Former injectors: A new paradigm for studying self-modification of addictive behavior

Objective: Among the various modes of drug administration, injection is the most cost-effective and provides the most intense drug effect. We examined characteristics of “former injectors,” drug users who transitioned from injecting to non-injecting use of heroin and cocaine, and avoided relapse back to injecting.

Methods: “Former injectors” were defined as persons who had injected illicit drugs, but not in the previous 6 months while continuing to use “injectable” drugs through intranasal use and/or smoking routes. 277 subjects were recruited from entrants to a drug detoxification program. Interviews and HIV counseling/testing were administered.

Results: The former injectors were 40% Black, 38% Latino/a, 21% White, 79% male, 21% female, and had a mean age of 44. They reported a mean of 12 years between first and last injection, and a mean of over 10 years since last injection.

Length of time since last injection was associated with later age at first drug injection and shorter injection histories. Controlling drug use was the most frequently reported reason for ceasing to inject but avoiding AIDS, other health concerns, maintaining positive social relationships, maintaining a positive self-concept as a non-injector, and preference for the more “mellow” high associated with intranasal heroin use were all cited frequently. A very large majority—88%--reported that it was “relatively easy” to avoid relapsing to injecting.

Conclusions: Being a long-term “former injectors” contradicts a number of current assumptions about drug addiction. Research on former injectors may provide important insights into drug users' abilities to modify addictive behaviors.