Executive summary

The current study examined transitions in routes of benzodiazepine administration among heroin users in Sydney. Of 312 heroin users, 94% had used benzodiazepines and 72% had used them in the six months prior to interview. Benzodiazepine injecting was fairly common, with 28% ever having injected these drugs and 13% having done so during the six months preceding interview. Males and females were equally likely to have injected benzodiazepines.

A transition to injecting benzodiazepines did not necessitate injection becoming the primary route of benzodiazepine administration. In this way a transition to injecting benzodiazepines differed markedly from a transition to injecting heroin or amphetamines. Nevertheless, the injection of tablets, intended exclusively for oral consumption, represents a serious health concern.

While there were clear harms associated with oral benzodiazepine use among the sample, these harms appeared to be exacerbated among subjects who had injected benzodiazepines. Current benzodiazepine injectors showed greater polydrug use, injection-related HIV risk-taking behaviour, criminal involvement, psychological distress, and injection related health problems, as well as poorer general health, and an increased risk of having overdosed than oral users of benzodiazepines.

Of clinical importance were the reasons given by ex-benzodiazepine injectors for having ceased injecting benzodiazepines. Concern for general health emerged as the most common rationale for having made a transition away from injecting, and for being likely to make such a transition.

The results of the present study suggest that heroin users can change their behaviour with regard to injecting benzodiazepines. Of those subjects who had ever injected benzodiazepines, 55% no longer did so. To enable heroin users to make better informed decisions about how they use benzodiazepines, they need to be advised of the risks associated with injecting these drugs. Staff in needle and syringe exchange programs and methadone clinics could play a pivotal role in the education process.