patient clinic specialised in substance use disorders. Methods: Eighty patients in methadone maintenance treatment were interviewed with a short questionnaire. Mean age was 32 years, 76% were male, mean methadone dose was 55 mg. Results: Twenty-six patients (32%) indicated having injected methadone at least once in their life. Only four patients (5%) reported having injected methadone within the preceding month (mean dose 56 mg). All four had injected additional substances during this month. Conclusions: Frequency rates appeared low compared with other studies despite a generous take-away policy. The results suggest an association between methadone injecting and a more general tendency to inject substances.

Abstract: A series of unexplained deaths associated with soft-tissue inflammation and severe systemic sepsis was reported among injection drug users (IDUs) in the United Kingdom and the Republic of Ireland in 2000. Health Canada has identified one reported fatality in an IDU that matched the case definition. Although the cause of the epidemic in the UK and Ireland is not fully understood, contributing factors include injecting into muscle or beneath the skin, rather than directly into a vein, and the use of acid to dissolve the heroin. This single Canadian case is considered to be a sporadic event that occurs at a low background rate among IDUs. These cases serve to remind primary health care providers to be vigilant in cases of soft-tissue infection among IDUs and not to underestimate the potential severity of the situation.

Abstract: Dans de nombreux pays développés, les programmes d’échange de seringue (PES) sont un des éléments clefs de la politique de réduction des risques chez les usagers de drogues. La plupart des études sur les PES tendent à montrer qu’ils sont protecteurs vis-à-vis de la transmission du virus du sida (VIH) à condition d’être complétés par d’autres actions de réduction des risques. Leur efficacité sur la transmission du virus de l’hépatite C (VHC) semble beaucoup moins certaine. De plus, il apparaît que les jeunes usagers de drogues par injection (UDI), groupe à haut risque de contamination par le VIH et le VHC, ne fréquentent pas ou très peu les PES. En plus de maintenir un niveau d’accès suffisant aux seringues stériles, il est nécessaire de s’interroger sur la manière de toucher les jeunes usagers de drogues commençant à s’injecter des produits, en travaillant notamment sur leurs réseaux sociaux. Il faut également développer la prévention des pratiques sexuelles à risque, qui sont fortement associées aux pratiques à risque liées à l’injection. Enfin, il faut améliorer la qualité des évaluations de ces programmes. In several developed countries, needles exchange programs (NEPs) are a key preventive tool in harm reduction policy related to drug use. Many studies about NEP show it reduces HIV infections related to syringes sharing when part of others preventive actions. NEPs seem to have no impact on HCV transmission. Furthermore, young drug users, who are at high risk for HIV and HCV infections, are not attending NEPs very often. Trying to maintain high accessibility to sterile syringes, efforts must be stressed on hard-to-reach populations such as young injection drug users (IDU), focusing on their social network. Emphasis must also be put on prevention of unsafe sexual intercourse, often related to syringe sharing, which must be more prevented. Finally, design of assessment studies should be improved.