Between May 1997 and October 1998, Merchants Quay Ireland evaluated the activities and outcomes of the work programme at its Health Promotion Unit. One of the findings of the research was that new female injectors were significantly more likely to suffer from physical and mental health problems than their male counterparts.1 This was surprising, as new female injectors had shorter injecting careers than new male injectors. Based on this finding, Merchants Quay Ireland designed a study to examine the health status of female drug users attending the Unit.2 The study employed a mix of quantitative and qualitative methods and was funded by the Health Research Board. The research was conducted over an eight-week period and commenced in November 2001.

The researchers conducted a focus group to ascertain female drug users’ interest in the research project and to assist the design of appropriate data collection tools. They administered a health information form to establish the participants’ socio-demographic details, drug-using history including drug-taking practices, sexual-risk behaviours, current health problems, and prior use of health services. Following completion of the health information interview, participants took part in semi-structured interviews. The data collected during the semi-structured interviews provided insight into each woman’s perception of her health status and her past experience of primary care services. Each client had a detailed medical assessment, which included a medical, surgical and gynaecological history. Details of current medication were documented. A physical examination and laboratory tests were completed. Seventeen clients completed the health information form and participated in the semi-structured interviews. Fifteen clients had a medical assessment, though two did not request any laboratory tests. Eleven women returned for follow-up interventions.  

At the time of the study the main findings were:

• Of the 17 women interviewed, the majority were under 30 years of age (14/17), homeless (9/17) and had child-care responsibilities (11/17). Almost half of the women (8/17) reported that they their partner was an injecting drug user. 
• eroin was the primary drug of choice for all 17 participants. Over three-quarters were polydrug users. All 17 had injected illicit drugs and nine were currently injecting. Of those currently injecting, six had experienced one or more problem at an injection site. Thirteen were currently taking prescribed methadone. Excluding methadone, eight participants were taking other prescribed medications, mainly antidepressants and sleeping tablets. 
• Over two-fifths (7) of the participants reported that their health status was either bad or very bad. In the three months prior to the study, 16 women reported psychological problems; of these, 11 reported anxiety and 14 reported depression. With respect to sexual risk factors, three women reported ever having a sexually transmitted infection. 
• f the 16 clients who had a medical assessment, six reported that they had asthma, while three had epilepsy. Twelve had experienced a gynaecological problem. Nine women were either obese or overweight. Thirteen clients had been admitted to hospital one or more times and, of these, three were admitted as a result of a suicide attempt. In the three months prior to the study, over three-quarters (13/17) had contact with a medical service provider. The most frequent sources of medical consultation were general practitioner, drug worker and accident and emergency services. 
• Of the 17 women who participated in the interview, 11 had received at least one dose of the hepatitis B vaccine. Thirteen clients requested one or more laboratory tests. Of these, all 13 tested positive for antibodies to hepatitis C and two tested positive for antibodies to hepatitis B.

 Overall, the study findings indicate that women who inject opiates have complex health and social problems and do utilise health services, though the services used in each instance may not be the most appropriate. Polydrug use, depression, anxiety and hepatitis C were common health problems for these women, confirming the need to provide mental health, addiction and infectious disease interventions at drug treatment centre level. The young age profile, level of child care responsibilities and lack of stable housing highlight the importance of and need for social services (such as counsellors, family therapists, community welfare officers and social workers) at all similar drug treatment centres.

1. Cox G, O’Shea M and Geoghegan T (1999) Gender differences in characteristics of drug users presenting to a Dublin syringe exchange. Irish Journal of Psychological Medicine, 16(4): 131–135.

2. Lawless M (2004) Private lives – public issues: an investigation into the health status of female drug users. In Pieces of the jigsaw: six reports addressing homelessness and drug use in Ireland. Dublin: Merchants Quay Ireland.