One in 62: Young Injectors
Due to the usual limitations inherent in researching a population as "invisible" as injection-drug users (IDUs), the number of injectors under age 25 is hard to determine. However, it's common knowledge among adolescent health workers and those operating syringe exchanges in large American cities that use of injection drugs among youth is high and rising. Rapidly increasing rates of injection-drug use have been found among homeless and transient youth -- some studies indicate that IDU rates in these populations are close to 50%. But many young adult injectors also hold jobs and maintain regular living situations even while using drugs, and many school-age youths inject drugs, hormones, or steroids while living at home. Young injectors also live in rural or suburban areas that are not targeted for research. These young people will not be counted in research focusing on "street injectors," even though their numbers may also be high.
Youth InjectionDan Bigg doesn't need numbers to "prove" more and more youth are injecting drugs -- he sees them regularly through his work with the Chicago Recovery Alliance, an organization providing legal syringe exchange and other harm-reduction services to IDUs in the Chicago metro area. Bigg notes that the number of young injectors taking advantage of CRA's services "has increased steadily over the last nine years."
"Over the years, working with young injectors to reduce risk has been a progressively larger part of our work," states Bigg. "Most of all the under-24 injectors are white, and around half female." While some young injectors also shoot cocaine, speed, and other substances, heroin is still the most commonly injected substance in this age group.
Bigg estimates that there may be around 6,000 young injectors utilizing CRA services in Chicago and the surrounding suburbs, "based on 10% of those we see, and an estimated 60,000 injectors in the area." He notes also that most of the young injectors he sees initially come from the suburban areas surrounding the city of Chicago, and that the younger injection crowd "is much whiter" than the over-24 IDUs who use CRA's harm-reduction services.
Jae's Story"It's a part of my history that I'm trying to deal with but haven't quite figured out or come to terms with."
27-year-old Jae* began injecting drugs in 1990 at the age of 17, while working as a political activist in Seattle. In 1993, she left Seattle and returned to the East Coast, where she stopped using injection drugs. She is now a graduate student, married, and the mother of a preschool-aged child. "I haven't used needles since I left, in 1993. I nursed my daughter for longer than I shot heroin. I still have scars on my arms, however, from shooting up many times a day."
While Jae doesn't fit the profile most people associate with injection-drug users, her story would come as no surprise to those knowledgeable of youth injection trends throughout the United States.
"I come from a middle-class background, with educated parents. I went to good public schools, management programs, was a National Merit Scholar in 10th grade -- then I dropped out of school to travel around the country with a Greenpeace job. I ended up in Seattle, and soon had a new roommate, a guy in his mid-twenties who urged me to try shooting cocaine. After a week of deliberation, I decided it was my mission in life to experience everything I could and this was a chance I couldn't pass up.
"So, of course, blah blah blah, flash three years ahead to me, totally strung out on heroin, having done (many times) each and every thing I had sworn I would never stoop to, 20 pounds too skinny, with everything I owned in my backpack."
During her time as an injection-drug user in Seattle, Jae's injection peer group consisted of "mostly white twenty-somethings, about 2/3 male, a few older black and Latino men, and some mid-teenage street kids. Most of the people I hung out with were involved in some way in . . . the intellectual hippie/punk scene."
Also contrary to popular opinion, Jae and her peers were not primarily "initiated" into injection-drug use by older, hardcore injectors. "Most of the people I knew sought it out for themselves . . . I think most often someone would hint at their own needle use and the people who were interested in that would follow through by pursuing that person . . . the boyfriend/girlfriend element, when it occurred, really increased the pressure."
She adds "the young people I hung out with were really into exchanging needles -- not the case with the older folk -- but not safe sex."
In addition to an age-specific enthusiasm for needle exchanges, Jae also noticed a generational difference in comfort level with injection, as well as specific youth-culture and gender issues that contributed to her injection use. "The older people I knew who did dope were either out-and-out junkies or dead set against needles -- mostly against," she states. "The young people I knew, even those who didn't use weren't too freaked out by needles. They looked at it as a clinical, exact way to get really high. We definitely romanticized [writer William S.] Burroughs and all the dead rock stars and the whole nihilistic fuck-everything junkie image. Also, shooting up was as bad as you could get . . . so, especially for the teenagers, there was that badness appeal. . . . And for me, as a young woman, I liked showing how tough I was, I mean, I wasn't scared of anything."
Jae has repeatedly tested negative for both HIV and hepatitis C, and considers her access to syringe exchange services the main reason she was able to avoid infection. "At first I would never have shared needles -- being an educated person, I knew how dangerous it was. Later, by the time I was 19 or so, I cared so little about my life that I'm sure I would have used dirty needles if the needle exchanges had not been so available and convenient. As it was, I had new needles every week, always had plenty of bleach, and never had to use a dirty needle."
The Importance of Needle ExchangeThe Centers for Disease Control estimate that the percentage of cumulative AIDS cases directly attributable to IDU in youth under age 25 are around 9% for males 13-19, 14% for males 20-24, 20% for females 13-19, and 31% for females 20-24. The percentage of cumulative reported cases of HIV infection directly attributable to IDU in that age group is 5% for males 13-19, 6% for males 20-24, 7% for females 13-19, and 12% for females 20-24.
These figures do not take into account young people infected through sexual contact with an HIV positive injector, nor can they predict the number of HIV positive youth who are infected but either have no access to HIV testing or choose not to test.
Research during the 1990s yielded a great deal of data showing that syringe exchange programs can dramatically reduce the rates of new HIV and hep C infection in IDUs, and younger injectors in particular appear anxious to take advantage of available exchange programs. Organizations such as the American Medical Association, American Academy of Pediatrics, and the World Health Association all support making such programs available throughout the United States. But so far, federal policy has not been enacted to establish such programs. Currently, syringe exchange programs in the United States receive funding from their state, city, or county governments, as well as donations from private organizations and individuals, and only under the heading of research. All programs are subject to the restrictions their state places on programs providing syringes and other "paraphernalia" for the purpose of injecting drugs
Dan Bigg sees a link between the perceived IDU population and the slow turnabout in establishing a nationwide policy of syringe exchange, and wonders if the increasing visibility of young injectors will have an effect on national syringe-exchange policy. "There are many effective ways to reduce the harm from heroin injection which have been slow to be adopted to date -- seemingly because of the race and class of the majority of users. As heroin use is increasingly seen as a more white and suburban kid kind of problem, it may be society will be willing to take effective action to reduce sickness and death associated with heroin use."
Jae doesn't care what provokes the change. Like many who have clearly benefited from syringe exchange and other harm-reduction services, she is outspoken about the need for such programs.
"I've been incensed by the local movements against needle exchange -- how can you be against something that saves lives? And I feel compelled to share my story if there's a chance I can help people. I mean, there are bad junkies, and pretty much all junkies do creepy things, but a lot of them are also smart and funny and kind and utterly human."
WebsitesChicago Recovery Alliance (Chicago metro area)
Narcotics Anonymous IL: (708) 848-4884
The Night Ministry (outreach and services to street people)
Outside In (services and harm-reduction for street youth in Portland, OR -- additional West Coast information)
CAPS Publication: Needle Exchange Report
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