al. ( 1 992) note that investigation of factors which encourage change of route of administration either at the level of the individual drug taker or his/her culture in general are needed in order to inform harm minimisation strategies. However, such research is of most utility in locations where drug purity is high enough to encourage users to change from injecting to smoking. This is not the case for heroin in Australia, where the present studies were conducted. Des Jarlais et al. ( 1994)

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... reported a large increase in intranasal use of heroin in New York City. Intranasal use as the main route of administration increased from 25% of admissions to Beth Israel Medical Centre drug detoxification program in 1988 to 46% in 1992. Des Jarlais et al. ( 1994) draw together a number of suggestions from previous researchers for the popularity of non-injection routes of administration. These include: concern about AIDS; the discomfort associated with injection; the desire for a greater sense of self-respect (Casriel et al., 1990); and the high purity (25%-30%) of heroin recently available on the New York market (Frank, Galea, & Simeone, 1992). However, DesJarlais et al. ( 1 994) caution that as many individuals were injecting and sniffing heroin within the same time period, intranasal use should not be considered a simple replacement of injecting. They maintain that as it also appears that there tends to be similarity between routes of administration for both heroin and cocaine, a complex combination of situational, personal and community level factors probably affect change from injection to intranasal use. They suggest that interventions such as cognitive-behavioural skills training programs for the prevention of transition to injecting (DesJarlais et al., 1992b), should be developed further in order to reduce parenteral transmission of HIV. Darke, Cohen, Ross, Han do and Hall ( 1994b) have investigated reasons for transition to and from IDU among 301 regular amphetamine users in Miller, W. R. (1989). Increasing motivation for change. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches (pp. 67-80). New York: Pergamon Press.