Trends in treated opiate misuse in Dublin: the emergence of chasing the dragon.

AIMS To examine trends in treated opiate misuse and identify factors associated with route of heroin use. DESIGN Cross-sectional survey. SETTING Services providing addiction treatment in Dublin. PARTICIPANTS Individuals making their first ever contact seeking treatment for current opiate misuse, between January 1991 and December 1996. MEASUREMENTS Data on socio-demographics and current drug use. FINDINGS The study population was 3981. Over the 6-year period, there was a 330% increase in the number of new attenders. The proportion of females increased. The mean age of first opiate use declined and users began presenting earlier in their opiate-using careers, causing a decline in the age profile of new attenders. Heroin users were more likely to smoke (chase) rather than inject after 1994 (odds ratio 3.3, 95% confidence interval 2.4-4.5). Apart from year of presentation, the other significant independent predictors of chasing as the preferred route of heroin use were being in employment, shorter history of use, less frequent use, younger age, longer period in education and absence of polydrug use. Gender did not independently predict route of use. CONCLUSIONS Ireland has joined the growing number of European countries witnessing a movement towards heroin chasing. This has coincided with a surge in the number of people entering treatment. We are concerned that the greater acceptability of this route of use may be drawing increased numbers of individuals into heroin use.