An Overview of Injecting Drug Use and HIV Infection in Edinburgh, Scotland-Maximizing Benefit and Minimizing Harm

By Lewis, Roger | Journal of Drug Issues, Winter 1997 | Go to article overview

An Overview of Injecting Drug Use and HIV Infection in Edinburgh, Scotland-Maximizing Benefit and Minimizing Harm


Lewis, Roger, Journal of Drug Issues


Since 1983 parts of Scotland, unlike England, have experienced a major drug-related HIV epidemic. Edinburgh and Lothian currently have a known HIV-infected population of 1,105. A variety of harm-reduction measures, including needle exchanges, methadone prescription, community drug agencies, and targeted prevention campaigns have been implemented since 1985. The number of drug-related HIV infections reported has fallen significantly since 1988. However, sexual transmission remains a cause for concern, particularly among the injecting and non-injecting partners of HIV-positive drug users.

Introduction

Edinburgh, the capital of Scotland, is renowned for its culture and architectural beauty. It is also said to be one of the most socially segregated cities in the United Kingdom. Problem drug use in the form of heroin consumption became evident in some multiply-deprived districts in the early 1980s. Pharmaceutical preparations subsequently became popular among problem drug users, particularly following the identification of a drug-related HIV epidemic in 1985 and a tailing off in heroin supplies. A rapid and concerted response to HIV based on the concept of harm reduction has determined the success of treatment and prevention services over the past 10 years in influencing drug-use practices. Drug use in prisons remains a cause for concern. As elsewhere, services have been less successful in changing the sexual behaviors of injecting drug users.

Context

Edinburgh has a population of 415,000. The region of Lothian in which it is located has a population of 0.75 million. The overall population of Scotland is 5.4 million. Difficulties arising from problem drug use in Scotland, especially the HIV epidemic, need to be viewed in the context of the past 15 years. Initially, there was little evidence of illicit drug consumption in depressed urban areas. However, in the early 1980s a black market in heroin emerged, accompanied by a rapid increase in the consumption of other drugs, particularly in Edinburgh and in Glasgow. It did not take long for illicit opioids and those who injected them to become part of the landscape (Barnard and McKeganey 1990). Typically, addicts were young, injectors, frequently from poor urban areas and unemployed. In 1986 when unemployment throughout Edinburgh approached 13, male unemployment in one area with a large addict and HIV-infected population was estimated at 32.3 (Robertson and Bucknall 1986).

Patterns of Consumption

In the early 1980s heroin dealers in Scotland's largest city, Glasgow, who bought and sold in ounce quantities, seemed to be heavy users themselves. Other user-dealers operated at the gram level as retail outlets for other suppliers. Distribution tended to be organized at a local community level, reflecting the traditional organization of the Glasgow criminal subculture. Anecdotal reports suggest a similar pattern occurred in Edinburgh. Until the mid-1980s, heroin arrived in Edinburgh in ounce or multi-ounce quantities. It was subsequently broken down for distribution by minor wholesalers employing user-dealers. By the late 1980s the Glasgow market was far more sophisticated than that of Edinburgh, with established connections to bulk suppliers in England. Stealing and dealing were two common ways of financing heroin consumption, shoplifting being seen as less risky than other forms of revenue-raising crime.

The incarceration of a number of wholesale heroin dealers, a move from heroin into mortgage fraud by local career criminals with disposable capital, high levels of HIV infection, and a significant increase in substitute prescribing led to a reduction in the supply and consumption of heroin in Edinburgh by the latter 1980s. This reinforced a growing trend towards the consumption of pharmaceutical products The `illicit pharmacopeia' is remarkably varied and subject to continuous change (Hammersley et al. 1990). Prior to the identification of HIV, Scots experimenting with heroin tended to initiate consumption by injection or rapidly shift to that route. …

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