title: From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits.
abstract: Transitioning from injecting to non-injecting routes of drug administration can provide important individual and community health benefits. We assessed characteristics of persons who had ceased injecting while continuing to use heroin and/or cocaine in New York City.
  
  
  
  We recruited subjects entering Mount Sinai Beth Israel detoxification and methadone maintenance programs between 2011 and 2015. Demographic information, drug use histories, sexual behaviors, and "reverse transitions" from injecting to non-injecting drug use were assessed in structured face-to-face interviews. There were 303 "former injectors," operationally defined as persons who had injected at some time in their lives, but had not injected in at least the previous 6 months. Serum samples were collected for HIV and HCV testing.
  
  
  
  Former injectors were 81% male, 19% female, 17% White, 43% African-American, and 38% Latino/a, with a mean age of 50 (SD=9.2), and were currently using heroin and/or cocaine. They had injected drugs for a mean of 14 (SD=12.2) years before ceasing injection, and a mean of 13 (SD=12) years had elapsed since their last injection. HIV prevalence among the sample was 13% and HCV prevalence was 66%. The former injectors reported a wide variety of reasons for ceasing injecting. Half of the group appeared to have reached a point where relapse back to injecting was no longer problematic: they had not injected for three or more years, were not deliberately using specific techniques to avoid relapse to injecting, and were not worried about relapsing to injecting.
  
  
  
  Former injectors report very-long term behavior change toward reduced individual and societal harm while continuing to use heroin and cocaine. The behavior change appears to be self-sustaining, with full replacement of an injecting route of drug administration by a non-injecting route of administration. Additional research on the process of long-term cessation of injecting should be conducted within a "combined prevention and care" approach to HIV and HCV infection among persons who use drugs.
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: ddesjarlais@chpnet.org.
authors: Don C Des
authors: DC
authors: Jarlais
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Kamyar
authors: K
authors: Arasteh
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Jonathan
authors: J
authors: Feelemyer
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: Courtney
authors: C
authors: McKnight
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: David M
authors: DM
authors: Barnes
authors: New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
authors: Susan
authors: S
authors: Tross
authors: Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors: David C
authors: DC
authors: Perlman
authors: New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States.
authors: Aimee N C
authors: AN
authors: Campbell
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. United States.
authors: Hannah L F
authors: HL
authors: Cooper
authors: College of Nursing, New York University, New York, NY, United States.
authors: Holly
authors: H
authors: Hagan
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D040242:Risk Reduction Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*
keywords: Former-injectors; HIV; Hepatitis C; Non-injection drugs use; Relapse