Infections among injecting drug users in the UK 2012. An update: November 2013

1. People who inject image and performance enhancing drugs, such as anabolic steroids and melanotan, are at greater risk of HIV, hepatitis B and hepatitis C infection than previously thought. In England and Wales, the level of HIV infection among this group is similar to that among people who inject psychoactive drugs, such as, heroin and crack-cocaine. The proportion that had ever been infected with hepatitis B is lower than that among people who inject psychoactive drugs, although recent survey findings suggest the level of infection has increased over time.
2. Infections remain common among people who inject psychoactive drugs. Overall around half of this group have been infected with hepatitis C; around one in every 100 has HIV; and almost one-third report having a recent symptom of an injecting site bacterial infection. Hepatitis B infection among people who inject psychoactive drugs has declined, probably reflecting the marked increase in the uptake of the hepatitis B vaccine.
3. Needle and syringe sharing is lower than a decade ago, although around one in seven of people who inject psychoactive drugs continue to share needles and syringes.
4. There has been a recent increase in the injection of amphetamines and amphetamine-type drugs, such as, mephedrone. Though these psychoactive drugs are much less commonly injected than opiates, crack-cocaine, or image and performance enhancing drugs, there is evidence that their injection is associated with higher levels of infection risk.
5. To minimise the harm from injecting drug use, changes in the patterns of use that increase infection risk need to be detected and responded to promptly. The continued public health monitoring of injecting drug use is therefore important. Services to prevent infections among people who inject either psychoactive or image and performance enhancing drugs need to be maintained and be responsive to any changes in drug use.