Routes of drug administration and multiple drug misuse: regional variations among clients seeking treatment at programmes throughout England

To investigate regional variations across England in routes of administration for heroin, non-prescribed methadone, non-prescribed benzodiazepines, cocaine powder, crack cocaine and amphetamines.

A survey of 1053 clients recruited to 54 residential and community drug misuse programmes.

Structured face-to-face interviews conducted with clients at admission to treatment.

Routes of administration included injecting, smoking, snorting and oral use. For some drugs (methadone and benzodiazepines) one main route of administration was used. For other drugs (heroin, amphetamines and cocaine powder) there were marked variations in route. For all drugs except benzodiazepines, there were regional differences in routes of administration. Heroin injectors were more likely also to use other drugs by injection.

The differences in routes of administration of different drugs, and the regional differences in routes of use, have implications for the provision of preventive and treatment services. Interventions to prevent transitions to injecting may be especially appropriate in areas where injecting is not prevalent. Hepatitis B vaccination continues to be advisable in both areas of high and low injecting prevalence. Needle exchange schemes and interventions targeted at drug overdose may be more suitable in areas of high injecting prevalence. Further research into regional differences in routes of drug use should be conducted with non-clinical samples.