More people are injecting new psychoactive drugs, amphetamine-type substances and anabolic steroids, according to a report from Public Health England (PHE). In England and Wales, HIV infection levels among people who inject image and performance-enhancing drugs (IPED), such as steroids or melanotan, are similar to those among people who inject heroin, warns Shooting Up: Infections among people who inject drugs in the UK 2012. While needle and syringe sharing overall is lower than a decade ago, one in seven injecting drug users continue to share injecting equipment, says the report. The number of people injecting amphetamines or amphetamine-like substances such as mephedrone, however, almost tripled in the decade to 2012, with this using population less likely to have been tested for HIV or hepatitis C and more likely to report sharing. While heroin remains the most commonly injected drug – either on its own or in combination with crack – changes in patterns of use ‘that increase infection risk need to be detected and responded to promptly’ in order to minimise harm, the document states. In many areas, IPED users are the largest group accessing needle exchange services, with one in ten having been exposed to one or more of HIV, hepatitis C or hepatitis B. ‘Viruses don’t discriminate,’ said PHE’s lead on injecting drug use, Dr Fortune Ncube. ‘We must maintain and strengthen public health interventions focused on reducing injection-related risk behaviours to prevent HIV and hepatitis infections among all drug users. This includes ensuring easy access for those who inject image and performance enhancing drugs to voluntary confidential testing services for HIV and hepatitis, as well as to appropriate sterile injecting equipment through needle and syringe programmes.’ Meanwhile, the overall number of people in drug treatment has continued to fall, according to PHE’s most recent statistics. The total number in treatment in 2012-13 was 193,575, down from 197,110 the previous year and a peak of almost 211,000 in 2008-09. People over 40 now constitute the largest group entering treatment, with 13,233 over 40s entering treatment for heroin or crack, up from 12,535 the previous year. ‘Drug misuse is by its nature a highly challenging issue to address and the indications are that the going is getting even tougher for services in meeting the needs of an evolving and increasingly complex treatment population,’ said PHE’s director of drugs and alcohol, Rosanna O’Connor. Shooting up: infections among people who inject drugs in the UK 2012. An update: November 2013, and Drug treatment in England 2012-13 at www.gov.uk/government/organisations/public-health-england For more on changing patterns of drug use and the latest treatment statistics, see our report from DrugScope’s conference in December’s DDN.