This part of the report begins by summarising findings from previous Australian research (discussed in greater detail in Appendix C) which may shed light on issues of interest in the present study.
2.1.1 Levels of injecting drug use
2.1.2 Characteristics of Indigenous IDUs
2.1.3 Patterns of drug use
2.1.4 Obtaining clean equipment
2.1.5 Safe and unsafe injecting
2.1.6 Suggested improvements
2.1.1 Levels of injecting drug useStatistical information currently available is not adequate to provide reliable information on the incidence or prevalence of drug injecting among Aboriginal and Torres Strait Islander Australians. However, survey research and analysis undertaken in several previous studies suggest that overall levels of injecting drug use among Indigenous Australians are relatively high (reportedly somewhat higher than in the non-Indigenous population) and that they have tended to increase over time.
2.1.2 Characteristics of Indigenous IDUs
GenderInformation presented in previous studies suggests that between about half and two-thirds of Indigenous IDUs are male. Thus, while female injectors may be in the minority, their numbers are significant.
AgeThe research indicates that the age range of Indigenous IDUs is wide, and that many young people (teenagers and even children) are included. In both an early Queensland study conducted in 1996, and a 2003 South Australian study, the mean age of first injecting was around 18 years. The findings of other studies are generally consistent with this, recording that injecting commonly begins in the teenage years, and below the age of 12 in some cases. There is some evidence of a trend towards increasingly young initiation of drug injecting.
Available Australian data on age and gender among IDUs in general indicate little difference between Indigenous and non-Indigenous IDUs.
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EducationThe research indicates typically low levels of educational achievement among Indigenous IDUs.
ImprisonmentPrevious studies report that many Indigenous IDUs , both male and female, have been in juvenile and/or adult detention, and that incarceration is more common among Indigenous than non-Indigenous IDUs.
2.1.3 Patterns of drug useEarlier studies report that the drugs used by Indigenous IDUs may vary from time to time and place to place depending on availability, cost and the like. While injecting of amphetamines is common, heroin is often the drug preferred. People living in urban areas are generally more likely to report using heroin, while amphetamine use is more commonly reported in non-urban areas. It is quite common for amphetamines to have been used in other ways (eg smoked or ingested) before they are first injected. As is reported for IDUs in general, polydrug use is common.
Some of the previous research indicates that first-time Indigenous injectors typically have assistance from others more experienced, and that this most often comes from another Aboriginal person(s) who may be a relative, friend or partner. The existence of drug injecting among friends or family members can increase the likelihood of an individual beginning to inject.
According to a Western Australian study reported in 2001, relatively few Indigenous IDUs inject alone. Most tend to inject in company with some combination of friends, family members and partner. In the WA study, these companions were mostly Indigenous.
2.1.4 Obtaining clean equipmentSome earlier studies have reported community pharmacies as the main source of clean injecting equipment among Indigenous IDUs, but this is likely to reflect the fact that NSP services were less available in past years than they are today. Other sources include NSP outlets, secondary NSP services such as hospitals, Aboriginal medical services, and friends or drug dealers. The early Queensland study noted that younger people, in particular, were more likely to rely on friends than to visit a pharmacy or NSP. The South Australian study reported that it was common for Indigenous NSP clients to collect 'bulk' supplies of needles and syringes that they could then pass on to others who needed them.
Factors identified as inhibiting access to clean equipment include cost, limited hours of availability and, in particular, unfriendly or judgemental staff attitudes. Numbers of the Indigenous IDUs who participated in earlier studies have reported being reluctant to seek injecting equipment from an Aboriginal-specific service (eg an AMS) because of concerns about privacy, confidentiality, expertise and/or staff attitudes. Because of the anonymity they offer and the fact that they function without time limits, vending machines are seen as offering an important service.
2.1.5 Safe and unsafe injectingPrevious studies report that sharing of needles is quite common among Indigenous IDUs – and among young IDUs in particular. Using a needle before or after someone else is frequently said to involve cleaning the needle between users, but it is by no means clear that the methods used for this are consistently effective. (Some of the information resources available to IDUs describe cleaning methods that may be used when there is no alternative, but current best practice in the NSP sector is to urge 'a new fit for every hit'.) Past research with IDUs in general shows that they offer a range of reasons for sharing injecting equipment18. In the earlier Australian studies the reasons given by Indigenous IDUs for sharing needles or other equipment include lack of access to sterile equipment, being part of a group that regularly injects together, confusion or mistake, and lack of concern (sometimes of a fatalistic kind) about the possible consequences of sharing.
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2.1.6 Suggested improvementsIndigenous IDUs consulted in previous studies have advocated:
- better access to clean injecting equipment
- additional counselling and treatment services – either Indigenous-specific or mainstream, so long as they demonstrate awareness of both drug-using and Indigenous issues
- increased education and information in various forms – for IDUs themselves, in schools, in prisons, for the wider Indigenous community
- greater use, in particular, of peer education and support among Indigenous IDUs
- printed or graphic resources designed to communicate effectively with various groups of Indigenous IDUs and to demonstrate that services are Indigenous-aware
- use of other, non-print means of communication such as music, radio and social events or gatherings
- promoting a more realistic and open awareness within Indigenous communities of issues around drug use and drug injecting.
18 Reasons recorded as early as 1994 included difficulty in obtaining sterile equipment, the dangers not seeming so important when in withdrawal, and injecting occurring with friends or lovers – see Ross M, Wodak A, Stone A, Gold J (1994) 'Explanations for sharing injection equipment in injecting drug users', Addiction 89:4 pp 473-79.